Doctor Emma Howarth (University of Cambridge)
Doctor Anne-Marie Burn; Doctor Ayla Humphrey; Professor Graham Moore; Doctor Hannah Littlecott; Doctor Katie Harron; Doctor Kelly Buckley; Doctor Loraine Bacchus; Doctor Rhiannon Evans; Doctor Sara Long; Doctor Vashti Berry; Professor Anne Spencer; Professor Gene Feder; Professor Nicky Stanley; Professor Sandra Eldridge
There is strong evidence that children’s exposure to domestic violence and abuse (DVA) is associated with impairment in physical and mental health in childhood and into adulthood. There is mounting public policy support for the delivery of interventions to reduce suffering and the burden of disease associated with DVA, and greater emphasis on, and investment in, improving mental health (MH) outcomes for vulnerable groups of children. However there is limited evidence about cost effective interventions that prevent or limit poor MH outcomes in children who have been exposed to DVA.
In the UK it is established practice to offer Psycho-educational interventions to children who have been exposed to DVA. The Community Group Programme (CGP) in particular, has become well established in some areas. Whilst service evaluation suggests it is acceptable, the extent to which the programme can be successfully implemented is poorly understood and the degree to which it improves child outcomes is unknown. Well-designed and carefully implemented trials are urgently required to test the relevance of promising interventions in the UK context, and to evaluate those interventions, like the CGP, that are most commonly provided, but which currently lack empirical support.
Aims and Objectives
The study we propose aims to find out if it is possible to conduct an experimental study, or trial, to compare whether children who take part in the CGP do any better than similar children who receive the support that would normally be available to them. For this reason it is called a feasibility study. It is needed as a first step because we are not sure if families or the people working with them would be willing to support a trial where only some children and mothers are able to access the programme we are testing.
AIM 1: To evaluate whether the CGP can be implemented with fidelity in UK settings.
AIM 2: To provide information necessary to evaluate the feasibility and design of a definitive trial.
INTERVENTION AND SETTING: A manualised, 12 week trauma-informed, psycho-educational programme for children and their female caregivers. Delivered by professionals from different disciplines, in a range of community settings. Children are encouraged to recognise, name and explore feelings surrounding DVA, develop adaptive coping strategies and build peer networks. Parallel sessions for female caregivers help them to support their children to come to terms with their experiences. Victimised male caregivers are currently excluded from the intervention.
METHOD: i) A feasibility pragmatic, parallel group, individually randomised controlled trial (RCT) with embedded process and economic evaluations. ii) A nested qualitative sub-study to explore in-principle acceptability of the CGP to victimised male caregivers.
PARTICIPANTS: i) Children aged 7-11 years and their female caregivers (n=64 family clusters) referred to one of two host sites working with vulnerable children and families. Consenting families will be randomised to one of two treatment groups – usual care with full access to existing services (control group), or usual care plus CGP(intervention group). Participants will complete study measures at baseline, then six and 12 months post-randomisation. Quantitative and qualitative data will be collected to evaluate feasibility and acceptability of the intervention and trial methods, and to explore how implementation may vary as a function of context. ii) N=15 victimised male caregivers identified by community agencies or in contact with host agencies.
OUTCOMES: Judgement of feasibility of a full trial, assessed against pre-specified progression criteria.
TIMELINE: 28 months in duration. The study will begin September 2019 and will aim to recruit over a period of 12 months from April 2020.
IMPACT AND DISSEMINATION: This study is an essential step towards a larger RCT, and will provide important information about the process of implementing public health interventions in complex community systems.