ASSIST Trauma Care: Guiding Young Minds : Feasibility and pilot study report

Abstract

Executive summary The project The Guiding Young Minds (GYM) programme aims to support young people with experience of trauma to improve potentially challenging behaviour, establish a vision of a positive future, and set personal goals. In the long term, GYM aims to reduce gang involvement, anti-social behaviour, and violence. Delivered by ASSIST Trauma Care, the intervention lasts between six and 12 months, depending on the young person’s need. GYM then has an ‘open door’ policy for young people to reach back for help when required. GYM provides intensive mentoring (delivered by mentors with lived experience) and trauma-informed therapeutic support to young people identified as frequently truanting, at risk of gang membership, exposed to adverse childhood experiences, or displaying high impulsivity and/or hyperactivity. Schools, social services, police, and youth offending services may refer young people, or they can self-refer after attending a GYM outreach event. Alongside mentoring, the therapeutic interventions are tailored to need. This includes one-to-one trauma-focused cognitive behavioural therapy and joint family therapy. In this project, ASSIST Trauma Care aimed to recruit 80–90 young people from Northamptonshire and Coventry to GYM. YEF funded a feasibility and pilot evaluation of GYM. The feasibility study aimed to ascertain what factors supported or interfered with the successful delivery of the programmes and whether the intervention’s recruitment, retention, and reach were feasible, and to understand service users’ views and experiences of the intervention. Seventy-one children participated in the intervention during the feasibility phase, and 15 participants took part in interviews for the feasibility study (including four professionals, eight parents/carers, and three children). The pilot study then aimed to further describe the referral and screening process, assess retention, ascertain the readiness for a larger-scale evaluation, evaluate the implementation process, and assess the direction and magnitude of potential changes in child behaviour and family-functioning outcomes. An additional 20 young people were referred to the intervention during the pilot phase, which also considered longer-term outcomes for those young people who had been referred during the feasibility phase. Eighteen participants (including five young people, five adults with parental responsibility, and eight professionals) were interviewed for the pilot, while quantitative data for 74 young people were analysed. Data collected related to the delivery of the programme, demographic data, and some core measures (including the Strengths and Difficulties Questionnaire [SDQ], a measure of behaviour, and the SCORE 15 Index of Family Functioning and Change). The evaluation ran from February 2020–April 2022. The feasibility and pilot studies took place during the coronavirus pandemic, requiring both the delivery and evaluation teams to adapt to challenging circumstances. Key conclusions During the feasibility phase, the use of credible and relatable mentors was consistently identified as a strength. COVID-19 impacted service delivery in the feasibility phase, reducing the level and quality of engagement with children and their families. GYM practitioners responded flexibly, providing more virtual contact. GYM’s recruitment, retention, and reach were found to be feasible. In the feasibility phase, 98 children were referred to the programme, of whom 71 went on to engage. Eighty-nine per cent of those engaging with GYM were still in contact with the project by the end of the feasibility phase or had completed the programme and been discharged. The small number of children and parents/carers interviewed were overwhelmingly positive about GYM, praising the support provided by mentors. The pilot study found that the referral and screening processes worked appropriately, with little risk of bias. Retention in the intervention was also very high during the pilot phase, with 93% of enrolled families continuing to participate after 12 months. While programme retention was high, completion of core measures was poor, with less than a third of the families that completed measures at baseline completing them 12 months later. In the pilot phase, the evaluator found that GYM was broadly implemented as intended (despite changes made due to COVID-19). The degree of personalisation of the approach, particularly the open-ended mentoring, may make it difficult to ascertain the ‘dosage’ of the intervention in future evaluations. InterpretationIn the feasibility phase, the use of credible and relatable mentors was a consistently identified strength of GYM. Interviewees described good working relationships with GYM and expressed a considerable amount of respect, admiration, and appreciation for the work delivered by the project. COVID-19 and social distancing measures did impact service delivery during the feasibility phase and reduced the level and quality of engagement with children and their families. The GYM team responded flexibly and constructively to these restrictions, implementing a virtual service and increasing the use of social media to engage young people.GYM’s recruitment, retention, and reach were found to be feasible. In the feasibility phase, 98 children were referred to the programme, of whom 71 went on to engage. Those young people targeted by GYM were regarded as being largely neglected or overlooked by local services. At the point of engagement with GYM, families could often be found in a state of crisis and in urgent need of support for their children. Trauma, crime, and violence were consistently reported features of many GYM service users’ lives.Eighty-nine per cent of those engaging with GYM were still in contact with the project by the end of the feasibility phase or had completed the programme and been discharged. The small number of children and parents/carers interviewed were overwhelmingly positive about GYM, reporting superb support provided by mentors. Some parents observed how their children had become better at managing and controlling their emotions because of contact with GYM and its therapeutic support and suggested that children now responded more appropriately to negative or dangerous encounters. Some parents expressed concern and anxiety about the scope for a relapse to past behaviours once GYM support ended.The pilot study found that the referral and screening processes worked appropriately. For the majority of the referred young people, the child was 12 years old, predominantly male (90%) and white (66%) or mixed race (21%). Most referrals came from police and schools. For some young people, the time between referral and engagement was rapid; for others, it could take longer, something mainly attributed to lockdown periods and school closures. It appears that there is very little risk of bias in the referral and screening process.Retention in the intervention during the pilot phase was very high, with 93% (69/74) of enrolled families continuing to participate after 12 months. While programme retention was high, measure completion was not (with less than a third of the families that provided data at baseline providing data 12 months later). Data collection was compromised both by COVID-19 and by therapeutic decisions made about pursuing measure completion. Where data were collected from the core measures, there were improvements in reported behaviour and family functioning-related outcomes. However, without a counterfactual group that did not receive GYM, we are unable to be confident that positive changes were solely attributable to the programme.In the pilot phase, the evaluator found that GYM was broadly implemented as intended (despite changes made due to COVID-19). ASSIST Trauma Care consistently provided mentoring and therapeutic support, both of which were generally well received by referrers and young people. The degree of personalisation of the approach, particularly the open-ended mentoring, may make it difficult to ascertain the ‘dosage’ of the intervention in future evaluations.The evaluator judges that GYM has the potential to be evaluated in a large randomised controlled trial. However, several challenges would first need to be resolved, such as whether data collection can be improved, whether the current programme would be able to increase capacity, and whether a suitable control condition could be identified.YEF has opted not to proceed with further evaluation of ASSIST at this stage.