The effects of social interventions need to be examined in real life situations as well as studie

DuBois, D

Liabo, K

Lucas, P

Roberts, H

Sheldon, T A

English

PubMed

White Rose Research Online

This is a repository copy of Mentoring to reduce antisocial behaviour in childhood.White Rose Research Online URL for this paper:http://eprints.whiterose.ac.uk/187/Article:Roberts, H, Liabo, K, Lucas, P et al. (2 more authors) (2004) Mentoring to reduce antisocial behaviour in childhood. British medical journal. pp. 512-514. ISSN 0959-535X https://doi.org/10.1136/bmj.328.7438.512eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. doi:10.1136/bmj.328.7438.512  2004;328;512-514 BMJ  Sheldon Helen Roberts, Kristin Liabo, Patricia Lucas, David DuBois and Trevor A   childhoodMentoring to reduce antisocial behaviour in http://bmj.com/cgi/content/full/328/7438/512Updated information and services can be found at:  These include:Data supplement http://bmj.com/cgi/content/full/328/7438/512/DC1 "Further details" References http://bmj.com/cgi/content/full/328/7438/512#otherarticles1 online articles that cite this article can be accessed at:    http://bmj.com/cgi/content/full/328/7438/512#BIBLThis article cites 15 articles, 4 of which can be accessed free at: Rapid responses http://bmj.com/cgi/eletter-submit/328/7438/512You can respond to this article at:    http://bmj.com/cgi/content/full/328/7438/512#responsesfree at: 4 rapid responses have been posted to this article, which you can access for serviceEmail alertingbox at the top right corner of the article Receive free email alerts when new articles cite this article - sign up in theTopic collections (344 articles) Other evidence based practice • (1116 articles) Children • (567 articles) Health education (including prevention and promotion) • (272 articles) Sociology •  Articles on similar topics can be found in the following collections  Notes    http://bmj.bmjjournals.com/cgi/reprintformTo order reprints of this article go to:  http://www.bmjjournals.com/subscriptions go to: BMJTo subscribe to  on 12 November 2004 bmj.comDownloaded from Education and debateMentoring to reduce antisocial behaviour in childhoodHelen Roberts, Kristin Liabo, Patricia Lucas, David DuBois, Trevor A SheldonThe effects of social interventions need to be examined in real life situations as well as studiesPoliticians and policy makers are increasingly inter-ested in evidence based decision making. They areunder pressure to look to research for solutions topolicy problems and justify programmes by referenceto the knowledge base. It is tempting for policy makersto grasp any research on seemingly intractable socialproblems, however slim, in the hope of finding simplesolutions. Rolling out national programmes based oninadequate evidence can, however, do more harm thangood. We use the example of mentoring for youngpeople with, or at risk of, antisocial behaviourproblems to show the potential dangers of runningahead of the evidence.Social interventions aimed at childrenPublic health interventions to improve outcomes forchildren are an example of policy and research evolv-ing in tandem.1–3 Interventions such as Highscope,Headstart, parenting education, home visiting, andmentoring have been well designed and robustlyevaluated, some of them by randomised controlledtrials.4–10 Nevertheless, parent education, home visiting,and mentoring, as their proponents and evaluatorswould be the first to agree, largely remain black boxeswith a great many unanswered questions about whatspecific forms of intervention are effective and underwhich conditions.Meanwhile, a climate has been created in which it iswidely held that these interventions are effective andnational programmes are being established. Questionsabout who delivers the service, the kind of youngpeople who might benefit, and the content of serviceslikely to be effective can be lost in the drive to get theprogrammes running.11 These programmes can gainmomentum because they have strong face validity: theylook like the sort of things that should work, ourinstincts tell us that they will work, and we want them towork. This can not only result in premature roll out onthe basis of insufficient evidence but also make it diffi-cult to stop or change direction.Mentoring for antisocial behaviour inchildhoodAntisocial behaviour in childhood and adolescence is aproblem for young people and their families, for healthand welfare professionals planning multidisciplinaryservices, and for general practitioners approached byfraught parents.12 13 Behaviour problems in childhoodcan presage more serious problems in later