Care-Experienced Children and Young People’s Interventions to Improve Mental Health and Well-Being Outcomes: Systematic Review (CHIMES)

Introduction The mental health and well-being of children and young people who have been in care (foster care, kinship care, residential care) are a priority. There are a range of interventions aimed at addressing these outcomes, but the international evidence-base remains ambiguous. There is a paucity of methodologically robust systematic reviews of intervention effectiveness, with few considering the contextual conditions under which evaluations were conducted. This is important in understanding the potential transferability of the evidence-base across contexts. Our systematic review adopts a complex systems perspective to synthesise evidence, reporting evaluations of mental health and well-being interventions for children and young people who have been in care. It addresses impact, equity, cost-effectiveness, context, implementation and acceptability. This presentation will map the data from the initial scoping of the evidence base and present findings on context, implementation and acceptability.

Methods and analysis: We searched 16 bibliographic databases from 1990 to June 2020. Supplementary searching included citation tracking, author recommendation, and identification of evidence clusters relevant to included evaluations. The eligible population is children and young people (aged ≤25 years) with experience of being in care. Outcomes are (1) mental, behavioural or neurodevelopmental disorders; (2) subjective well-being; (3) self-harm; suicidal ideation; suicide. Study quality was appraised with methodologically appropriate tools. We constructed a taxonomy of programme theories and intervention types. Thematic synthesis was used for qualitative data reporting context, implementation and acceptability. Meta-analysis, which is in progress, will be conducted with outcome data. Convergent synthesis is being used to integrate syntheses of qualitative and quantitative data.

Results: Searches retrieved 116 eligible studies for inclusion. This included 17 studies reporting intervention theory of change; 90 reporting outcome evaluations; 26 process evaluations; and two economic evaluations. The majority of studies have been conducted in the USA (n=75). Most interventions (n=91) are parenting interventions that enhance the parenting skills of carers. There is a lack of approaches focused on structural change at the organisational, community and policy level. All studies include a measure of child mental health and wellbeing. One addresses self-injury. None focus on suicide. Process evaluation data indicates key context, implementation and acceptability factors: 1) The potential overburdening of carers with intensive interventions to support children and young people’s mental health; 2) Challenges in retaining participants in interventions; and 3) The absence of children and young people’s voices in evaluating intervention acceptability.

Discussion: The emergent findings are being consulted with a range of stakeholder groups, including social care professionals, carers, and children and young people with experience of care. Central reflections on the evidence-base to date, in addition to recommendations moving forward, include: 1) A need for interventions that focus more explicitly on wellbeing, self-harm and suicide; 2) A need for higher level, structural interventions that operate at the community and policy level; and 3) A need to develop more interventions locally, rather than relying on the transfer of evaluated approaches from other contexts.

Funder: This study is funded by the National Institute for Health Research (NIHR)- Public Health