Protocol for the RELATE trial: a feasibility and pilot randomised controlled trial of a low-intensity group intervention for young people in care with elevated posttraumatic stress symptoms

Rachel M Hiller, Rebecca S Davis, John Devaney, Sarah L Halligan, Richard Meiser-Stedman, Patrick Smith, Paul Stallard, Rebecca Kandiyali, Stephanie MacNeill, Rachel M Hiller, Rebecca S Davis, John Devaney, Sarah L Halligan, Richard Meiser-Stedman, Patrick Smith, Paul Stallard, Rebecca Kandiyali, Stephanie MacNeill

Abstract

Introduction: Young people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence. There is good evidence that rates of mental health difficulties are high in this group, including posttraumatic stress disorder (PTSD), a trauma-specific mental health outcome. There remains less evidence to guide how to effectively address elevated PTSD symptoms (PTSS) in these young people, particularly in ways that are feasible and scalable for stretched social-care and mental health services.

Methods and analysis: This protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Participants (N = 50) will be randomised to either (a) a group-based trauma-focused programme (Teaching Recovery Techniques), delivered by mental health practitioners both online and in-person, or (b) care-as-usual. Primarily, the trial aims to explore the key feasibility and protocol acceptability questions, including rates of recruitment and retention, as well as the acceptability of the intervention (particularly the online delivery format) to participants and services. In addition, outcomes including PTSS (primary clinical outcome), depression and functioning will be assessed at baseline (pre-randomisation), post-intervention and at a 3-month follow-up.

Ethics and dissemination: Ethical approval has been received from the Health Research Authority (Wales REC1 Ref 20/WA/0100) and University, with further approval from the host trust and social care site. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries.

Trial registration: ClinicalTrials.gov, NCT04467320 . Registered on 13 July 2020.

Keywords: Foster care; Intervention; PTSD; Posttraumatic stress disorder.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
SPIRIT figure for RELATE trial

