Although maternal, newborn, child, and adolescent health is a well-established determinant of health across the lifecourse and across generations, the underpinning concept of DOHaD has not had significant impact on policymaking. This chapter identifies some of the barriers involved and how DOHaD researchers may overcome them. Policymaking is a complex process that is influenced by many factors other than science. Translating evidence to policy requires brokerage that explains the implications of science in a clear, frank way, accompanied by impactful solutions. Yet, the largely preventive approach advocated by DOHaD science does not inherently offer simple, high-impact interventions but rather a broad shift in thinking within the policy community. DOHaD advocacy will need to demonstrate short- and medium-term, as well as long-term, benefits. A complementary approach is to engage with communities to adjust scientific ideas to local knowledge and expertise.

Chapter 1 provides essential orientation for the rest of the volume’s contents. It begins by introducing some key issues including recent attempts to define ‘law’ and the challenges of undertaking a comparative history of ancient law (past and present). The next section moves on to introducing the different types of source material covered in the volume, introducing seven ‘rough categories’ of evidence: normative texts; commentaries; documentary records; ‘reports’ or ‘records’ of ‘cases’; portrayals of legal processes, and model forensic speeches; ritual forms; and ‘law’ in other forms of text. The final part of the chapter gives an overview of the major features and specific historical contexts for the principal legal traditions, intended as both introduction and information to be referred back to when consulting the volume as a whole.

Mental health services are intended to provide the means to deliver interventions and care to people experiencing mental health problems. This can only be achieved if the staff and resources to provide interventions and care are available. Unfortunately, the current design and resourcing of services can seriously interfere with this happening. Services have evolved over centuries, and many practices are determined by convention and limited by resources, particularly availability of staff in sufficient numbers and with appropriate skills. Mental Health Service provision, commissioning and funding in the NHS, and the evidence base are rapidly developing. Community mental health services, early intervention, assertive outreach, inpatient, outpatient, intensive care units and home treatment teams form key components, but clinical and patient-rated outcomes are still too infrequently measured to guide service development. The complexity of these services and their interfaces with primary care and specialist mental health teams are discussed in this chapter.

Evidence-based interventions include psychological and social treatments and modes of service delivery such as early intervention for psychosis teams. Family work and individual cognitive behaviour therapy are the psychological approaches that have been best researched but remain limited in availability: assessment, engagement, case conceptualisation and specific work with hallucinations, delusions and negative symptoms have been adapted for clinical practice. The goal is self-determined recovery that will take into account key physical and mental health and social concerns (e.g. accommodation, employment and relationships).

This chapter examines laws governing witnesses at trial and their testimony as well as other rules related to legal procedure. It also looks at how these topics figure in a number of psalms and in prophetic literature, since the relationship of individuals and even entire nations to Yahweh is often depicted in legal terms.

The Victorian era is often seen as solidifying modern law’s idealization of number, rule, and definition. Yet Wilkie Collins thwarts the trend toward “trial by mathematics” and “actuarial justice” by adopting an antinumerical example as the basis for a literary experiment. The bizarre third verdict (“not proven”) of Scots law, which falls between “guilty” and “not guilty” and acts as an acquittal that nonetheless imputes a lack of evidence for conviction, structures his detective novel The Law and the Lady (1875). Revealing Collins’s sources in trial reports and legal treatises, this chapter shows how uncertainty inflects judicial reasoning and models of reading. The verdict of “not proven” undercuts the truth claims of binary judgment at law, subverts normative categories, and allows for more flexible visions of social judgment. Collins makes visible a counter-trend to certainty and closure in legal institutions and Victorian novels about the law. The chapter briefly treats Anthony Trollope’s Orley Farm (1862) and Mary Braddon’s An Open Verdict (1878), which also promote types of inference and models of critical judgment that value the tentative, hesitant, and processual, evading the calculative pressures of nineteenth-century law and life.

Exploring Consequences, the fourth Decision-Maker Move, is about understanding what will happen as the result of selecting any of the various options. Or rather, what is most likely to happen. Keep in mind, both uncertainty (about what occurs) and luck (either good or bad) often play a part in how things actually turn out. Study and do well on the exam, knowing that spending the evening studying won’t be much fun. Don’t study and probably do poorly on the exam but have a good time for a few hours the night before. It’s all about the consequences. Eat the fruit salad or soup special for lunch, feel great in the afternoon and get a lot done. Choose the huge burger and a double order of fries, feel sleepy and get less done the rest of the day. Consequences follow from the choices we make.