life.14 Anti-social behaviour in young people is also a problem forthe police, communities, and politicians. This makesfinding a solution a political as well as a therapeuticimperative—a potent driver for action.One approach is through mentoring schemes,which a meta-analysis has shown to have benefits.10 Ina typical non-directive mentoring programme, a men-tor will be a volunteer who provides support orguidance to someone younger or less experienced. Thementor aims to offer support, understanding, experi-ence, and advice. Mentoring is non-invasive and doesnot require drug treatment. It is easy to see why itmight work, and why it is attractive to politicians andpolicy makers.Not all mentoring to reduce antisocial behaviour is effectiveANDREWDUNSMORE/REXFurther details of the studies are on bmj.comChild HealthResearch and PolicyUnit, Institute ofHealth Sciences,City University,LondonEC1A 7QNHelen RobertsprofessorKristin Liaboresearch fellowPatricia Lucasresearch officerCommunity HealthSciences, School ofPublic Health(MC 923),University of Illinoisat Chicago,1603 W Taylor St,Chicago,IL 60612-4324,USADavid DuBoisassociate professorDepartment ofHealth Sciences,University of York,York YO10 5DDTrevor A SheldonprofessorCorrespondence to:H Robertsh.roberts@city.ac.ukBMJ 2004;328:512–4512 BMJ VOLUME 328 28 FEBRUARY 2004 bmj.com on 12 November 2004 bmj.comDownloaded from In February 2003, Lord Filkin, then a minister inthe Home Office, announced £850 000 ($1.6m;€1.26m) of funding for mentoring schemes inEngland: “Mentors can make a real difference to . . .some of the most vulnerable people . . . and help tomake our society more inclusive. There are . . . excellentexamples of schemes which really work.”15There is equal enthusiasm in the United States. Inhis state of the union address in January 2003,President Bush announced plans for a $450m (£238m;€352m) initiative to expand the availability of mentor-ing programmes for young people. This included$300m for mentoring at risk pupils and $150m toprovide mentors to children of prisoners.16What does the research show?One problem with interventions that become politi-cally attractive, and to which large sums are attached, isthat research may be used for support rather than illu-mination. Robust research does indicate benefits frommentoring for some young people, for someprogrammes, in some circumstances, in relation tosome outcomes.8–10 But there are also good descriptiveevaluations suggesting that those young people whostay on in programmes are inclined to reportfavourably on the experience.17 18We examined the existing reviews (see bmj.com) andconcluded that research on mentoring programmesdoes not provide evidence of measurable gains inoutcomes such as truanting or other antisocialbehaviours.19 When improvements have been reported,such as in reports of the Big Brothers Big Sistersmentoring programme,8 critical examination suggestsflaws that weaken the conclusions.8 Although this studywas well conducted, it failed to report on changesobserved from administrative records. A comprehensivemeta-analysis on mentoring found no effect in studiesusing more objective measuring tools than self reportand non-blinded reports of behaviour change.10Mentoring programmes for vulnerable youngpeople may have a negative impact, and adverse effectsassociated with breakdowns of relationships with men-tors have been reported.20 Worryingly, a three year fol-low up study of one well designed scheme found that asubgroup of mentored young people, some of whomhad previously been arrested for minor offences, weremore likely to be arrested after the project than thosenot mentored.21 On the basis of these findings, we con-cluded that non-directive mentoring programmesdelivered by volunteers cannot be recommended as aneffective intervention for young people at risk of oralready involved in antisocial behaviour or criminalactivities.We are not suggesting that mentoring cannot work.There are many different kinds of mentoring, and someshow better evidence of effect than others.10 Our currentstate of knowledge on the effectiveness of mentoring issimilar to that of a new drug that shows promise butremains in need of further research and development.There is no equivalent of the National Institute for Clini-cal Excellence or Food and Drug Administration formentoring. If there were, no more than a handful ofprogrammes might have realistic hopes of qualifying.And even then, it would have to be acknowledged thatwe lack full understanding of the safeguards needed toensure that young people are not harmed by participa-tion. For some of the most vulnerable young