Evaluating the impact of clinically underpinned digital gamification and animation onchildren and family mental health outcomes

Research Question: How does a digitally enabled self-help parenting platform impact parent and child clinical outcomes when delivered in home and school environments? Background: Early childhood is a period of rapid emotional growth during which essential foundations for future behaviours and mental wellbeing are established. Demand for emotional and behavioural support in children, growing yearly, is outstripping available resources. Conventional interventions have significant financial and logistical barriers to provision at scale, so the likelihood of medium and long-term detrimental impacts on individuals and society are increasing. Embers the Dragon has been designed to provide an accessible, affordable intervention to help address the growing unmet need. It is an innovative, digital programme of animated stories and parent and teacher resources, designed as an integrated approach for families and young children. An initial NIHR I4I Connect-funded evaluation as proof of concept, returned extremely positive results, and funding is now sought to grow the offer, evaluate its accessibility, efficacy and acceptability in real-world use, and prepare for commercialisation. One challenge is that routine outcome measures designed for measuring emotional wellbeing target a minimum age of 8. This project will deliver against NICE guidance PH40 and NG223 suggested research, generating essential evidence for the efficacy of early interventions in early years wellbeing, as well as information on collecting outcome measures from a younger age group. Aims and Objectives: The primary aim is to establish real-world efficacy of the Embers platform when deployed as an early intervention tool. The objectives are to develop additional digital resources and expand the platform s accessibility, followed by a pragmatic trial to establish real-world efficacy and acceptability of Embers by measuring impacts on (i) parenting style, confidence and effectiveness and (ii) children's psychosocial development. Methods: We will use a pragmatic field trial with elements of randomisation to compare the intervention used at home and school with no intervention. Conducted with a sample of 364 families of children aged 4-7, the primary outcome of the trial is to measure impacts on effective parenting responses and confidence, and child development markers. Secondary outcomes include examining acceptability, engagement, and adoptability across health services. A process evaluation will be largely qualitative and elicited from families to assess user engagement, the process of service delivery, mechanisms of impact, and outcomes - including an examination of how any perceived changes have arisen. Contextual examination will identify influencers and barriers to usage, including social inequality. Comparative intention-to-treat analyses will be analysed thematically, to examine users lived experiences of the intervention. Timelines: The study will last 36 months inclusive of contingency: 14 months product development, 14 months implementation, 8 months post-evaluation analysis/dissemination. Anticipated Impact and Dissemination: Results will be disseminated in academic peer-reviewed journals and in platforms/formats that are accessible to the public, supporting subsequent evidence-based uptake by the health and education sector. Wider impacts from the introduction of a clinically evaluated, affordable, scalable early intervention include: reduced family discord; reduced classroom disruption and longer-term impacts such as improved academic attainment and reduced conduct disorders and offending.