Matching support to needs: A children’s social care RCT testing a standardised comprehensive assessment of the mental health needs of young people in care

Background: Young people in local authority care (YPiC) have often had very difficult early life experiences. Most have experienced abuse and/or neglect, along with numerous other adversities (e.g., poverty, parental drug misuse, violence). In the UK, the majority of young people enter the care system from school age or older, meaning these experiences have often been prolonged. Once in care, many face ongoing instability, with multiple placement changes (and thus moving home, caregiver, neighbourhood) commonplace. The accumulation of these experiences can have devastating consequences for mental health. Decades of evidence shows at least 50% of YPiC meet criteria for a diagnosable mental health condition, and chronically elevated symptom profiles are common. Yet, in practice, YPiC rarely receive comprehensive mental health assessments (often despite significant cross-sector service contact), with important implications for the support they may (or may not) receive. Aims: The primary aim of this children s social care randomised controlled trial is to evaluate whether adding a standardised comprehensive mental health assessment tool to the social care mental health consultation process (usual care) improves social care and mental health decision-making and practice, and ultimately, the emotional wellbeing of young people in care. The project will also explore the costs and benefits of introducing this new practice framework, via a comprehensive health economics evaluation; and barriers and facilitators of implementation into routine practice, via a comprehensive process evaluation. Methods: This will be a multi-site trial, recruiting across 8-10 local authorities (children's social care). Participants will be 260 11-17 year olds under local authority care, where their social worker has flagged mental health concerns to be reviewed by the social care 'mental health consultation' team. Their caregivers will also be invited to participate (or key worker if in residential care). Young people will be randomised using a 1:1 ratio into either the usual care + assessment arm or usual care only arm. Baseline assessments are completed prior to randomisation. The intervention is the Development and Wellbeing Assessment (DAWBA), a validated comprehensive assessment of mental health. It is completed online by the young person and their caregiver (or key worker if in residential care). On completion, a 2-page mental health report is generated, which will be shared with the young person, caregiver, and relevant social care professionals. Follow-up points are at 1-, 6-, and 12-months post baseline. At 1-month we will gather service-data on any immediate referral decisions, whilst 6- and 12-months are full evaluations of emotional wellbeing (primary outcome), mental health, placement stability, cross-sector service decision-making, and cross-sector service-use. Timelines for delivery: 42 months, including an internal pilot. Anticipated Impact and Dissemination: Findings from this project have the potential to introduce a new practice framework to children s social care, which could improve efficiency of practice, build bridges between social care and mental health, facilitate access to higher quality mental health support, and ultimately improve outcomes for YPiC. A co-developed dissemination plan will have a local and national strategy, and include written, animated and recorded summaries, webinars and in-person workshops and round-tables.