Evaluating Service Interventions

CLAHRCs were invented to align research practice with service change. As a result of such alignment, here in the West Midlands we have been able to evaluate service interventions with the scope and timescale of the service imperative, including:

  • Peer support for mothers at high social risk to see whether there is an improvement in mother/child bonding – individual person RCT.[1]
  • Rearranging mental health services to reduce delay in treatment for schizophrenia in adolescents – multi-centre before and after study.[2]
  • Case-finding for cardiovascular risk in Primary Care to assess uptake of services – cluster step-wedge RCT.[3]
  • Educational intervention to improve attitudes to mental health in schools – cluster parallel RCT.[4]

A brilliant example of an evaluation driven by service change is the Oregon Health Insurance experiment. Expansion of medical coverage was implemented by lottery, inadvertently generating an RCT. This was used to evaluate the effects of improving access to health care. The political and logistical issues behind the trial are discussed by Allen et al.[5] and the result will be summarised in a forthcoming blog.

— Richard Lilford, CLAHRC WM Director

References:

  1. Kenyon S, Jolly K, Hemming K, Ingram L, Gale N, Dann S-A, Chambers J, MacArthur C. Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial. BMC Pregnancy Childbirth. 2012; 12: 11.
  2. Birchwood M, Bryan S, Jones-Morris N, Kaambwa B, Lester H, Richards J, Rogers H, Sirvastava N, Tzemou E. EDEN: Evaluating the development and impact of Early Intervention Services (EISs) in the West Midlands. NIHR Service Delivery & Organisation. HS&DR 08/1304/042. 2007.
  3. Marshall T, Caley M, Hemming K, Gill P, Gale N, Kolly K. Mixed methods evaluation of targeted case finding for cardiovascular disease prevention using a stepped wedge cluster RCT. BMC Public Health. 2012; 12: 908.
  4. Chisholm KE, Patterson P, Torgerson C, Turner E, Birchwood M. A randomised controlled feasibility trial for an educational school-based mental health intervention: study protocol. BMC Psychiatry. 2012; 12: 23.
  5. Allen H, Baicker K, Finkelstein A, Taubman S, Wright BJ, Oregon Health Study Group. What the Oregon health study can tell us about expanding Medicaid. Health Aff. 2010; 29(8): 1498-1506.
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