Trials and tribulations:challenges and prospects for randomised controlled trials of social work with children

Randomised controlled trials (RCTs) have rarely been used in evaluations of social work interventions with children in the UK. This article discusses the use of an RCT in the national evaluation of Multi-dimensional Treatment Foster Care for Adolescents (MTFC-A) in the English care system. A number of challenges were encountered in recruiting young people to the trial. These included professional anxieties about randomisation, concerns about accountability, a wish to maintain managerial control over allocations to expensive resources and the small number of MTFC-A places available in each local area, which meant that new placements became available infrequently. We discuss the challenges to the trial and the strategies developed to address these, including the adaptation of the design to take account of both professional concerns and of the particular circumstances of the children involved. Thirty-four children were eventually randomised either to an offer of an MTFC-A placement or to 'treatment as usual', an alternative placement selected by their social workers. A further 185 were included in the parallel observational arm of the study. Recommendations are made for the conduct of future trials in children's social care.