Abstract
BackgroundA significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. The most effective treatments for these children are currently unknown, partly due to a lack of robust, controlled studies. Researchers have identified a number of obstacles to conducting well-designed research with this population, making the need to test the feasibility of a randomised controlled trial especially important.Methods/designThis protocol outlines a two-arm, randomised control feasibility trial to explore the acceptability and credibility of mentalization-based treatment (MBT) as a treatment for reducing emotional and behavioural difficulties in looked after children and to test the possibility of addressing a number of methodological challenges to conducting high-quality research with this population. MBT is a relatively new intervention which, in the adaptation of the model tested here, includes many of the features of therapy identified in NICE guidelines as necessary to support children in care. The two arms are MBT and usual clinical care (UCC). The study will take place in Hertfordshire Partnership University NHS Foundation Trust with follow-up at 12 and 24 weeks.DiscussionThis study will aim to ascertain whether it is worthwhile and feasible to progress to testing the intervention in a full-scale definitive randomised controlled trial (RCT). This study therefore has the potential to improve our understanding of the obstacles to conducting high-quality research with this very vulnerable population, and in the medium term, could help to improve the stability of foster placements and the emotional well-being of children in care.Trial registrationISRCTN90349442
Highlights
A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties
This study has the potential to improve our understanding of the obstacles to conducting high-quality research with this very vulnerable population, and in the medium term, could help to improve the stability of foster placements and the emotional well-being of children in care
The lack of data on costeffectiveness is a particular obstacle for policy makers and commissioners, for whom difficult decisions need to be made about resources and funding
Summary
A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. In a comprehensive survey conducted in 2002 [3], 45% of CLA aged 5–17 met the criteria for a psychiatric disorder, including conduct disorder (37%), and anxiety and depression (12%), but more recent studies have suggested that the figure could be as high as 72% [4] This is in stark contrast to the figure for children with mental health conditions in the general population, which is estimated at 10% [3]. As the mental health problems that can arise in these circumstances are significant predictors of future, long-term maladjustment [8,9,10], tackling the emotional and behavioural difficulties of CLA promptly and effectively is an important priority for health and social care professionals [11]
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