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Sharon Witherspoon Deputy Director

What can badgers teach us about implementing implementation science? Science, politics and policies . Sharon Witherspoon Deputy Director. www.nuffieldfoundation.org. The Nuffield Foundation. Endowed charitable trust, annual spend £12m (about $18m) General objective:

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Sharon Witherspoon Deputy Director

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  1. What can badgers teach us about implementing implementation science? Science, politics and policies Sharon Witherspoon Deputy Director www.nuffieldfoundation.org

  2. The Nuffield Foundation • Endowed charitable trust, annual spend £12m (about $18m) • General objective: “The advancement of social well-being particularly by means of scientific research”

  3. Randomised Badger Culling Trial Background: • 25,000 cattle die of bovine TB each year in GB • Compensation of £100m p.a. • Half of all cattle infections come from badgers • Trial launched, 1998 -2007

  4. Randomised Badger Culling Trial Trial: • Triplets of areas, 100km2 each • Proactive cull, each year • Reactive cull, only after TB outbreaks • Control zone, no cull www.nuffieldfoundation.org

  5. Randomised Badger Culling Trial Results: • Reactive cull stopped as TB rates rose by 20% • Explanation: perturbation • Proactive cull: within zone, TB infections fell by 25%, but rose in the 2km ring around culling zone, because of ‘perturbation’ • Had to think through system effect: link between size of zone and size of ring effect

  6. Randomised Badger Culling Trial Implications: • Larger rings (scaling up) would save money if proactive cull • To enhance cost-effectiveness, killing method changed (without new pilot) • Now have “real world” trial (aka scaling up)

  7. Technical issues: fidelity, size of effects, scaling up, and value for moneyBut also controversy and values......

  8. Why relevant to human services implementation in UK? • Experience of Multidimensional Treatment Foster Care • Sure Start • Youth justice reforms • School reforms

  9. Other badger issues CONTEXT of TB in cattle in Southwest: • greater density of cattle, larger barns etc. • institutional organisation underestimated in early discussions. • But given pressures (economics, population growth etc), unlikely to change structures. • Implementation science needs to appreciate structural issues too

  10. Implementation programs on continuum with evidence-based wider policy change? • When is universal intervention a structural policy change? • And how context specific is this? • Why we need to understand moderators and mediators • UK family policy: shift from child outcomes to family form

  11. A. Cherlin Dominian lecture

  12. Cherlin Dominian lecture

  13. Effects of interventions to promote marriage (or stability)

  14. Kiernan, Dominian lectureUK data

  15. Family situation at age 5 by birth status

  16. IFS study of selection and causality of ‘marriage effect’ • Actively commissioned by Foundation • Longitudinal data show that most differences in 2 outcomes for children (cognitive and social/behavioural) between married and cohabiting parents in UK are selection effects • Longer term analysis suggests virtually alldifference due to pre-existing differences

  17. Some general issues in policy brokerage • Size of effects usually modest ( tho’ meaningful ) • Greater effects more costly (up front at least): dose response • Timescale for implementation vs. political cycle (ministerial career or parties)

  18. Some general issues in policy brokerage II • Values, and disagreement about aims (much less means) • Self-interest but also ideology • Politics: intermediaries and stakeholders: advocates of change

  19. And some larger questions • Is ultimate aim more and better interventions? • Targeted or universal? • If universal, is the game system change.... • And at what point does intervention implementation require building capacity and internal drivers for improvement.....

  20. Two tough questions • Is there a ‘science’ of implementation or are there some general abstract features we can understand but not predict a priori? • Why would politicians ever relinquish control of means, or agree about aims when they are value-laden (as well as politically-important)?

  21. Political science not implementation science? • Norway – longer-term commitment, development and funding • Anglo Saxon countries more ideologically riven on aims ? • Longer-term planning more difficult: US veto model, UK and other parliamentary systems have ‘pendulum swings’

  22. But not counsel of despair Features already know to be important • Centres of substantive expertise, with longer-term engagement (foundation funders can help bridge) • Intermediary bodies and strategic practitioners • Political stakeholders (NGOs, parents, etc) • Active PUSH for scaling: and communication

  23. But not counsel of despair Features already know to be important – II • Government advisers on inside (civil service, special advisers, research funding) • Culture of evaluation spending (mandate is good: by law or political oversight) • Longer term capacity building of ‘humans’ • Economic evaluations

  24. But.... Isn’t this just the politics of creating critical mass and drivers to make implementation science and use of evidence more self-sustaining? Or at least ensuring that there is enough power to embarrass?

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