The Herts and Minds study: feasibility of a randomised controlled trial of Mentalization-Based Treatment versus usual care to support the wellbeing of children in foster care

Abstract

Background There is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined the feasibility and acceptability of an RCT of MBT, delivered in a family-format, for children who are in foster care in the UK. Method Herts and Minds was a phase II, blinded feasibility RCT with follow-up of at 12 and 24 weeks post-randomisation. Participants were children (age 5–16) in foster care referred to a targeted mental health service, who had some level of difficulty as identified by the Strengths and Difficulties Questionnaire (SDQ). Aims were to assess: the feasibility of recruitment processes and study uptake; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; establish acceptability and credibility of MBT as an intervention for children in foster care; establish feasibility and acceptability to participants of conducting an RCT; and estimate the likely treatment efficacy effect size. Participants were randomly allocated to either MBT ( n = 15) or Usual Clinical Care (UCC) ( n = 21) individually or in sibling groups. A range of qualitative and quantitative data was gathered to assess feasibility. Results Feasibility was established with regard to: capacity to recruit participants to a study; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; acceptability and credibility of MBT; and feasibility and acceptability to participants of conducting an RCT. A number of issues made it difficult to estimate a likely treatment efficacy effect size. Conclusion With modifications, it is feasible to run an RCT of MBT for children in foster care. Both the therapy and research design were acceptable to participants, but modifications may be needed regarding both the timing of assessments and the identification of appropriate primary outcome measures. Given the lack of evidenced based therapies for this population, such a trial would be a significant contribution to the field. Findings may be useful for other groups planning clinical trials of psychological therapies for children in foster care. Trial registration ISRCTN 90349442 . The trial was retrospectively registered on 6 May 2016. Electronic supplementary material The online version of this article (10.1186/s12888-019-2196-2) contains supplementary material, which is available to authorized users.

Mentalization-based treatments with children and families: A systematic review of the literature

“…Two of four subscales on a measure of children's reaction to parental conflict evidenced large intervention effects (d = 1.35-1.63). Midgley et al (2019a) reported no significant improvement on foster-carerreported measures of child emotional and behavioural difficulties compared to those in the TAU. In contrast, child reported measures indicated significant improvements at 12 and 24 weeks, respectively, with medium effect sizes noted.…”

“…Bammens et al (2015) and Adkins et al (2018) assessed parental RF using the five minute speech sample (FMSS; Magaña-Amato, 1983) coded for RF using the RF scale (Fonagy et al, 1998) in their respective analysis of the Family Minds programme for foster and adoptive parents. Midgley et al (2019a) used the FMSS for foster parents but it was not reported as an outcome measure in the study. Finally, Midgley et al (2019b) used the PRFQ and an 8-item RFQ.…”

Toward a paradigm shift in treatment and research of mental disorders

“…Mothers with a borderline personality disorder, for example, may be supported by enhancing their capacities for mentalization and empathy. This applies to foster families as well (Midgley et al ., 2019).…”

The Reflective Fostering Programme – improving the wellbeing of children in care through a group intervention for foster carers: a randomised controlled trial: study protocol for a randomised controlled trial.

“…Economic measures include a version of the Child and Adolescent Service Use Schedule (CA-SUS) designed and tested for use with Children in Care in an earlier feasibility study [39,40] and the Child Health Utility 9 Dimensions (CHU9D) measure of health-related quality of life [41], proxy reported by foster carers.…”