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Table 2 Outline of key principles used for use of flawed, uncertain, proximate or sparse (FUPS) data in the Children and Young People’s Improving Access to Psychological Therapy (CYP IAPT) context

From: Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: learning from the case of child mental health

  Principles for facilitating discussion of FUPS data How instantiated in relation to CYP IAPT FUPS data
1 Curiosity
Help stakeholder to challenge their own and colleagues’ confirmatory biases, and to apply the same standards of scrutiny to analytic findings that support prior beliefs as to analytic findings that are uncomfortable or not wished for; encourage stakeholders to maintain curiosity
• Ensured range of perspectives present to encourage debate and crucially included young people themselves, providers and commissioners as three key groups
• Set clear ground rules for conversations (e.g. no point scoring, atmosphere of general interest, welcome critical thinking, focus on possible next steps and options that can aid best practice)
• Ensured enough time to reflect and absorb the information – allowed time for questions and debate
• Whilst introduced notion of FUPs, data did not allow that to be the only thing discussed and encouraged discussion of alternative explanations, e.g. FUPS data leading to negative skew in outcomes considered against possibility it has led to positive skew in outcomes
• Invited reflection on other sources of information that either supported or challenged these findings, including from stakeholders’ lived experience as well as from published literature
• Facilitated conversations between different stakeholders to consider any differences in perspective
• Invited stakeholders to predict what results were prior to seeing results
• Encouraged stakeholders to discuss reasons for prediction
• Encouraged discussion of reasons for disparity between prediction and findings
2 Apply the standard of ‘clear and convincing evidence’ rather than ‘beyond reasonable doubt’ drawing on how it meshes with existing narratives and how it triangulates with other information • Encourage consideration of what can be done with the available evidence
• Introduced findings from other areas of healthcare for context and consideration
• Encouraged consideration of current use of other forms of evidence
3 Encourage action
Help relevant stakeholders to consider possible initiatives that, even if not definitively indicated, may do more good than harm and challenge the assumption that change is always riskier than the status quo
• Encouraged discussion of potential initiatives drawing on those findings that could be trialled
• Encouraged sharing of current practice development that aligns with potential implications of findings
• Supported networks of practitioners and others taking ideas forward and checking in on progress and recognise that change takes time and draws on long-term relationships
• Supported teachers to consider if this might support idea that not everyone is better if seen by specialist services, so still may need support in schools
• Supported initiatives that focus on and how to address ongoing needs when, at the end of treatment, the child has not achieved reliable improvement or recovery, e.g. establishment of a long-term conditions clinic that allows people to opt in for up to 2 years post treatment