Care-experienced young people (those in care, adopted, or on special guardianship order) experiencing high posttraumatic stress disorder symptoms Mental and Behavioural Disorders Anxiety, PTSD
Conditions
Interventions
Our study design has been developed with input from care-experienced young people, caregivers, and local authorities, as well as with input from Trust Research & Development teams.
Broadly, the method
Sponsors
University College London
Eligibility
Sex/Gender
All
Age
8 Years to 18 Years
Inclusion criteria
Inclusion criteria: Services: Any service that provide mental health interventions to care-experienced young people, including CAMHS and specialist CAMHS. For feasibility, this primarily targets specialist looked-after children CAMHS or teams within CAMHS who specialise in the assessment and management of care-experienced young people. The participants are the mental health service providers within the participating services, who complete training in the tf-CBT. Young people: 1. A care-experienced young person, which includes three specific categories: (i) a young person under the care of a local authority (Looked-after child), (ii) a young person adopted from care, or (iii) a young person on a special guardianship order. 2. Aged 8yrs - 17yrs 11mo 3. Attending a participating mental health service and been offered a trauma-focused CBT 4. Have adequate English skills and intellectual capacity to complete questionnaires (based on clinician and care-giver judgment) The young person's primary caregiver will also be invited to participate. They can decline and the young person can still participate (but not visa versa).
Exclusion criteria
Exclusion criteria: As this is a naturalistic case study of implementation, there are no exclusion criteria for the young person that can access the intervention. The clinician ultimately decides whether or not to screen the young person for PTSD and whether or not to provide the treatment (which then makes the young person eligible for our study), based on their clinical judgment. Via service data collation and qualitative interviews with service providers, we will gather information on what groups of young people they choose not to provide the treatment to and why.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The project is primarily interested in understanding barriers and facilitators of services conducting routine screening for PTSD and the delivery of tf-CBT (cognitive therapy for PTSD) to their care-experienced young people (children looked-after, adopted, or on special guardianship orders). The project primarily seeks to understand the process of implementation of the Child Revised Impact of Events Scale (CRIES-8) symptom measure and the tf-CBT intervention with care-experienced young people. This is captured via: 1. Anonymised service data (e.g., percentage of those referred who are screened using the CRIES-8; percentage of those who are offered tf-CBT), capturing the 3 months before the training and subsequently every 3 months, for a period of approximately 12 months; 2. Descriptive quantitative reports from therapists (tracking whether individual therapists are using the tools), and qualitative feedback from therapist focus groups and interviews around facilitators and barriers to using the screening tool and treatment. These data collected from therapists is collected 1 month after the training, and subsequently every 3 months for a period of approximately 12 months. | — |
Secondary
| Measure | Time frame |
|---|---|
| Current secondary outcome measures as of 28/04/2023: The feasibility and pilot effectiveness component of the project explores key feasibility and acceptability questions, using mixed methods: 1. Qualitative feedback from service providers about the feasibility of referring young people to the study, along with descriptive numbers of eligible young people who are actually invited to the study, and then who participate. 2. Qualitative interviews with young people who were offered tf-CBT and their caregivers, at the post-treatment assessment. In addition, because not all young people offered tf-CBT will decide to be involved in the trial, we will also draw on service data to understand how many young people are offered the intervention and general retention rates; 3. Measure symptom change from pre- to post-treatment and 3-monthly follow-up. The primary outcomes assessed at these timepoints are PTSD symptom severity and complex PTSD symptom severity (both measured via the Child & Adolescent Trauma Screen-2) and/or the routinely collected Children's Revised Impact of Event Scale (CRIES-8). The secondary outcomes assessed at these timepoints are symptom change on: 3.1. The young person’s self-reported anxiety and depression (Revised Child Anxiety and Depression Scale), perceived support (Multidimensional Perceived Support Scale) and quality of life (Investigating Choice Experiments for the preferences of people CAPability); 3.2. The carer’s report of the child’s symptoms, relationship quality (Relationship Problems Questionnaire) and general wellbeing (Strengths and Difficulties Questionnaire; KINDL questionnaire of young people’s quality of life), and the carer’s own mental health (Depression, Anxiety and Stress Scale). 3.3. A third component will explore whether tf-CBT was associated with change (assessed at the same timepoints) in key proposed target mechanisms, spanning child report of their maladaptive cognitions (Child Post-Traumatic Cognitions Inventory), memory | — |
Countries
England, United Kingdom
Outcome results
None listed