Title: Improving the mental health and mental health support available to adolescents looked-after via low-intensity life story work: A realist review
Funder: Department of Health and Social Care

Abstract: Background Adolescents are the fastest growing age group entering social-care in England and the group most at risk of mental-ill health. Evidence has repeatedly highlighted that their mental health needs are unsupported. Better evidence to support the mental health of adolescents looked-after by social-care is therefore an urgent priority. Life Story Work (LSW) is an existing intervention used to improve the mental health of younger children looked-after by assisting the processing of trauma(s). Whilst widely valued by stakeholders, it is poorly evidenced, lacks standardisation and focuses on younger children. LSW is also high-intensity, relying on specialist input over a number of months. With demand for services increasing, early intervention and the delivery of adolescent-focused low-intensity LSW is a potential alternative. However, there is scant guidance on how LSW, let alone low-intensity LSW should be delivered to adolescents. This has led to inconsistencies in pre-existing LSW practices reported by adolescents, carers and professionals alike. Aims and objectives Addressing this evidence and practice gap, we will generate in-depth knowledge to understand if LSW can be delivered to adolescents looked-after as a low-intensity intervention by asking: &quot;How, why, to what extent, for whom and in what circumstances can low-intensity LSW interventions, or elements of LSW interventions, be delivered to improve important and relevant outcomes for adolescents looked-after with mental health needs?&rdquo; To achieve this aim, we will meet the following objectives: Undertake a realist review, to develop and refine a realist programme theory (PrT) that explains how and why adolescent-focused low-intensity LSW interventions (or elements of interventions) may or may not work for adolescents looked-after and in what contexts (deliverable 1); Use the PrT to produce preliminary guidance on the nature of good practice when delivering adolescent-focused low-intensity LSW to adolescents looked-after and hence provide benefits for them, their carers and health/social-care professionals (deliverable 2). Methods To answer this question we will undertake a realist review. Realist reviews are a theory-driven interpretive type of literature review, suited for making sense of complex interventions using a range of information sources to fully understand the issue and the contexts and mechanisms that influence it. This involves developing an explicit PrT, detailing the underlying assumptions about how an intervention(s) is meant to work and what impacts are expected. We will work iteratively with expert groups (comprising of care-experienced youth, carers, academics and health and social-care professionals) to create and develop a PrT of adolescent-focused low-intensity LSW that is underpinned by evidence obtained via systematic searches of published and grey literature. This process will allow the PrT to evolve until we have a sufficiently in-depth understanding of the heterogeneous and dynamic needs of adolescents looked-after and contexts in which LSW may be used. Outputs We will produce outputs aimed at a range of lay and expert audiences. Our adolescent-focused low-intensity LSW PrT will inform preliminary guidance to optimise current practices in this area to better support the mental health of adolescents looked-after. We will also produce peer-reviewed publications, conference presentations, popular science articles and youth-focused infographics/video clips.

Lay abstract: Aims and background We aim to improve the mental health of looked-after adolescents by improving the guidance available to support them. Adolescents are the fastest growing age group entering the English social-care system and the group most at risk of mental ill-health. There are a variety of reasons for the poor mental of this group including abuse and frequent changes in housing arrangements. Better evidence to support the mental health of looked-after adolescents is a priority. One way of supporting mental health widely of looked-after populations is life story work. Life story work aims to help this group understand who they are, how past experiences and relationships might have shaped to them. However, life story work is currently delivered as a &ldquo;high-intensity&rdquo; intervention, meaning it relies on specialist professional input over a number of months and evidence supporting its usefulness is of poor quality. Evidence also currently focuses on younger children, meaning there is minimal guidance available for adolescents. As budgetary restrictions continue and demand increases, better evidence on cost-effective low-intensity interventions is urgently needed. There is no clear guidance on how or when life story work should be best undertaken, by whom and why it improves (or not) the mental health of looked-after adolescents. Design and methods To find out what is likely to work best, there is a need to combine what we know about life story work with younger children with what is known about how to support adolescents. We will review the evidence using an approach called a realist review. Our team will review literature together with seeking the expert opinion of young adults who have lived in care, carers, social workers and mental health professionals. We will combine this information to build and improve our understanding of adolescent-focused low-intensity life story work. Public and Patient Involvement (PPI) PPI team members will be involved at all stages, working with, and as part of, the research team to interpret and refine our understandings of adolescent-focused low-intensity life story work. They will provide their opinions as recipients and users of life story work. Regular PPI engagement will ensure guidance created is fit for purpose and shared in relevant ways to stakeholders. Dissemination We will share findings with our national partners to ensure improvements in practice benefit adolescents, their carers and health and social-care professionals. Our team has strong connections with local authorities and charitable bodies that provide training and we will produce guidance to help stakeholders improve how they deliver life story work to support the mental health needs of adolescents looked-after. We will work with our range of partners to co-create this guidance and co-produce accessible versions of findings. We will also publish and publicise findings accordingly.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH