The key therapeutic factors needed to deliver behavioural change interventions to decrease risky substance use (drug and alcohol) for looked after children and care leavers: a qualitative exploration with young people, carers and front line workers

Abstract

Background Looked after children and care leavers have an increased risk of drug and alcohol use compared to their non-LAC peers. Despite high prevalence rates within this population, looked after children are reported to show low levels of engagement in services resulting in unmet needs emerging from substance use. This paper reports on the initial formative phase of a pilot feasibility randomised controlled trial; SOLID ( S upp o rting L ooked After Children and Care Leavers I n D ecreasing Drugs, and Alcohol) that aimed to adapt two evidence-based psychosocial interventions, Motivational Enhancement Therapy and Social Behaviour and Network Therapy, which will aim to reduce substance misuse by looked after children. Methods We conducted qualitative semi-structured interviews and focus groups with 19 looked after children aged 12 to 20 years old, 16 carers and 14 professionals across four local authorities in the North East of England. The data gathered were analysed and then presented within co-production workshops inclusive of 13 young people and 14 professionals (drug and alcohol practitioners and social workers). Findings were used to adapt and refine the interventions prior to the trial. Results Overall findings suggested that whilst original components of both interventions were feasible to deliver and acceptable, specific process areas were highlighted including: increased emphasis upon therapeutic relationships, the benefits of using creative non-traditional methods of engagement and identification of treatment goals wider than those narrowly focused on substance misuse. Conclusion This paper provides an example of methods used to collect multiple perspectives to refine and co-develop interventions to reduce drug and alcohol use in the specific population of looked after children. Trial registration ISRCTN80786829 (first registered 06.06.2016- prospectively registered).

A pilot feasibility randomised controlled trial of two behaviour change interventions compared to usual care to reduce substance misuse in looked after children and care leavers aged 12-20 years: The SOLID study

“…Young people in care are an under-researched group and there are well-known challenges in conducting trials in this group, including the lack of research infrastructure in Social Care [47]. We undertook extensive formative work, adapted interventions with young people in care and relevant staff [19] and then conducted a pilot trial and parallel process evaluation. Despite the detailed preparatory work, we found that is it not feasible to conduct a trial of the adapted substance use behaviour change interventions within the current screening, referral and treatment pathway.…”

“…25 questions to assess four difficulty subscales and measure pro-social behaviour. Total difficulties scores range from 0-40, each one-point increase in this score corresponds with an increased risk of developing mental health disorders; close to average (0-14), slightly raised (15)(16)(17), high (18)(19), very high (20-40).…”

“…Interventions were offered at a location convenient to the participant. Further details regarding the interventions and the rationale for choosing them are reported elsewhere [19].…”

“…Though 161 (18.7%) participants reported poly-substance use on the CRAFFT, the majority did not perceive their alcohol and/or drug use as problematic. Linked formative work suggested that young people in care feel that other challenges cause them more problems than substance use per se [19,50]. Currently, drug and alcohol interventions are delivered in a vertical manner by a specialist service.…”

“…Young people in care aged [11][12][13][14][15][16][17][18][19] years have a four-fold increased risk of drug and alcohol use compared to their peers [7]. A national survey of care leavers in England showed that 32% smoked cannabis daily [7] and data from 2012 showed that 11.3% of young people in care aged [16][17][18][19] years had a diagnosed substance use problem [8,9]. In addition, young people in care have a significantly increased risk of mental health disorders and exposure to and/or involvement in risk taking behaviour [10].…”