Randomised controlled trials are the most rigorous means of assessing the outcomes of interventions. A control group enables the ‘signal’ of the intervention effect to be distinguished from the ‘noise’ of the other influences in the absence of intervention. Randomised allocation to intervention and control groups allow as fair a comparison as possible. However, most trials and systematic reviews are not as useful as they could be. Trials generally focus on estimating effects, often failing to explore the mechanisms through which these occur or how these interact with context to generate different outcomes in different settings or populations. Systematic reviews concentrate on pooling effect estimates from multiple trials from different contexts, as though there were one underlying effect that can be uncovered by pooling. They often, like most trials, fail to examine mechanisms and how these might interact with context to generate different outcomes in different settings and populations. These omissions hinder trials and systematic reviews in their role of providing useful evidence for understanding which interventions are likely to be the most promising candidates for transfer to other settings and with other populations.

This chapter dwells at the intersection of the social psychology of knowledge resistance and epistemic normativity to offer the first full taxonomy of resistance to evidence. It first individuates the phenomenon via paradigmatic instances, and then it taxonomises it according to two parameters: (1) paradigmatic triggering conditions and (2) epistemic normative status. I argue that the phenomenon of resistance to evidence is epistemologically narrower but psychologically broader than is assumed in the extant literature in social psychology. This, in turn, gives us reason to believe that addressing this phenomenon in policy and practice will be a much more complex endeavour than is currently assumed. In the remainder of the book, I examine the extant literature on evidence, defeat, justification, permissible suspension, and epistemic responsibility in search of the normative resources required to fully accommodate the psychological breadth and epistemic normative status of the phenomenon of resistance to evidence.

This conclusion summarises how realistic trials and realistic systematic reviews offer a method by which evaluation and evidence synthesis can become more useful by becoming more scientific and moving beyond being a form of sophisticated descriptive monitoring of ‘what works’. Evaluation can become more scientific both by continuing to use the most scientifically rigorous methods, as well as by being focused on the testing and refining of scientific theory. Critical realism and realist evaluation approaches offer a useful framework for constructing such theory because they offer the most plausible account of how causality operates in the complex social world. We hope that, by making these arguments, we have persuaded readers that trials and systematic reviews need to be reoriented and reformed rather than thrown away altogether. The incorporation of realist enquiry methods into randomised trials and systematic reviews offers us the best hope of evaluation and evidence synthesis that generate evidence which is both more scientific and more useful.

Health interventions are purposeful activities intended to improve health. They may involve treatment or care of the ill, or health promotion to prevent disease and illness. Complex health interventions have multiple components interacting with each other and with the context of delivery. Evaluation is important to ensure that complex health interventions are effective in achieving their intended outcomes, represent good value for money and cause minimal harm. Evaluation is also important to detect if interventions reduce or increase health inequalities. Intervention effects are not always obvious. They can easily be confused with other changes that occur. Hence, there is a need for evaluation to use rigorous methods to distinguish the ‘signal’ of intervention effects from the ‘noise’ of other effects in the absence of intervention. Evaluation should provide evidence to inform policy. If not based on evidence, there is a risk that policies may not achieve their intended effects or may create harms.

This chapter reflects on how evidence from realist trials and systematic reviews might be of value, not only in drawing conclusions about specific interventions and their theories of change but also in testing and refining the middle range theories which inform these and other interventions. While evaluation evidence should be of most immediate use in informing decisions about the implementation of the specific interventions being evaluated, a broader and more enduring use for evaluation could be in suggesting refinements to middle range theory. Such refinements might then be used to inform and influence the next generation of complex health interventions. In order to be useful in assessing the validity of middle range theory, evaluations will need to assess interventions informed by a limited number of middle range theories comprising a limited number of well-defined constructs. There may be value in conducting proof of principle studies separately from more pragmatic evaluations in order to test and refine middle range theory.

This chapter explores how policymakers and practitioners in settings beyond the sites of evaluation might make use of evidence from realist trials and systematic reviews, plus local needs assessment, to identify the best candidate interventions for their local contexts. To do this, local decision-makers need to assess how likely are interventions to achieve benefits in their contexts. This is partly a matter of assessing whether interventions are likely to be feasible, accessible and acceptable in their settings, which will be influenced by local capacity and norms. It is also a matter of assessing whether intervention mechanisms will be triggered and whether these are likely to generate beneficial outcomes. This will be influenced by what aetiological mechanisms are generating adverse outcomes in the context and hence what vulnerabilities exist which the intervention may be able to address. It will also be influenced by whether the local context provides affordances so that potential beneficiaries may be able to benefit from the intervention. Thinking through these issues should enable local policymakers and practitioners to decide whether such interventions could be delivered immediately at scale, be implementing but only within evaluated pilot studies or be rejected in favour of other interventions.

This chapter puts forth a novel view of evidence in terms of knowledge indicators, and it shows that it is superior to its competition in that it can account for the epistemic impermissibility of resistance cases, as well as for the effect that resistance to evidence has on doxastic justification. Very roughly, knowledge indicators are facts that enhance closeness to knowledge: a fact e is evidence for S that p is the case if and only if S is in a position to know e and e increases the evidential probability that p for S.