Title: Shared Training and Assessment of Well-Being for looked-after children (STrAWB): Feasibility study
Funder: Department of Health and Social Care

Abstract: What is the issue?_x000D_ Around 75,000 children in England are ‘looked-after children’, living with someone other than their birth parents. Three-quarters of these live either with members of their extended family (‘kinship care’) or with another family who are trained and supported (‘foster care’). Most looked-after children have experienced difficulties including abuse or neglect, family stress, or absent parenting while living with birth families. Many children survive very difficult childhoods without developing any mental health issues, but research suggests that almost half of looked-after children might have some sort of mental health condition such as depression or conduct problems, even if it hasn’t been diagnosed. These sorts of conditions are often preceded by difficulties with emotions and social relationships. Spotting such issues in younger children and putting support in place can prevent problems from escalating, reducing the risk of later mental health difficulties, and the problems at home and at school that often follow. _x000D_ _x000D_ What will we do?_x000D_ We have worked with foster carers, social workers, young people, and mental health experts to develop a package to help the key adults in looked-after children’s lives to support their well-being. The Shared Training and Assessment of Well-Being (STrAWB) package consists of:_x000D_ a) A joint training course for foster carers and teachers to increase their understanding of mental health and well-being _x000D_ b) A set of surveys completed by the foster carer, teacher, and the child, that tells us about different aspects of well-being both at home and at school _x000D_ c) A mental health specialist who looks at all the answers to the surveys and uses these to create a profile of strengths and needs for each child, which is fed back to foster carers, teachers, and children’s social workers with practical recommendations for support._x000D_ _x000D_ We now need to know whether we can try out the STrAWB package with a large number of looked-after children to see if it is effective in improving well-being. In order to do this, we first have to run it with a smaller group in what is called a ‘feasibility trial’, to see whether everything works as it should and whether people are willing to be part of a research study on STrAWB._x000D_ _x000D_ We will work with 70 looked-after children in school years 4-6, and their foster carers and teachers. Half of them will get the STrAWB package, and the other half will act as a comparison group so we can see what happens for children under normal circumstances. We will collect surveys about children’s well-being just after the joint training, and again 12 months later. We will also use surveys, interviews, documents, activity monitoring sheets, and case studies to decide whether the package and the research processes all worked as planned. We can then decide whether it would be worthwhile to offer STrAWB to a larger group of looked-after children._x000D_ _x000D_ What happens next?_x000D_ We hope the children who receive STrAWB will benefit by having any well-being difficulties identified and supported, and we hope foster carers and teachers will benefit from having a shared understanding of children’s mental health and well-being at home and at school. _x000D_ We will tell people about our findings through magazines and newsletters, social media and a webinar, and in our meetings with looked-after children, the adults who support them, and the people who make decisions that affect their lives.

Lay abstract: Background_x000D_ Up to 45% of looked-after children have a diagnosable mental health difficulty. Poor mental health predicts lower educational attainment and problems in adulthood; but early identification can prevent problems from escalating, reducing the risk of later difficulties. The STrAWB package for primary-aged looked-after children, their foster/kinship carers (FCs) and designated teachers (DTs), consists of:_x000D_ a) A training course for FCs and DTs to increase understanding of potential mental health problems, well-being, resilience and guidance on assessments_x000D_ b) Measures completed by the FC, DT, and child, to provide an assessment of well-being across the home and school contexts _x000D_ c) A mental health expert’s review of all measures, to create individual profiles of strengths and needs for feedback to FCs, DTs, and children’s social workers_x000D_ _x000D_ Aims and objectives_x000D_ The overall aim of the study is to determine the feasibility of an RCT of STrAWB. _x000D_ Our study objectives are to:_x000D_ 1. Test the procedure of randomisation, and its acceptability to all participants_x000D_ 2. Determine the consent rate and time to consent from those approached to take part_x000D_ 3. Test the acceptability of the intervention to participants_x000D_ 4. Select the most appropriate primary outcome measure for a main trial_x000D_ 5. Provide data to inform a sample size calculation for a main trial_x000D_ _x000D_ Methods_x000D_ Thirty-five looked-after children (aged 8-11), and their FCs and DTs, will receive the STrAWB intervention, and 35 will receive care as usual. We will use mixed methods (post-training and service use surveys, interviews with participants and stakeholders, documentary evidence, activity monitoring sheets, and case studies) to assess acceptability of randomisation and the intervention, recruitment and retention rates, intervention fidelity, and data completion rates. We will also test two multi-informant measures of mental health (the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Scale), to assess which is more comprehensible, developmentally appropriate, and useful for measuring impact in this population._x000D_ _x000D_ Timelines for delivery_x000D_ Project: April 2020 to June 2022_x000D_ Intervention: June 2020 to December 2020_x000D_ Primary outcomes data: Time 1 (before randomisation) and Time 2 (12 months later)_x000D_ Feasibility data: Time 1 through to Time 2 _x000D_ _x000D_ Impact and dissemination_x000D_ The main role of this project is to establish whether the main trial can be done, and investigate parameters which may inform the design of that trial. Any benefits for the public can only follow after that trial has delivered its results. The 35 young people in the study will benefit directly from a process that: a) identifies earlier, and in their daily contexts, the difficulties they are experiencing and support needed to address them; and b) documents their experiences and perspectives in order to influence future support. Pupils who share a learning environment with these children will also benefit, as they are likely to see a reduction in classroom disruption. Foster carers and teachers will benefit by improved knowledge of mental health and well-being which will enable them to better support the looked-after children in their care now and in the future. _x000D_ _x000D_ Outputs will include written pieces for an academic journal, Children & Young People Now and the general media, NIHR CLAHRC East of England, and the Rees Centre website and newsletter; a webinar; and presentations at national academic and practice conferences. We will make use of existing routes of dissemination, including meetings with key groups of stakeholders, relevant organisations (e.g. NSPCC, Coram Voice) and the DfE’s Children in Care team, and ‘trade’ newsletters.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH