Title: A feasibility trial of remotely-delivered Video Interaction Guidance [VIG] for families of children with a learning disability referred to specialist mental health services
Funder: Department of Health and Social Care

Abstract: Research Question: Is a randomised controlled trial of remotely-delivered Video Interaction Guidance (VIG) to families of children with a learning disability feasible and acceptable within specialist child mental health services? Background: Children with a learning disability are at a higher risk of challenging behaviours. Challenging behaviours can lead to family breakdown and out of home placement. Access to therapies is difficult. Specialist CAMHS services are increasingly under strain, also as a result of the COVID-19 pandemic. Remotely-delivered therapies could provide efficient support to families as part of the post-pandemic recovery. VIG is a brief, personalised, and strengths-based therapy that focuses on the parent-child interaction and relationship, one of the key mechanisms for challenging behaviours. VIG is delivered remotely since the pandemic. To date, no effectiveness trial of VIG or remote VIG has been conducted, and there is no evidence for children with a learning disability. There is a clear need for an effectiveness trial but there are many uncertainties that need to be addressed first. Aims & Objectives: To evaluate the feasibility of a randomised controlled trial (RCT) of VIG offered remotely to parents of children with a learning disability referred to specialist child mental health services. The primary outcomes will be the acceptability of remote VIG as evidenced by both recruitment rate and engagement with the intervention (VIG completion), and retention to the study at 6 months follow-up. Additional feasibility questions will explore barriers and facilitators of remote VIG, perceived impacts, barriers and facilitators, service use and costs, as well as completeness of key outcomes, such as measures of child challenging behaviour. Method: A feasibility RCT aiming to recruit 50 parents with a child with a learning disability (aged 6-12) referred to specialist mental health services. Parents will be randomised on a 1:1 basis to remote VIG and any treatment as usual or just treatment as usual. Measures will be collected remotely at baseline, 3-month, and 6-month follow-up. To provide a comprehensive description of treatment as usual, we will do a brief service survey at the start of the study and collect data directly from parents at 3-month follow-up. An embedded process evaluation will focus on the feasibility and acceptability of implementation and evaluation. As part of the process evaluation, we will conduct approximately 18 qualitative interviews with parents, VIG therapists and service managers. A parallel feasibility economic evaluation will provide a preliminary assessment of service use and costs of remote delivery of VIG in specialist mental health services Timeline: A 30-month project. Study set up and ethical review months 0-5. Months 6 to 18: recruitment. Months 12 to 24: 6-month follow-up. Months 25-30: data analysis, reporting and dissemination. Anticipated impact and dissemination: The study is a crucial first step in evaluating remotely-offered therapy in specialist child mental health services. The study will also be the first to evaluate a video-feedback intervention (of any kind) for children with learning disabilities in the UK. Findings will be disseminated to NHS clinicians, therapists, researchers, and families through publications and presentations.

Lay abstract: Challenging behaviours and mental health problems are 3-4 times higher in children with a learning disability (LD) compared to typically developing children. They can lead to family breakdown and out of family placements. The National Institute for Health and Care Excellence (NICE) recommends that services support families to manage effectively at home. Children with LD and behaviour or mental health problems are referred to specialist child mental health services for support. These services are increasingly under strain, particularly during the COVID-19 pandemic. Remote therapy could increase the reach of therapies that can help these families. Video Interaction Guidance (VIG) is increasingly used in specialist mental health services to help families. VIG is a brief, personalised, strengths-based intervention: it uses video to identify successful moments of communication between a parent and a child as a tool to improve parent-child interaction and relationships. The quality of the parent-child relationship affects the risk for challenging behaviours and mental health problems in children with LD. VIG has been offered remotely since the start of the pandemic. However, to date, there has been no robust test of VIG or remote VIG. Parents may not want remote therapy or a therapy that focuses on the parent-child relationship. We also do not know what the main effects of VIG are for these families, and whether any gains made from the therapy are present six months later, a time when parenting intervention effects are expected to be present. To determine if VIG works well as a remote therapy, the first step is to determine if we can recruit parents to a study and if they like VIG. Working alongside parent advisors and the Challenging Behaviour Foundation, we will recruit 50 parents with a 6-12 year-old child with LD referred to specialist child mental health services. Parents will be allocated by chance (randomly) to receive VIG remotely alongside the usual service support or just the usual service support. We will follow families up to 6 months to measure: how many parents are recruited to the study; how many stay in the study at 6 months and complete the study questionnaires; how many families complete VIG, whether remote VIG is acceptable to families and services, and what factors make it easy or difficult to offer or take up remote VIG. At the end of the study, we will determine, using pre-specified criteria, if we can proceed with testing in a large multicentre trial whether VIG is an effective therapy delivered remotely within specialist mental health services. We will communicate findings to parents, specialist mental health services and researchers.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH