A controlled trial of implementing a complex mental health intervention for carers of vulnerable young people living in out-of-home care: the ripple project

Abstract

BackgroundOut-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required.This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC.MethodsThe study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts:1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention.ResultsEarly findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers.ConclusionsImplementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615000501549. Retrospectively registered 19 May 2015.

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“…Family factors (eg, parent-child conflict and coercive parenting) are consistently associated with youth delinquency [7][8][9][10]. As family-based interventions effectively improve outcomes among justice-involved adolescents [11][12][13], involving family members, particularly primary caregivers, in therapeutic interventions may be an effective way to support positive youth outcomes [14].…”

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“…Other resource use not captured by these national databases, including the use of broader health and welfare services and effects on productivity (i.e. education and workforce participation), will be assessed via self-report using an adapted questionnaire developed by members of the research team and used in numerous other Australian mental-health intervention trials [ 70 – 72 ].…”

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“…This study comprised one component of formative evaluation for the Ripple study of implementing a complex mental health intervention for carers of young people in OoHC in Victoria, Australia (Herrman et al, 2016). It complements interview studies conducted with foster carers and kinship carers (Fergeus et al, 2019) and with young people in OoHC (Monson et al, 2019).…”