Title: Adult-caregiver Supported Positive psychology intervention to Increase Resilience (ASPIRE): Developing and refining a caregiver-delivered positive psychology intervention to increase the resilience of children who have experienced multiple adversities
Funder: Department of Health and Social Care

Abstract: Background: Adverse Childhood Experiences (ACEs) are traumatic or stressful events that occur before age 18 that have been linked to increased risk of a wide range of negative health outcomes across the life course. Both retrospective and prospective studies confirm a strong and consistent dose-response relationship between the number of ACEs a person is exposed to and their odds of developing a mental health disorder. The key moderator of the relationship between ACEs and later psychopathology is resilience. Resilience is not a static trait and, therefore, intervening to increase the resilience of children exposed to multiple ACEs has the potential to decrease the rate of mental ill health. Aim: To develop and refine a caregiver-delivered positive psychology intervention to enhance the resilience to mental health difficulties of children who have experienced multiple ACEs. Positive psychology interventions focus on enhancing the factors that allow individuals and communities to thrive. Though still a relatively new field, there is growing evidence that positive psychology interventions are effective in increasing resilience. A consistent positive relationship with at least one adult caregiver has been shown to be among the strongest protective factors against the adverse effects of ACEs. Therefore, to maximise potential benefits by strengthening existing attachments, we will develop an intervention that supports caregivers to implement positive psychology principles in their child s daily life, rather than a health professional working with the child directly. Research design: A prototype intervention will be developed by a Stakeholder Research Team comprising children, caregivers, health and social care professionals and researchers. The design of the prototype will be informed by component analysis of existing evidence-based positive psychology interventions for children, and semi-structured interviews and focus groups with a range of stakeholders. In the next stage of the research, we will evaluate the acceptability, feasibility and safety of the prototype intervention via a waitlist-controlled pilot study involving 12 families. All participating families will receive the intervention, either immediately or after a delay equivalent to the length of the intervention. Quantitative and qualitative data will be gathered to assess feasibility and fidelity of intervention delivery, potential benefits and adverse effects, and acceptability from the perspective of children, caregivers and professionals. Outputs and dissemination: The Stakeholder Research Team will use the findings to refine the intervention and inform the design of future research. If the pre-specified progression criteria are met, we plan to progress directly to a multi-site feasibility randomised controlled trial. If these criteria are not met, the Stakeholder Research Team will consider whether modifications can be made to the intervention to improve the feasibility, safety or acceptability of the intervention. If so, the intervention will be refined accordingly before progressing to a multi-site feasibility randomised controlled trial. The findings of the current study will be disseminated to relevant audiences, including children, caregivers, social care providers and commissioners, and researchers, through peer-reviewed publications, a short video, and informally through the team s established networks.

Lay abstract: Background Children who go through certain stressful or upsetting events are more likely to experience health problems as they grow up. These events are known as Adverse Childhood Experiences (or ACEs) and include things like: being neglected or abused, seeing domestic violence, living with adults who misuse drugs or alcohol, a family member being in prison, family break-up, the death of someone close, being bullied, or having a serious illness. Children who have experienced several ACEs are much more likely to develop mental health problems than children who have not experienced these stressful events. However, not all children who experience several ACEs become unwell. Some children have social support and personal strengths that allow them to remain healthy despite difficult experiences. This is known as resilience . The amount of resilience someone has is not fixed, so if we can increase their resilience, we can decrease the risk of a lifetime of poor mental health. Aims This project aims to create a positive psychology support package to increase the resilience of children who have been through several ACEs. Positive psychology is about understanding what helps people to thrive, and support based on positive psychology has been shown to increase resilience. However, there is not yet a positive psychology support package designed for children at risk of long-term mental health problems because of past ACEs. One of the most powerful sources of resilience for a young person is having a positive relationship with at least one adult caregiver. Therefore, we plan to develop a package that provides caregivers (e.g. parents, family carers or foster carers) with ongoing training and support to use positive psychology in their child s day-to-day life. Project design The project will be led by a Stakeholder Research Team made up of children, caregivers and health and social care professionals. The project will have two stages. In Stage 1, we will look at the elements of existing positive psychology programmes and ask children, caregivers and professionals what they would want from a support package. The Stakeholder Research Team will use this information to create the initial design for the new support package. In Stage 2, families will be invited to try out this new support package. We will collect information about whether families like the support offered, whether it is practical to deliver, and check there are no potential safety concerns. Sharing the findings and next steps The Stakeholder Research Team will use the information from this project to improve the design of the support package if needed and decide on the next steps for future research. We will share our findings with children, caregivers, health and social care providers, and other researchers.

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