Award Title: Care-experienced cHildren and young people’s Interventions to improve Mental health and wEllbeing outcomes (CHIMES): Systematic review
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: Care-experienced children and young people are individuals who have been placed in care at some point during their life. They are more likely to have poor mental health. This may affect their future, as it increases the risk of poor physical health, being involved in crime and being unemployed. Poor mental health may be the result of a young person’s time in care, but may also be because of the reasons why they have had to come into care._x000D_
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There have been efforts to improve the mental health and wellbeing of children and young people who are care-experienced. Some aim to encourage positive mental health and wellbeing. Others offer treatment for those diagnosed with a mental health disorder (e.g. depression or anxiety). There are many different types of programmes. They might look at improving the social and emotional skills of the individual child, or they might try to give support and training to foster carers and residential carers. Some programmes look to change how medical professionals or social workers work with children and young people._x000D_
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In the UK it is not clear which programmes are successful as not much research has been done in this area. It is also hard to know if programmes that have worked in other countries could work in the UK._x000D_
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Aim: We want to find out which programmes work in different countries and the reasons why they work. This will help us to see what programmes might be successful in the UK._x000D_
We will aim to answer six questions:_x000D_
1) What types of programmes have been used to improve the mental health and wellbeing of care-experienced children and young people?_x000D_
2) Have these programmes been successful? _x000D_
3) What helps these programmes to be delivered well and what are the challenges?_x000D_
4) Do children and young people, and their carers, like these interventions?_x000D_
5) From our findings, can we take the most successful parts of the different programmes and build a new programme that might work best?_x000D_
6) Which programme do different children and young people, and their carers, think is most likely to work in their community?_x000D_
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In answering these questions, we hope to have a programme that we can try out in the UK with the aim of improving the mental health and wellbeing of care-experienced children and young people._x000D_
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Research method: We will bring together existing research that has tested programmes aiming to improve the mental health and wellbeing of care-experienced children and young people. From this, we should be able to understand what programmes work and how, and also what more research is needed._x000D_
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Involving care-experienced children and young people: We will involve care-experienced children and young people. They will advise on all parts of the research and will help us to decide how best to share our findings. The Fostering Network and CASCADE Voices will help us to engage children and young people and carers in our research._x000D_
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Sharing our findings: We will share our results through a number of reports, conferences, and online blogs. The Fostering Network will hold two events for foster carers, and care-experienced children and young people, with activities and games to explore what we found out and what to do next. We will also share our findings with the social care sector by hosting a CASCADE ExChange event and meeting with CASCADE Voices, a group of young people who have been in care and now advise on research studies.

Lay Abstract: Background: Care-experienced children and young people are individuals placed in out-of-home care (e.g. foster, residential or kinship care) or in receipt of statutory home support. This population are at increased risk of mental health conditions. Poor mental health has long-term impacts, including limited physical health, increased involvement in criminality, and higher rates of unemployment. There has been a drive to develop effective interventions, with approaches aiming to promote positive mental health and wellbeing or intervene with diagnosable mental health conditions. Interventions often include clinical guidance, health assessments, training for carers, and mentoring programmes for children and young people. At present there are limits to our understanding of intervention impacts, particularly in the UK context where there are relatively few robust evaluations. Although there are numerous studies elsewhere, it is difficult to know if these can be successfully transferred to the UK as social care and health systems vary. _x000D_
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Aims: To systematically review the international evidence to identify effective interventions, understand the contextual contingencies of these effects, and consider the transportability of different approaches to the UK._x000D_
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Research Questions: The study will address the following research questions:_x000D_
RQ1: What are the types, theories and outcomes tested in mental health and wellbeing interventions for care-experienced children and young people?_x000D_
RQ2: What are the effects (including inequities and harms) and economic effects of interventions?_x000D_
RQ3: How do contextual characteristics shape implementation factors, and what are key enablers and inhibitors of implementation?_x000D_
RQ4: What is the acceptability of interventions to target populations?_x000D_
RQ5: Can and how might participants, intervention types, components, and outcomes (including inequities and harms) be related in an overarching system-based programme theory? _x000D_
RQ6: Drawing on the findings from RQ1-5, what do stakeholders think is the most feasible and acceptable intervention in the UK that could progress to further outcome or implementation evaluation?_x000D_
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Methods: We will conduct a systematic review of prevention and intervention approaches aimed at improving outcomes for care-experienced children and young people (aged up to 25 years). Outcomes are: mental, behavioural or neurodevelopmental disorders; subjective wellbeing; and self-harm, suicidal ideation and suicide. A taxonomy of interventions’ theories of change will be constructed. We will integrate outcome and process findings to understand intervention effectiveness, and how effects might be explained by contextual characteristics, implementation and acceptability. We will seek to develop an overarching candidate theory of change that might best address multiple outcomes, and which could progress to future evaluation within the UK context._x000D_
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Impact and Dissemination: The study partner is the Fostering Network. We will undertake dissemination activities in conjunction with the Network, CASCADE Voices and CASCADE ExCHANGE Network. The review will inform identification of a potentially feasible and acceptable intervention, while providing policy-makers and practitioners with direction on what works, which interventions should be disinvested in, and how implementation might be optimised._x000D_
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Timeline for Delivery: The study will commence 04/2020 and run for 24 months.

Research Activity Codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health Categories: MENTAL HEALTH