Improving the mental health and mental health support available to adolescents in out-of-home care via Adolescent-Focused Low-Intensity Life Story Work: a realist review

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Abstract

Objectives

Life Story Work (LSW) is used to promote the mental health and well-being of children and adolescents living in out-of-home care. LSW should be offered to all but is conventionally delivered in high-intensity ways. Low-intensity approaches are more accessible but there is significant variation and little guidance for supporting adolescents. We aimed to create guidance for Adolescent-Focused Low-Intensity LSW.

Design

Realist review.

Data sources

MEDLINE, Embase, PsycINFO, Sociology Collection (ProQuest), CINAHL, CDAS, Web of Science (SCIE, SSCI), Social Care Online and grey literature sources. Searches were performed between December 2021 and March 2022.

Eligibility criteria

Documents on children and adolescents in care, LSW and/or low-intensity interventions to improve mental health were included. Documents focusing on parenting style and contact with birth family were excluded.

Analysis

Documents were analysed using a realist logic of analysis. In consultation with Content Expert Groups (comprising professionals and care leavers), we developed an initial programme theory. Data relating to and challenging the initial programme theory were extracted and context-mechanism-outcome-configurations developed, critiqued and refined in an iterative fashion. Interpretations were drawn from context-mechanism-outcome-configurations to enhance the programme theory.

Results

75 documents contributed to the analysis. Generally, studies were small-scale and lacked in-depth methods and evaluation descriptions. Findings indicated important factors contribute to the development of high-quality Adolescent-Focused Low-Intensity LSW. Adolescent-Focused Low-Intensity LSW should be person-centred, begin in the now, involve co-construction, record everyday positive life events and be supported by trained carer(s). Context-mechanism-outcome-configurations relating to these themes are reported.

Conclusions

Using this knowledge we developed initial practice guidance to support social care to deliver better quality Adolescent-Focused Low-Intensity LSW more consistently. To address gaps in our knowledge about the impact of Adolescent-Focused Low-Intensity LSW, further primary research is needed to strengthen understandings of how this intervention works (or not) in different contexts.

PROSPERO registration number

CRD42021279816.

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Most cited references 106

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Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

T C Hoffmann, P P Glasziou, I Boutron … (2015)

Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.

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Realist review--a new method of systematic review designed for complex policy interventions.

Ray Pawson, Trisha Greenhalgh, Gill Harvey … (2005)

Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems--things like league tables, performance measures, regulation and inspection, or funding reforms. These are not 'magic bullets' which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. Traditional methods of review focus on measuring and reporting on programme effectiveness, often find that the evidence is mixed or conflicting, and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes. This paper offers a model of research synthesis which is designed to work with complex social interventions or programmes, and which is based on the emerging 'realist' approach to evaluation. It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. The first step is to make explicit the programme theory (or theories)--the underlying assumptions about how an intervention is meant to work and what impacts it is expected to have. We then look for empirical evidence to populate this theoretical framework, supporting, contradicting or modifying the programme theories as it goes. The results of the review combine theoretical understanding and empirical evidence, and focus on explaining the relationship between the context in which the intervention is applied, the mechanisms by which it works and the outcomes which are produced. The aim is to enable decision-makers to reach a deeper understanding of the intervention and how it can be made to work most effectively. Realist review does not provide simple answers to complex questions. It will not tell policy-makers or managers whether something works or not, but will provide the policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level.

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Is Open Access

Standards for Reporting Implementation Studies (StaRI) Statement

Hilary Pinnock, Melanie Barwick, Christopher Carpenter … (2017)

Implementation studies are often poorly reported and indexed, reducing their potential to inform initiatives to improve healthcare services. The Standards for Reporting Implementation Studies (StaRI) initiative aimed to develop guidelines for transparent and accurate reporting of implementation studies. Informed by the findings of a systematic review and a consensus-building e-Delphi exercise, an international working group of implementation science experts discussed and agreed the StaRI Checklist comprising 27 items. It prompts researchers to describe both the implementation strategy (techniques used to promote implementation of an underused evidence-based intervention) and the effectiveness of the intervention that was being implemented. An accompanying Explanation and Elaboration document (published in BMJ Open, doi:10.1136/bmjopen-2016-013318) details each of the items, explains the rationale, and provides examples of good reporting practice. Adoption of StaRI will improve the reporting of implementation studies, potentially facilitating translation of research into practice and improving the health of individuals and populations.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2023

Publication date (Electronic): 9 October 2023

Volume: 13

Issue: 10

Electronic Location Identifier: e075093

Affiliations

[1 ] departmentSchool of Education and Lifelong Learning , Ringgold_6106University of East Anglia , Norwich, UK

[2 ] Ringgold_8953Norfolk and Suffolk NHS Foundation Trust , Norwich, UK

[3 ] departmentNuffield Department of Primary Care Health Sciences , University of Oxford , Oxford, UK

[4 ] departmentDivision of Psychology and Language Sciences , Ringgold_4919University College London , London, UK

[5 ] departmentSchool of Social Work , University of East Anglia , Norwich, UK

[6 ] National House Project , Crewe, UK

[7 ] Ringgold_4851The Fostering Network , London, UK

Author notes

[Correspondence to ] Dr Simon P Hammond; s.hammond@ 123456uea.ac.uk

Author information

Simon P Hammond http://orcid.org/0000-0002-0473-3610

Claire Duddy http://orcid.org/0000-0002-7083-6589

Article

Publisher ID: bmjopen-2023-075093

DOI: 10.1136/bmjopen-2023-075093

PMC ID: 10565277

PubMed ID: 37813542

SO-VID: a9a33cab-32ed-45b4-9bad-522d1a62b169

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 26 April 2023

Date accepted : 21 August 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100009128, Research for Patient Benefit Programme;

Award ID: NIHR 201963

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ScienceOpen disciplines: Medicine

Keywords: adolescent,mental health,systematic review

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ScienceOpen disciplines: Medicine

Keywords: adolescent, mental health, systematic review

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Improving the mental health and mental health support available to adolescents in out-of-home care via Adolescent-Focused Low-Intensity Life Story Work: a realist review

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Abstract

Objectives

Design

Data sources

Eligibility criteria

Analysis

Results

Conclusions

PROSPERO registration number

Related collections

Emerald: Healthier Lives

Most cited references 106

Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

Realist review--a new method of systematic review designed for complex policy interventions.

Standards for Reporting Implementation Studies (StaRI) Statement

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Journal

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Author notes

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Cited by 1

Most referenced authors 486