Abstract
BackgroundYoung people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers.AimThe SOLID study aimed to investigate the feasibility of a definitive randomised controlled trial, comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol), and improve mental health, in young people in care.MethodsWe recruited young people in care aged 12–20 years, self-reporting substance use within the previous 12 months and residing in 1 of 6 participating local authority sites in the North East of England. Participants were randomised to either i. Motivational Enhancement Therapy (MET), ii. Social Behaviour and Network Therapy (SBNT) or iii. Control (usual care). All interventions were delivered by trained drug and alcohol workers. Follow-up data were collected 12 months post recruitment. Feasibility for trial progression was compared to pre-specified stop: go criteria (recruitment of 60% of eligible participants, 80% of participants attending 60% of offered sessions and retention of 70% of participants at 12 month follow up).ResultsOf 1450 eligible participants, 860 (59%) were screened for drug and alcohol use by social workers, 211 (24.5%) met inclusion criteria for the trial and 112 young people (7.7%) consented and were randomised. Sixty of these 112 participants (54%) completed 12-month follow-up questionnaires. Only 15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered MET or SBNT sessions.ConclusionBy reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format. Despite co-designing procedures with staff and young people in care, the screening, referral and treatment pathway did not work here. Future work may require dedicated clinically embedded research resource to evaluate effectiveness of new interventions in services.
Highlights
There were 78,150 young people in the care of the state in England on 31 March 2019, this represents 65 young people per 10,000 under the age of 18 years old [1]
15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered Motivational Enhancement Therapy (MET) or Social Behaviour and Network Therapy (SBNT) sessions
By reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format
Summary
There were 78,150 young people in the care of the state in England on 31 March 2019, this represents 65 young people per 10,000 under the age of 18 years old [1]. Young adults who were in the care system, typically aged 18–21 years, are termed care leavers; these include young people who were previously under the legal care of local authorities and are still entitled to receive support [4]. Many have been typically exposed to multiple adverse childhood experiences including parental poverty, absence of support networks, parental substance misuse, poor maternal and/or paternal mental health and early family disruption. These factors greatly increasing the risk of substance use, poor mental health, school failure and early parenthood within this population [5, 6]. Young people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers
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