Abstract
IntroductionYoung people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence. There is good evidence that rates of mental health difficulties are high in this group, including posttraumatic stress disorder (PTSD), a trauma-specific mental health outcome. There remains less evidence to guide how to effectively address elevated PTSD symptoms (PTSS) in these young people, particularly in ways that are feasible and scalable for stretched social-care and mental health services.Methods and analysisThis protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Participants (N = 50) will be randomised to either (a) a group-based trauma-focused programme (Teaching Recovery Techniques), delivered by mental health practitioners both online and in-person, or (b) care-as-usual. Primarily, the trial aims to explore the key feasibility and protocol acceptability questions, including rates of recruitment and retention, as well as the acceptability of the intervention (particularly the online delivery format) to participants and services. In addition, outcomes including PTSS (primary clinical outcome), depression and functioning will be assessed at baseline (pre-randomisation), post-intervention and at a 3-month follow-up.Ethics and disseminationEthical approval has been received from the Health Research Authority (Wales REC1 Ref 20/WA/0100) and University, with further approval from the host trust and social care site. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries.Trial registrationClinicalTrials.gov, NCT04467320. Registered on 13 July 2020.
Highlights
Young people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence
Young people in care have some of the poorest outcomes of any group of youth in the UK, yet there remains uncertainty about how best to treat their psychological needs, using intervention methods that are scalable and feasible for the large number of young people who may benefit from support
This project will assess the feasibility of conducting a definitive multi-site randomised controlled trial (RCT) that would evaluate the effectiveness of an easy to disseminate and potentially cost-effective intervention for young people in care with elevated PTSD symptoms (PTSS)
Summary
This protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Whilst some young people in care with very complex presentations will certainly require high-intensity psychological support, developing more scalable and feasible lower-intensity interventions may be one way to target the needs of a larger group of young people. One such potential lower-intensity intervention is Teaching Recovery Techniques (TRT), developed by the Children and War Foundation [34]. Aims The primary goal of this study is to determine the feasibility both of delivering TRT as a lower-intensity online or in-person intervention and of recruiting, retaining, and collecting outcome data on young people in care with elevated PTSS. Explore the acceptability of the intervention and key practical considerations from the perspective of stakeholders, including (a) young peoples’ experiences of the programme components, including the group and online delivery format; (b) carers’ experiences of supporting young people through this programme and their own engagement in carer sessions; (c) engagement in assessments (e.g. rates of assessment completion); (d) engagement of young people who may not have a consistent caregiver; (e) the appropriateness of mixed-gender groups and groups where young people may have varied maltreatment experiences; and (f ) whether the manual needs further refining before any future trial
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