people,mentoring programmes as currently implemented mayfail to deliver on their promises.How should we respond to the evidence?Showing that something works (or not) is one thing,and difficult enough. But what happens next in real lifesettings? We summarised the research findings andpresented them to practitioners and planners whowere implementing mentoring. Unsurprisingly, theirresponse was not to abandon the projects. Instead, theyasked how they could make it work.They asked for evidence on what seemed to have amore positive effect for the group of children withwhom they were working. The research suggests thatcognitive behaviour therapeutic approaches are effec-tive in attaining some of the outcomes sought,including when these are delivered through amentoring-like component.22 23 The practitionerstherefore decided to include a directive element intheir approach. They also drew on practices that seemto be associated with stronger benefits for youngpeople, such as ongoing training for volunteer mentorsand involvement of parents.10 Of course, withoutimplementing such innovations in a trial setting, wewill never know whether new approaches are better,worse, or much the same.ConclusionSocial interventions are complex and are capable ofdoing as much or even more harm than medical ones.They need to be as thoroughly evaluated before andafter implementation.Those of us who have been pushing policy makersand practitioners to adopt evidence based practiceneed to be careful that we do not sell it as a simple wayto solve problems. We need a lot more work on how tohelp policy makers deal with complex interventionsand evidence. Research and development in healthand social care needs huge investment if we are todevelop adequate social interventions for big prob-lems. At present, practitioners, parents, and childrenand young people themselves, looking for goodresearch evidence on common problems, will find theevidence cupboard disappointingly bare.Summary pointsMentoring of children and young people involvedin antisocial behaviour has become a popularinterventionResearch evidence to support the mostcommonly used programmes is lackingFailed mentoring relationships may have adetrimental effect on some young peopleCommitment to research based practice needs toinclude focus on what works in implementation aswell as evidence of effectEducation and debate513BMJ VOLUME 328 28 FEBRUARY 2004 bmj.com on 12 November 2004 bmj.comDownloaded from Young people have the right to evidence basedinterventions. We know from the past that many wellmeaning attempts to do good resulted in harm, but wenow have the means through systematic review, trials,sound evaluations, and good qualitative work, to dobetter.Contributors and sources: HR and TAS are grant holders of theWhat Works for Children? project. Under their guidance, KLand PL authored the EvidenceNugget on mentoring for youngpeople. Drawing on the EvidenceNugget, HR drafted the origi-nal idea for this paper and coordinated comments from KL, PL,DDB, and TAS. Sarah Frost of What Works for Children? facili-tated work with practitioners and Mark Anslow, who is aChildren’s Fund manager, provided a practitioner’s views onputting research into practice.Funding: HR and TAS hold a grant from the Economic andSocial Research Council under its evidence network pro-gramme (www.evidencenetwork.org). HR also had a grant fromthe Health Development Agency for work on interventions thatmay reduce inequalities in child health.Competing interests: All the authors are involved in research onevidence based services.1 Roberts H. Socio-economic determinants of health: children, inequalitiesand health. BMJ 1997;314:1122-5.2 Glass N. Sure Start: the development of an early intervention programmefor young children in the UK. Child Soc 1999;13:257-64.3 Glass N. What works for children: the political issues. Child Soc2001;15:14-20.4 Schweinhart L, Weikart D. A summary of significant benefits: the HighscopePerry pre-school study through age 27. Ypsilanti, MI: High/Scope Press,1993.5 Barlow J. Systematic review of the effectiveness of parent-training programmes inimproving behaviour problems in children aged 3-10 years. 