References

    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Arlington, VA: Author; 2013.
    1. Ancold A, Costello EJ, Messer SC. Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatry Res. 1995;5:237–249.
    1. Armsden GC, Greenberg MT. The inventory of parent and peer attachment: individual differences and their relationship to psychological well-being in adolescence. J Youth Adolescence. 1987;16(5):427–454. doi: 10.1007/BF02202939.
    1. Barron I, Abdallah G, Heltne U. Randomized control trial of teaching recovery techniques in rural occupied Palestine: effect on adolescent dissociation. J Aggress Maltreat Trauma. 2016;25(9):955–973. doi: 10.1080/10926771.2016.1231149.
    1. Barron IG, Abdallah G, Smith P. Randomized control trial of a CBT trauma recovery program in Palestinian schools. J Loss Trauma. 2013;18(4):306–321. doi: 10.1080/15325024.2012.688712.
    1. Barron I, Mitchell D, Yule W. Pilot study of a group-based psychosocial trauma recovery program in secure accommodation in Scotland. J Fam Violence. 2017;32(6):595–606. doi: 10.1007/s10896-017-9921-8.
    1. Bennett RS, Denne M, McGuire R, Hiller RM. A systematic review of controlled-trials for PTSD in maltreated children and adolescents. Child maltreatment. 2021;26(3):325–343. doi: 10.1177/1077559520961176.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Children’s Commissioner for England . The state of children’s mental health services. London: Author; 2020.
    1. Cohen JA, Mannarino AP, Kliethermes M, Murray LA. Trauma-focused CBT for youth with complex trauma. Child Abuse Negl. 2012;36(6):528–541. doi: 10.1016/j.chiabu.2012.03.007.
    1. Department for Education . Statistics on children under local authority care. London: Author; 2020.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot and Feasibility Studies. 2016;2(1):64. doi: 10.1186/s40814-016-0105-8.
    1. Foa EB, Asnaani A, Zang Y, Capaldi S, Yeh R. Psychometrics of the child PTSD symptom scale for DSM-5 for trauma-exposed children and adolescents. J Clin Child Adolesc Psychol. 2018;47(1):38–46. doi: 10.1080/15374416.2017.1350962.
    1. Ford T, Vostanis P, Meltzer H, Goodman R. Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. Br J Psychiatry. 2007;190:319–325. doi: 10.1192/bjp.bp.106.025023.
    1. Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1337–1345. doi: 10.1097/00004583-200111000-00015.
    1. Hiller, R. M., Meiser-Stedman, R., Elliott, E., Banting, R., & Halligan, S. L. (2020). A longitudinal study of cognitive predictors of (complex) post-traumatic stress in young people in out-of-home care. Journal of Child Psychology and Psychiatry. In Press.
    1. Hiller RM, St Clair MCS. The emotional and behavioural symptom trajectories of children in long-term out-of-home care in an English local authority. Child Abuse Negl. 2018;81:106–117. doi: 10.1016/j.chiabu.2018.04.017.
    1. Jones, A. M.,& Morris, T. L. Psychological adjustment of children in foster care: review and implications for best practice. J Publ Child Welfare. 2012;6(2):129–148. doi: 10.1080/15548732.2011.617272.
    1. Kaufman J, Jones B, Stieglitz E, Vitulano L, Mannarino AP. The use of multiple informants to assess children’s maltreatment experiences. J Fam Violence. 1994;9:227–248. doi: 10.1007/BF01531949.
    1. Lewis SJ, Arseneault L, Caspi A, Fisher HL, Matthews T, Moffitt TE, Odgers CL, Stahl D, Teng JY, Danese A. The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. Lancet Psychiatry. 2019;6:247–256. doi: 10.1016/S2215-0366(19)30031-8.
    1. Mavranezouli I, Megnin-Viggars O, Daly C, Dias S, Stockton S, Meiser-Stedman R, Trickey D, Pilling S. Research review: psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis. J Child Psychol Psychiatry. 2020;61(1):18–29. doi: 10.1111/jcpp.13094.
    1. Newton RR, Litrownik AJ, Landsverk JA. Children and youth in foster care: disentangling the relationship between problem behaviors and number of placements. Child Abuse Negl. 2000;24(10):1363–1374. doi: 10.1016/S0145-2134(00)00189-7.
    1. National Institute of Health and Care Excellence (NICE) (2018). Post-traumatic stress disorder (NICE Guideline 116). Available from: .
    1. Perrin S, Meiser-Stedman R, Smith P. The Children’s revised impact of event scale (CRIES): validity as a screening instrument for PTSD. Behav Cogn Psychother. 2005;33(4):487–498. doi: 10.1017/S1352465805002419.
    1. Rubin DM, O’Reilly AL, Luan X, Localio AR. The impact of placement stability on behavioral well-being for children in foster care. Pediatrics. 2007;119(2):336–344. doi: 10.1542/peds.2006-1995.
    1. Sachser C, Keller F, Goldbeck L. Complex PTSD as proposed for ICD-11: validation of a new disorder in children and adolescents and their response to trauma-focused cognitive behavioral therapy. J Child Psychol Psychiatry. 2017;58(2):160–168. doi: 10.1111/jcpp.12640.
    1. Sim J, Lewis M. The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2012;65(3):301–308. doi: 10.1016/j.jclinepi.2011.07.011.
    1. Smith P, Yule W, Perrin S, Tranah T, Dalgleish TIM, Clark DM. Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2007;46(8):1051–1061. doi: 10.1097/CHI.0b013e318067e288.
    1. Stevens K, Ratcliffe J. Measuring and valuing health benefits for economic evaluation in adolescence: an assessment of the practicality and validity of the child health utility 9D in the Australian adolescent population. Value Health. 2012;15(8):1092–1099. doi: 10.1016/j.jval.2012.07.011.
    1. Tarren-Sweeney M. Rates of meaningful change in the mental health of children in long-term out-of-home care: a seven-to nine-year prospective study. Child Abuse Negl. 2017;72:1–9. doi: 10.1016/j.chiabu.2017.07.002.
    1. Thabet AA, Tawahina AA, El Sarraj E, Vostanis P. Exposure to war trauma and PTSD among parents and children in the Gaza strip. European Child & Adolescent Psychiatry. 2008;17(4):191. doi: 10.1007/s00787-007-0653-9.
    1. Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP. A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev. 2012;32(2):122–138. doi: 10.1016/j.cpr.2011.12.001.
    1. Williamson V, Hiller RM, Meiser-Stedman R, Creswell C, Dalgleish T, Fearon P, Goodall B, McKinnon A, Smith P, Wright I, Halligan SL. The parent trauma response questionnaire (PTRQ): development and preliminary validation. Eur J Psychotraumatol. 2018;9(1):1478583. doi: 10.1080/20008198.2018.1478583.
    1. Yule W, Dyregrov A, Raundalen M, Smith P. Children and war: the work of the children and war Foundation. Eur J Psychotraumatol. 2013;4(1):18424. doi: 10.3402/ejpt.v4i0.18424.

Source: PubMed

3
S'abonner