Title: SOLID (Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol): a pilot feasibility study of interventions to decrease risky substance use (drugs and alcohol) and improve mental health of Looked After Children and Care Leavers aged 12 -20 years
Funder: Department of Health and Social Care

Abstract: Young people looked after by the Local Authority (Looked After Children –LAC) are four times more likely to misuse drugs and alcohol compared to their peers. We do not know the most effective intervention to decrease substance misuse in this vulnerable population. The SOLID pilot trial (Supporting Looked after children In Decreasing Drugs, and alcohol) aims to assess the feasibility and acceptability of a definitive multi-centre randomised controlled trial (RCT) of two behaviour change interventions to reduce substance misuse, and improve mental health in LAC aged 12-20 years. We will undertake a two-phase formative study and pilot feasibility trial in 3 sites in the North East of England which will include: Phase 1: The formative study will use qualitative methods to adapt and integrate two evidence based interventions: Motivational Enhancement Therapy (MET) and Social Behavioural Network Therapy (SBNT) into care pathways for LAC. MET is a concentrated form of motivational counselling where young people are encouraged to discuss the pros and cons of specific behaviours, which are fed back to increase motivation for change. SBNT in contrast uses methods to identify and enhance the social network around the young person to support behaviour change. This is particularly salient for LAC as they are often away from parental support. Qualitative interview data will be collected from a purposive sample of LAC aged 12-20 and their carers to assess the needs of potential service users in relation to the delivery and content of the interventions. Focus group discussions will be held with drug and alcohol and social workers to consider barriers, facilitators and feasibility of intervention delivery. Thematic data analysis will be based on the constant comparative method. Key findings will be shared and the intervention finalised with participants in two workshops. The adapted interventions will be integrated into LAC care pathways. An online survey will also be conducted with named paediatric and local government leads for LAC in each Local Authority in England (n=152) to map models of ‘usual care’ for LAC with drug and alcohol misuse, and identify potential collaborative centres for a definitive trial. Phase 2: In the three arm pilot feasibility randomised controlled trial (RCT), LAC aged 12-20 years will be screened for risky drug and alcohol use by their social worker using the CRAFFT, a validated and extensively used drug and alcohol screening tool. Young people who screen positive for Mirza’s ‘at risk for substance misuse’ stage (= 2 on the CRAFFT) will be consented for individual randomisation to MET or SBNT delivered by drug and alcohol workers, or usual care (control). The intervention arms will each involve 6, 1:1, 50 minute sessions. LAC enrolled into the trial will be followed up after 12 months to assess recruitment and retention, self-reported drug and alcohol use, mental health and wellbeing, sexual behaviour, quality of life, antisocial behaviour and placement stability using validated tools. The pilot evaluation will give insights into the acceptability of the interventions and feasibility of a definitive multicentre RCT. Specifically, the mixed methods process evaluation will provide rich data on both interventions including “dose” delivered (how many sessions taken up), its fidelity (assessment of content and interaction), acceptability (LAC and practitioner perceptions about receiving and delivering the actual interventions) and the potential “mechanism of change” from both the perspective of the service provider and LAC (service user). These data will allow us to assess if either of the interventions is clearly more acceptable to both service users and providers, is most likely to be integrated into routine service delivery, and to elicit behaviour change in the young person. These data along with feedback from LAC and practitioners will be used to draw element of the interventions together into a single ‘optimised’ intervention if appropriate to take forward as an enhanced treatment intervention, designed for LAC, to a definitive trial. The team will develop economic evaluation tools and complete a value of information analysis to inform a definitive study. Stop:go criteria, based on recruitment, retention and acceptability of the intervention, will inform a recommendation regarding a definitive multicentre RCT.

Lay abstract: Young people in Local Authority Care (Looked After Children) are four times more likely to use drugs and alcohol compared to their peers. These young people, aged up to 21 years, live away from their parents and are supported by social workers whilst in foster care or group homes. Most Looked After Children have experienced some form of emotional, physical or sexual abuse which increases their risk of drug or alcohol use and mental health problems. We know that counselling can help reduce drug and alcohol use but most research is done with young people who live with parents. What we do not know is the best way to help young people in ‘Care’ who may be harder to work with due to their own social problems and sometimes because they are moved around the care system. Substance misuse costs the UK £39 billion per year due to its impact on health and the criminal justice system. Early intervention to reduce misuse in Looked After Children could be highly cost effective because of the higher rates of substance use in this group. In developing this study we have talked to young people in Care and also with key staff. Their views have shaped our work so far and we plan to seek further views on how they feel about being involved in our study and being asked about sensitive topics such as drug usage and sexual behaviours. The SOLID study (Supporting Looked after children In Decreasing Drugs and alcohol) aims to reduce drug and alcohol use and improve mental health in Looked After Children aged 12 to 20 years. We will adapt two counselling approaches called motivational enhancement therapy (MET) and social behavioural network therapy (SBNT). We will also see if core components of these interventions can be combined into a single optimised intervention. MET focuses on changing internal thoughts and feelings that affect drug and alcohol use. SBNT focuses on external or social factors such as the influences of friends, carers and possibly other important people like grand-parents. The proposed study has two linked phases: Phase 1: We will seek the views of young people in care and key staff using interviews and group discussions to help make sure our counselling approaches are as helpful and relevant as possible. We also want to make sure they can be delivered easily by the right staff. Phase 2: We will then conduct a pilot trial in three areas of North East England to see if young people will enter our study and if we can contact them after one year to measure their drug and alcohol use and their mental well-being. Young people aged 12 to 20 years will be screened by their social worker for drug and alcohol use. Those who are using drugs or alcohol and who are happy to be in the study will be sorted at random (like throwing a dice to decide who is in each group) into three groups to receive: 1. usual care; 2. six sessions of MET; or 3. six sessions of SBNT. All sessions will be one-hour long. After a year, we will re-contact the young people to ask them about their drug and alcohol use as well as some other important behaviours affected by it, including sexual behaviour, mental health and whether they have been moved between different carers or not. This is the first study in the UK to think about the best ways of helping Looked after Children decrease their drug and alcohol use. We will only decide that a bigger study can be done in the future if we find that enough young people are willing to be in the study and re-contacted after a year and that they understand and are happy with the questions we have asked.

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