Navigating Real-World Randomized Controlled Trials In Home Visiting: Lessons from a Community Study

Abstract Title: Navigating Real-World Randomized Controlled Trials in Home Visiting: Lessons from a Community Study

Background and Purpose: Randomized controlled trials (RCTs) are widely regarded as the gold standard for establishing causal evidence in social work and prevention research. However, their implementation in real-world community settings presents significant ethical, practical, and methodological challenges that are often underexamined. This study addresses this gap by examining the implementation of a large-scale RCT of the Parents as Teachers (PAT) home visiting model in Arizona. The purpose of this paper is to explore the benefits, challenges, and strategies associated with conducting rigorous research in community-based settings and to consider how such efforts can advance socially responsive and democratic approaches to evidence generation.

Methods: This study employed a mixed-methods case study design to examine the Arizona PAT RCT. Data were collected through semi-structured interviews with a diverse group of stakeholders, including program administrators, evaluators, parent educators, and participating parents, as well as an online survey of parent educators (N = 31). Interview data were analyzed thematically using an inductive approach, while survey data were analyzed descriptively. The study focused on stakeholder experiences, perceived benefits and challenges, and strategies used to mitigate implementation barriers.

Findings: Findings highlight both the value and complexity of conducting RCTs in community settings. Stakeholders identified key benefits, including strengthening the evidence base for home visiting programs, enhancing program credibility, and increasing access to funding. Parent educators overwhelmingly endorsed the value of RCTs, with over 90% agreeing that they provide useful benefits and support long-term program improvement. At the same time, significant challenges emerged, including ethical concerns related to withholding services from control group families, recruitment difficulties, participant confusion about research processes, and challenges in measuring complex, multifaceted outcomes.

To address these challenges, the study identified several effective strategies, including modifying the randomization ratio (2:1), providing limited service bypasses, offering resources to control group families, enhancing communication and trust with participants, and incorporating qualitative methods to elevate participant voice. These strategies illustrate how methodological rigor can be balanced with ethical and practical considerations in real-world settings.

Conclusion and Implications: This study underscores the need to balance rigor with feasibility, propriety, and utility when conducting RCTs in community contexts. Findings suggest that while RCTs remain critical for advancing evidence-based practice, they must be adapted to reflect the realities of service delivery and the needs of participating communities. By highlighting strategies that promote ethical engagement, stakeholder voice, and practical implementation, this research contributes to a more democratic approach to social work research—one that values both scientific rigor and community responsiveness. These insights have important implications for researchers, practitioners, and policymakers seeking to generate meaningful evidence that serves the common good.