Relationships in Good Hands Trial: clinical and cost-effectiveness of Dyadic Developmental Psychotherapy for abused and neglected young children with maltreatment-associated problems and their parents

Research Questions: Within three contrasting service contexts (NHS, Social Care, Private Practice), what is the clinical and cost-effectiveness of an intensive therapy (DDP) for improving mental health in abused and neglected children? Background: 92,000 UK children are in care or adopted, nearly all have been abused and neglected and > 50% have psychiatric problems – often complex difficulties with genetic and environmental underpinnings. These maltreatment-associated psychiatric problems (MAPP) can include ADHD, Conduct Disorder, PTSD and Attachment Disorders. Maltreated children are at high lifetime risk of educational difficulties, homelessness, crime and premature mortality, yet a systematic review has found no evidence-based treatments for MAPP. Successful early intervention could greatly impact lifetime prospects – as well as UK health and social care budgets. DDP is a parent-child therapy taking around 20 sessions, focusing on “Playfulness, Acceptance, Curiosity and Empathy”. It is UK practitioners’ preferred treatment for MAPP, but requires weekly commitment for around 6 months from children and families. NICE has recommended a randomised controlled trial of DDP. Methods and timelines for delivery: PHASE 1 (9 months, cost £388,710) will optimise DDP and care pathways in the service contexts in which DDP is delivered: NHS, Social Care and Private Practice. We will conduct 24-36 qualitative interviews/focus groups with therapists and managers linked to DDP and services as usual (SAU) in each site, feeding into early stage economic modelling. If a site can deliver adequate assessment and pathways of referral to any additional services that children need, that site will be included in Phase 2. PHASE 2 (17 months, cost £653,549) will be a feasibility randomised controlled trial within the three contexts. Outcomes include acceptability of clinical and economic data collection methods, trial processes and recruitment/retention rates for DDP and SAU. PHASE 3 (27 months, cost £1,152,488) will be a definitive randomised controlled trial examining clinical and cost-effectiveness of DDP for improving child mental health, compared to SAU. The principle outcome will be child mental health at 12 months post randomisation. Adoptive parents, foster carers, care experienced young people, Health and Social Care Commissioners have advised us on study design and, with our Trial Steering Committee, will do so throughout. Anticipated impact and dissemination: NICE Guidelines recommend that abused and neglected children need services from health AND social care but, in practice, families often ricochet around an incoherent service landscape, using resources to little effect. Workable multi-agency service models would be a major advance in improving care for children with MAPP, regardless of trial outcome. If DDP is cost-effective, the study could have a major impact on abused and neglected children, their families and on society by allowing the first evidence-based treatment for children with MAPP to be implemented in the UK and beyond. By updating NICE Guidelines and directly lobbying service leaders, the families, young people and Commissioners involved will help us ensure dissemination goes beyond traditional conferences and high profile papers to translate quickly into an effective multi-agency service to benefit our most vulnerable children and families.