• By Dartington SRU
  • Posted on Thursday 20th August, 2009

Systematically not quite convinced

In medicine, systematic reviews are recognised as being the ultimate source of reliable evidence, and slowly but surely they are becoming as vital to the reputation and direction of interventions in child development.In the field of parenting and the early years, Jane Barlow, Professor of Public Health at Warwick University, is one of the leading proponents. She is also a prolific producer.Her latest review, published in Child and Adolescent Psychiatry and Mental Health, examines the effectiveness of parenting programs in improving the behavior of children with conduct disorder – and comes to the happy conclusion that they work. But it also establishes that more needs to be learned about which program features have most impact, and how this tallies with their relative costs – in order to indicate, for example, whether they can be effectively delivered through groupwork. In the past few years, Barlow has been involved in numerous systematic reviews, covering everything from ethnic minority parenting to the reduction of intentional injury. “I love them!” she laughs, but in the next breath acknowledges they are are not without their limitations. “I think the problem with them to date is that they have tended to focus on quantitative data. Now we’re moving towards more mixed methods research, and that’s really interesting,” she says. First evidence of that experimental broadening will be the results from her first qualitative systematic review — a meta-ethnography of parenting programs. Much of her recent activity has been for the Campbell Collaboration. She was recently appointed to their Psychosocial, Learning and Development Review Group – a prestigious appointment for one whose career has been built on much hard grind.She confesses that she lived a somewhat nun-like existence at university and still spends every evening and weekend writing. Her interests go far wider than systematic reviews. For example, after the initial evaluation of Sure Start showed it to have mixed effects, she became involved in a study looking at process data to identify which Sure Start centers had been a success, and what it was that distinguished them. As an undergraduate at Warwick she studied sociology and immersed herself in social theory. She was particularly inspired by the philosophy of critical realism.“It’s so reasonable. It reconciles the two views of the world (objectivism and social constructionism) in a way that’s really exciting,” she says. Doctoral studies at Nuffield College, Oxford, among “number crunchers” led her along a different path, studying the psychosocial consequences of screening for high cholesterol. After that she worked at the Health Services Research Unit, where the then director Sarah Stewart-Brown (a long-time collaborator) encouraged her to apply for a fellowship with the Medical Research Council. It was around this time that she made her first forays into parenting research, with several local studies and randomized controlled trials of interventions with older children. The next step was a Primary Care Career Scientist Award which set her up for the next five years, enabling her to learn how to manage other researchers and to bring in grants and to locate a niche for her research focusing on the early years.“I was shifting back in time,” she explains. “I think the first three years of a child’s life and what goes on in pregnancy are fundamental. It’s what sets us up for the rest of their lives.” Her background in social theory means she continues to question the assumptions behind these studies. So she backs the use of randomized controlled trials for testing whether interventions work or not, but suspects that by ironing out the significance of context something vauable is being lost. Now back at Warwick in the Faculty of Public Health and her first permanent position, she is busy setting up the Warwick Infant and Family Well-Being Unit, part of whose mission is to disseminate evidence to practitioners working with children. She is particularly enthusiastic about the non-accredited training programs her Unit is developing to enable people working with children, who lack the qualifications to pursue a Masters to degree, to learn about how they can best help children. There may even be a bit more freedom in how research is carried out. “I have never yet quite had the confidence to try and get a critical realist evaluation funded,” she says. “It’s a privilege to do the sort of work I do, to share evidence with practitioners who really want to make a difference with children. I’ll go and talk to whoever wants me to. I don’t say how much will you pay me!”For more about Jane Barlow’s work, see:Barlow J, Kirkpatrick S & Wood D (2007), Family and Parenting Support in Sure Start Local Programmes, National Evaluation of Sure Start, DFES Kane G, Wood V and Barlow J (2007), “Parenting programmes: a systematic review and synthesis of qualitative research,” Child care, health and development, 33, 6 pp 783-793Dretzke J, Davenport C, Frew E, Barlow J, Stewart-Brown S, Bayliss S, Taylor R, Sandercock J and Hyde C (2009), “The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials,” Child and Adolescent Psychiatry and Mental Health, 3, 7For more on systematic reviews: Greenhalgh T (1997), ‘How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses)’, British Medical Journal, 315, 7109, pp 672-675

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