Commentary: Contextualizing Alternatives to RCTs: Measuring the Impact of a Non‐Governmental Sponsorship Organization's Projects to Strengthen Children's Supportive Environments

Abstract

ChildFund International (ChildFund) is a child‐focused International Non‐Governmental Organization (INGO) which, since 1938, has worked with local implementing partners (LIPs), government, and other partner organizations to help create the safe environments children need to thrive. The purpose of this commentary is to reflect on the utility and possible application of the suggestions and study designs in this special issue to real‐life intervention studies in dynamic context settings. The commentary provides three regional case examples with evaluation study lessons learned from ChildFund's global evaluation work. Specific insights from this issue are discussed regarding their application to effectiveness studies for projects delivered by a child‐focused INGO, like ChildFund, in resource‐limited settings.

Introduction to the Special Issue. Randomized Controlled Trials (RCTs) in Clinical and Community Settings: Challenges, Alternatives, and Supplementary Designs

“…When assessing clinical interventions targeting complex conditions with low prevalence, such as children with autism spectrum disorder and comorbid depressive symptoms and suicidal ideation (Wijnhoven et al., ), target populations may be very small, which makes it difficult to conduct a meaningful RCT with sufficient statistical power. When assessing interventions in dynamic and challenging real‐world settings, such as in low‐ and middle‐income countries that are comprised of vulnerable population or affected by man‐made or natural disasters, it may be difficult to implement the intervention with good integrity, to standardize outcome assessment, or to map and properly control for other ongoing interventions targeting the same populations (Grolnick et al., ; Strouse & Moore, 2019, this issue).…”

“…Moreover, RCT designs are very costly and might limit the opportunity and available resources for frequent, extensive, and/or multi‐method assessment of mechanisms of change. In cases where interventions are aimed to decrease the negative effects of crises and disasters, there may simply be no time to await the results of an RCT (Grolnick et al., ; Strouse & Moore, 2019, this issue). The translation of RCT results to practice takes a lot of time and the controlled setting under which an RCT is conducted sometimes complicate translation to less controlled real‐world settings (Green & Glasgow, ).…”

“…The contributions in this issue address challenges and different methods for conducting RCTs in real‐world clinical and community settings, as is synthesized and discussed in two insightful commentaries. Strouse and Moore (2019, this issue) comment from the perspective of an international non‐governmental sponsorship organization. According to the authors, inherent to working in dynamic real‐world settings is the urgency to act quickly and flexibly, in some cases without sufficient time to plan and execute an RCT.…”