Addressing PTSD in young people in care: A feasibility RCT
Research type
Research Study
Full title
Addressing the trauma-related distress of young people in care: A randomised feasibility trial across social-care and mental health services
IRAS ID
274914
Contact name
Rachel Hiller
Contact email
Sponsor organisation
University of Bath
Clinicaltrials.gov Identifier
Duration of Study in the UK
2 years, 1 months, 0 days
Research summary
RESEARCH SUMMARY
Most children who have been removed from their family home and placed under the care of a Local Authority have been exposed to many frightening experiences, including witnessing violence, not being fed or cared for, or being abused. These experiences can lead to significant emotional difficulties. One such difficulty is posttraumatic stress (PTSD), which can involve symptoms like having constant “flashbacks” of scary experiences, and feeling like you are always in danger. This can have a big effect on children’s lives. Yet, we do not have a good idea of how to help young people in care who are experiencing high PTSD symptoms.
One idea we have is to use a group-based programme which has successfully helped other young people who have been exposed to different kinds of stressful experiences (for example, war). To test whether this programme could help children in care too, we first need to see whether social workers have the time to check in with a child about PTSD symptoms; whether young people and their carers are willing to be involved in a research project which will test out the treatment programme; and whether mental health workers might face any problems when delivering the programme. This project aims to answer these questions.SUMMARY OF RESULTS
We tested a group intervention called Teaching Recovery Techniques (TRT) – which is a seven-session intervention for children and teens with high PTSD symptoms. Five sessions were with the young people and two sessions were with the caregiver. We wanted to test whether this intervention might be feasible to use with children in foster care. The primary goal of this first-step trial was to test whether the intervention was acceptable to the young people, their caregivers, and to local authority and NHS mental health team delivering it; and to understand whether our trial procedures worked and were acceptable.
The project was designed to be a randomised controlled trial (RCT), with 50 young people in care. This means half of the young people would have receive the intervention and half would have received the service’s standard care, decided at random (like flipping a coin). However, we found this was not feasible to do within one local authority, because of delays in social worker screening and challenges with randomising into a group intervention. Ultimately, we tested the intervention as an open-trial, where all participants were offered the intervention. Participants were 34 10-17 year olds in local authority care, and their caregiver (e.g., foster carer, key worker). Out of the 34 young people who started TRT, 80% attended at least 3 out of 5 sessions, and most completed all five. This, and the qualitative feedback, suggested that the program was feasible and acceptable for most young people. Some groups were run online (due to COVID), and others were held in person — both formats seemed to work, although there were some concerns with whether the young people fully engaged in the online format.
Of the caregiver sessions, only about half of the carers attended at least one of the two sessions. Caregivers who did attend said it helped them understand the child’s needs better. However, the low attendance shows that getting caregivers involved consistently can be a challenge.
Based on questionnaires and interviews, many young people felt less distressed by memories of past trauma following the intervention. They said they had better coping strategies, were sleeping better, and felt more able to talk about their experiences. They particularly valued the shared experience elements (i.e., coming together with other young people in care). However, some also said that they wanted more sessions or needed further support. Unfortunately, further individual support was often not available because of capacity issues in the mental health services.
Overall, TRT was found to be acceptable and feasible for children and teens in care struggling with high PTSD symptoms. With some careful considerations and modifications it could be tested in a fully-powered trial.
REC name
Wales REC 1
REC reference
20/WA/0100
Date of REC Opinion
6 May 2020
REC opinion
Further Information Favourable Opinion