2nd ed. Oxford:Health Services Research Unit, 1999.6 Webster-Stratton C, Hollinsworth T, Kolpacoff M. The long-termeffectiveness and clinical significance of three cost-effective training pro-grams for families with conduct-problem children. J Consult Clin Psychol1989;57:550-3.7 Olds DL, Robinson J, O’Brien R, Luckey DW, Pettitt LM, Henderson CRJr, et al. Home visiting by paraprofessionals and by nurses: a randomised,controlled trial. Pediatrics 2002;110:486-96.8 Tierney JP, Grossman JB, Resch NL. Making a difference. An impact study ofBig Brothers Big Sisters. Philadelphia: Public/Private Ventures, 2000.9 Grossman JP, Tierney JP. Does mentoring work? An impact study of theBig Brothers Big Sisters program. Eval Rev 1998;22:403-26.10 DuBois DL, Holloway BE, Valentine JC, Cooper H. Effectiveness of men-toring programs for youth: a meta-analytic review. Am J Community Psychol2002;30:157-97.11 Sheldon TA. It ain’t what you do but the way that you do it. J Health ServRes Policy 2001;6:3-5.12 Scott S, Knapp M, Henderson J, Maughan B. Financial cost of socialexclusion: follow up study of antisocial children into adulthood. BMJ2001;323:191.13 Webster-Stratton C. Long-term follow-up of families with young conductproblem children: from preschool to grade school. J Clin Child Psychol1990;19:144-9.14 Scott S. Fortnightly review: aggressive behaviour in childhood. BMJ1998;316:202-6.15 Home Office. Mentoring capital grant round 2003/4.www.homeoffice.gov.uk/docs/capital_mentoring_grants.html (accessed13 Aug 2003).16 Bush G. State of the union speech, 2003. www.cnn.com/2003/ALLPOLITICS/01/28/sotu.transcript (accessed 13 Aug 2003).17 St James-Roberts I, Samlal Singh C. Can mentors help primary schoolchildren with behaviour problems? Final report of the Thomas Coram ResearchUnit between March 1997 and 2000. London: Home Office, 2001.18 Tarling R, Burrows J, Clarke A. Dalston youth project part II (11-14) anevaluation. London: Home Office, 2001.19 What works for children? www.whatworksforchildren.org.uk (accessed 13Aug 2003).20 Grossman JB, Rhodes JE. The test of time: predictors and effects of dura-tion in youth mentoring programs. Am J Community Psychol 2002;30:199-206.21 O’Donnell CR, Lydgate T, Fo WSO. The buddy system: review andfollow-up. Child Behavior Therapy 1979;1:161-9.22 Davidson WS, Redner R, Blakely CH, Mitchell CM, Emshoff JG. Diversionof juvenile offenders: an experimental comparison. J Consult Clin Psychol1987;55:68-75.23 Cavell TA, Hughes JN. Secondary prevention as context for assessingchange processes in aggressive children. J School Psychol 2000;38:199-235.Where is the evidence that animal research benefitshumans?Pandora Pound, Shah Ebrahim, Peter Sandercock, Michael B Bracken, Ian Roberts on behalf of theReviewing Animal Trials Systematically (RATS) GroupMuch animal research into potential treatments for humans is wasted because it is poorly conductedand not evaluated through systematic reviewsClinicians and the public often consider it axiomaticthat animal research has contributed to the treatmentof human disease, yet little evidence is available to sup-port this view. Few methods exist for evaluating theclinical relevance or importance of basic animalresearch, and so its clinical (as distinct from scientific)contribution remains uncertain.1 Anecdotal evidenceor unsupported claims are often used as justification—for example, statements that the need for animalresearch is “self evident”2 or that “Animal experimenta-tion is a valuable research method which has proveditself over time.”3 Such statements are an inadequateform of evidence for such a controversial area ofresearch. We argue that systematic reviews of existingand future research are needed.Assessing animal researchDespite the lack of systematic evidence for its effective-ness, basic animal research in the United Kingdomreceives much more funding than clinical research.1 4 5Given this, and because the public accepts animalresearch only on the assumption that it benefitshumans,6 the clinical relevance of animal experimentsneeds urgent clarification.Several methods are available to evaluate animalresearch. These include historical analysis,7 critiques ofanimal models,8 investigations into the development oftreatments,5 surveys of clinicians’ views,9 and citationanalyses.10 However, perhaps the best way of producingevidence about the value of animal research is to con-duct systematic reviews of animal studies and, wherepossible, compare the results of these with the resultsof the corresponding clinical trials. So what do studiesthat have done this show?Details of the search strategy and references w1-w18 are onbmj.comEducation and debateDepartment ofSocial Medicine,University ofBristol, BristolBS8 2PRPandora Poundresearch fellowShah EbrahimprofessorDepartment ofClinicalNeurosciences,University ofEdinburgh, WesternGeneral Hospital,EdinburghEH4 2XUPeter Sandercockprofessorcontinued overBMJ 2004;328:514–7514 BMJ VOLUME 328 28 FEBRUARY 2004 bmj.com on 12 November 2004 bmj.comDownloaded from 

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