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Table 2 Challenges of Complexity

From: Measuring the tail of the dog that doesn't bark in the night: the case of the national evaluation of Choose Life (the national strategy and action plan to prevent suicide in Scotland)

Nature of the challenge

Its manifestation in Choose Life

i. The multiple purposes that evaluation is anticipated to serve

The national evaluation team had objectives in relation to: monitoring progress towards implementation of programme milestones; examining the extent to which effective practice was being generated; assessing the development of sustainable infrastructure; providing summative as well as formative feedback.

ii. Multiple outcomes of the programme

The programme had seven multi-faceted objectives. These were:

 

1) Early prevention and intervention: providing earlier intervention and support to prevent problems and reduce the risks that might lead to suicidal behaviour;

 

2) Responding to immediate crisis: providing support and services to people at risk and people in crisis, to provide an immediate crisis response and to help reduce the severity of any immediate problem;

 

3) Longer-term work to provide hope and support recovery: providing on-going support and services to enable people to recover and deal with the issues that may be contributing to their suicidal behaviour;

 

4) Coping with suicidal behaviour and completed suicide: providing effective support to those who are affected by suicidal behaviour or a completed suicide;

 

5) Promoting greater public awareness and encouraging people to seek help early: ensuring greater public awareness of positive mental health and well-being, suicidal behaviour, potential problems and risks amongst all age groups, and encouraging people to seek help early;

 

6) Supporting the media: ensuring that any depiction or reporting by any section of the media of a completed suicide or suicidal behaviour is undertaken sensitively and appropriately and with due respect for confidentiality; and,

 

7) Knowing what works: improving the quality, collection and availability of information on issues relating to suicide and suicidal behaviour and on effective interventions to ensure the better design and implementation of responses and services and use of resources.

iii. Horizontal complexity

The local authority areas received their funding through the Community Planning Partnership mechanism. These statutory planning groups had representation from across public sector organisations (such as the NHS, local government and education) and the voluntary sector. The national level also required partnerships to be made and sustained between a wide range of organisations.

iv. Vertical complexity

Impacts were anticipated among individuals at risk, their families, the organisations with which they engage, and at a structural level.

v. The lack of opportunity to establish control/comparison groups

All local authority areas in Scotland were provided with funding to take forward Choose Life. It was not possible, therefore, to identify areas within the country that could act as 'controls'.

vi. Context as integral to a programme intervention

Local areas were given flexibility in how they organised the local manifestations of Choose Life. For example, they were able to identify their own local priority groups in addition to those identified by the Scottish Executive, determine how their funding would be utilised, and develop their own management arrangements for the programme of work undertaken.

vii. Long-term goals

To reduce the rate of suicide in Scotland by 20% by 2013