Well-being package for foster carers and teachers of looked-after children aged 8 to 11 years: the STrAWB feasibility RCT

Abstract

Background: Children in care are at elevated risk of mental health issues and poorer well-being, and social care and health services are under pressure to meet their needs. The Shared Training and Assessment for Well-being (STrAWB) programme is a recent approach to training and assessment designed to bring together foster carers and designated teachers to identify and meet the well-being needs of primary school-aged children in care, across the home and school contexts.
Objectives: This feasibility randomised controlled trial (RCT) addressed key questions concerning the acceptability of the STrAWB intervention (including training, assessments, clinical review and feedback), and the feasibility of the research design for a larger RCT (including recruitment, randomisation, and outcome measures).
Design: This was a two-arm randomised controlled trial (STrAWB intervention vs. control group), with two points of data collection (baseline and 12-month follow-up) for our primary and secondary outcomes.
Setting: The study focused on looked-after children from four local authorities in southern England. In the context of the Covid-19 pandemic, both the research and intervention activities were undertaken online with participants.
Participants: Looked-after children aged 8 to 11 years were recruited from the participating local authorities, along with their foster/kinship carers and designated teachers. Carers for all children in the authorities meeting inclusion criteria were initially invited to participate. The original target sample size was 70 children, with 35 receiving the STrAWB intervention and 35 in the control group. However, only 21 looked-after children were successfully recruited and randomised.
Interventions: STrAWB is an integrated approach that combines training on mental health, well-being, and resilience for foster carers and designated teachers, a multi-informant assessment package, review of assessments by mental health experts, and feedback to enable key adults to respond to identified needs and strengths. Covid-19 adaptations enabled all key elements to be delivered remotely.
Main outcome measures: Two multi-informant primary outcome measures were included as possible candidates for a larger RCT: the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Scale. A further multi-informant secondary outcome measure was also included: the Behavioural and Emotional Rating Scale.
Results: Feasibility was not demonstrated as recruitment was heavily impacted by the Covid-19 pandemic and further attrition occurred over the extended project duration. For the small number who completed the STrAWB package, key elements of the intervention were acceptable to participants. In addition, beyond issues with recruitment and retention, key aspects of the RCT design, including randomisation, were acceptable.
Limitations: It is impossible to distinguish precisely between impacts of Covid-19 and broader challenges with securing the capacity and stability needed to deliver and evaluate the STrAWB intervention.
Conclusions: Key elements of the STrAWB intervention and RCT process were acceptable, but the overall RCT research design was not feasible in this study. The project was heavily compromised by the impact of the Covid-19 pandemic on foster carers, schools, local services, and children.
Future work: Potential strategies are suggested to address challenges with evaluating integrated training and assessment approaches aimed at key adults supporting looked-after children.
Study registration: The protocol for this project can be downloaded at https://njl-admin.nihr.ac.uk/document/download/2032646. Research Registry UIN: researchregistry5616

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ORCID for Andrew Cook: orcid.org/0000-0002-6680-439X

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