Title: Promoting good health in Care Leavers through training for Personal Advisors
Funder: Department of Health and Social Care

Abstract: Children in care have often had difficult lives. Many were badly treated before coming into care, and have behavioural, emotional and other health problems that affect their day-to-day lives. Foster care can help children to recover, but many children will still have mental and physical health problems. Some also have disabilities and long-term health conditions, and some spend a lot of their lives in residential settings. Despite all these challenges, young people in care cease to be ‘looked after’ on their 18th birthday, and many leave care as young as 16 years old._x000D_ _x000D_ The government knows that leaving care so early is a problem, and has taken steps to provide more support to care leavers. Some care leavers can now remain with their foster parents after the age of 18, and all care leavers can now receive support from children’s services until they are 25 years old. _x000D_ _x000D_ This support is often provided by someone called a Personal Adviser (PA). The PA can be someone the care leaver already knows, but is often someone employed by the local authority. The PA should work in partnership with the young person to ensure that he or she has all the information and support they need to manage their own health and wellbeing (feeling good about life). This includes helping young people make the move from children’s services (like Child and Adolescent Mental Health Services) to services for adults, which are organised very differently. _x000D_ _x000D_ Care leavers say that, at the moment, PAs focus mainly on practical issues like housing and money. Of course, solving these practical problems is extremely important, but it is not enough. Emotional issues like feeling sad or lonely, and other things like sexual health, having a good diet, getting enough exercise, and knowing when and how to talk to your GP, also matter. We think that PAs could make a real difference to care leavers' health and wellbeing if they had the right training and support._x000D_ _x000D_ This study is about finding out how best to do that. We are planning to do two things. _x000D_ _x000D_ First, we are going to find out what PAs should know about how to support care leavers’ health needs. We will find out what has already been shown to be helpful and talk to care leavers about what they want, and what they think PAs need to know and do. We will also talk to health and social care professionals. We will then use all of this information to develop a training course for PAs, which we will ‘test run’ with a small group of PAs. _x000D_ _x000D_ In the second part of the study we will evaluate the training programme in three or four local authorities in order to find out how helpful the training is. We will use a design called a randomised controlled trial. By doing something like ‘tossing a coin’ we will select half the teams in each local authority to receive the training. We will compare the experiences and health of care leavers who receive support from PAs we trained, to care leavers supported by PAs who did not have this training. We will also talk to PAs, care leavers and other people about their experiences._x000D_ _x000D_ Our team involves academics from Bristol University and Queen’s University Belfast, and CORAM Voice – a children’s rights charity. Young people from Coram Voice will help to develop the training, and conduct the research. We want this study to be a true partnership with young people who know what leaving care is like._x000D_ _x000D_ We will share our findings on the CORAM Voice website and in one of their 'Snapshot' reports.

Lay abstract: RESEARCH QUESTION_x000D_ Can we enhance the health and wellbeing of Care Leavers by training their Personal Advisors with relevant public health knowledge and skills?_x000D_ _x000D_ BACKGROUND_x000D_ Each year, some 10,000 children aged 16-18 years leave local authority care in England. They have to negotiate both the transition to young adulthood and that from children’s to adult services. Compared with the general population of young adults, Care Leavers (CLs) have poorer physical, emotional and mental health, and are also more likely than those who have not been in care to engage in risky behaviours e.g. smoking, substance misuse, and unprotected sex._x000D_ _x000D_ AIMS AND OBJECTIVES_x000D_ This study seeks to improve health outcomes for CLs by equipping the group of staff responsible for supporting them with appropriate knowledge and skills. These staff are called Personal Advisors (PAs). The objectives are:_x000D_ 1. To scope current training provision for PAs._x000D_ 2. To determine the appropriate content and mode of delivery of training to assist PAs to address the health and wellbeing of care leavers._x000D_ 3. To test and refine a manualised training programme and associated logic model. _x000D_ 4. To conduct a feasibility trial to determine the appropriateness of seeking funding for a Phase III randomised trial._x000D_ 5. To conduct a process and implementation study of factors that facilitate or impede the acquisition and use of PA knowledge and skills, and the perceptions of care leavers and other key stakeholders on the impact of PA training._x000D_ _x000D_ METHODS_x000D_ Reflecting good practice in the development and evaluation of complex social interventions, the study comprises two phases, both co-produced with care leavers and other key stakeholders. Peer researchers (recruited, trained and supported by Coram Voice) will be full members of the research team._x000D_ _x000D_ Phase 1: Developing the intervention._x000D_ We will survey local authorities to map the training currently provided to PAs and undertake a rapid review of factors that can help lay workers recognise and facilitate help-seeking. These data will inform consultations with care leavers and other key stakeholders on what they see as priorities for health promotion. We will then develop a manualised training programme and logic model, which we will ‘road-test’ in one local authority, using the learning from that to finalise the intervention. Candidate outcomes and possible measures will also be identified in consultation with care leavers._x000D_ _x000D_ Phase 2: A feasibility trial._x000D_ This will be a cluster-randomised trial in which 12 teams of PAs will be randomized to one of 2 arms: training or ‘practice as usual’. We will recruit a sample of CLs from whom we will collect additional data on the impact of training at 26- and 52-weeks. The feasibility study will include i) an economic analysis (to determine intervention costs and a precise estimate of the costs that would be incurred in a Phase III trial) and ii) a process and implementation study to aid the interpretation of the results of what is a complex social intervention._x000D_ _x000D_ TIMELINES FOR DELIVERY_x000D_ Phase 1: Months 1-12. Phase 2: Months 13-36._x000D_ _x000D_ ANTICIPATED IMPACT AND DISSEMINATION._x000D_ The main ‘impact’ will be a clear indication of the intervention’s potential effectiveness, and whether it is appropriate to seek funding for a Phase III trial. We will publish the feasibility study in an open access journal, and disseminate the findings via a highly accessed website hosted by Coram Voice.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE