Well-being package for foster carers and teachers of looked-after children aged 8 to 11 years: the STrAWB feasibility RCT
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 programme is a recent approach to training and assessment designed to bring to...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2025-03-01
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| Series: | Public Health Research |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/NGXR5244 |
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| Summary: | 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 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 addressed key questions concerning the acceptability of the Shared Training and Assessment for Well-Being intervention (including training, assessments, clinical review and feedback) and the feasibility of the research design for a larger randomised controlled trial (including recruitment, randomisation and outcome measures). Design This was a two-arm randomised controlled trial (Shared Training and Assessment for Well-Being 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 8–11 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 Shared Training and Assessment for Well-Being intervention and 35 in the control group. However, only 21 looked-after children were successfully recruited and randomised. Interventions Shared Training and Assessment for Well-Being 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 randomised controlled trial: 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 Shared Training and Assessment for Well-Being package, key elements of the intervention were acceptable to participants. In addition, beyond issues with recruitment and retention, key aspects of the randomised controlled trial 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 Shared Training and Assessment for Well-Being intervention. Conclusions Key elements of the Shared Training and Assessment for Well-Being intervention and randomised controlled trial process were acceptable, but the overall randomised controlled trial 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. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR127799.
Plain language summary What is Shared Training and Assessment for Well-Being? The Shared Training and Assessment for Well-Being (STrAWB) programme brought together the foster carer and designated teacher for children in care in primary school. They both attended training on the mental health and well-being of children in care. They also completed forms about children’s well-being. These were looked at by a mental health expert who wrote a summary about each child’s strengths and needs, helping the teacher and foster carer to support the child at home and in school. Why did we do this study? We wanted to find out whether STrAWB was useful for foster carers, designated teachers and other professionals. This was a small study to allow us to see if it would be possible to do this with a larger number of children in the future, so that we could see whether the STrAWB programme improved the well-being of children in care. What happened? We randomly put children, their carers and designated teachers into one of two groups. Only one group received the full STrAWB programme, which was delivered online due to the COVID-19 pandemic. Both groups completed questionnaires about the child’s well-being at the start and again a year later, to see if it was possible to collect this sort of information across time. We also spoke to those who took part to see how they found it, whether it was useful, and whether anything needed to change. What did we find out? Due to the pandemic we were not able to find the number of people to take part that we needed, so we could not show that a bigger study would be possible. But those who participated thought the project was useful and much needed and felt that splitting children into two groups to see if STrAWB improved well-being was acceptable. |
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| ISSN: | 2050-439X |