Evaluating the effectiveness of Mentalization-Based Treatment (MBT) as an intervention for children in foster care with emotional or behavioural problems: a phase II (feasibility) randomised controlled trial

A significant proportion of children in the social care system in England present with mental health problems, with the vast proportion experiencing some form of emotional and behavioural difficulties. The most effective treatments for such children are currently unknown. Mentalization-Based Treatment (MBT) is a relatively new intervention developed for use with adults with Borderline Personality Disorders, many of whom have suffered abuse and attachment trauma in childhood. Adaptations of MBT for use with children and young people, including those in foster care, include many of the features identified as necessary for effective therapy for children in care. This protocol outlines a two-arm, randomised control feasibility trial to explore the acceptability and credibility of MBT-Fostering as a treatment for reducing emotional and behavioural difficulties in looked after children, and to test the possibility of addressing a number of methodological challenges to conducting high-quality research with this population. The study will take place in one site over 24 weeks with 42 participants, and will aim to ascertain whether it is worthwhile and feasible to progress to testing the intervention in a full scale definitive Random Controlled Trial (RCT).

Background: About 60,000 children are in foster care in England, over fifty percent due to abuse and neglect. Forty-five percent of looked after children have mental health problems, but there is evidence to suggest that these children (and their carers) do not always get the support they need.
Aims: We plan to test a new approach to supporting foster children with mental health problems, and their carers. Our new approach has been developed to promote good communication between professionals, carers and children in care. It aims to support caring relationships, and to improve emotional well-being.
Design: Our longer-term aim is to do a large study which would find out whether this new way of working improves the well-being of children in care. To prepare for this large study, we will firstly run a smaller study, based in Hertfordshire's Targeted Looked After Children team. This should give us the information we need to design the full scale study. 42 children, referred to the Looked After Children service in Hertfordshire, will take part in this study - half of them will be offered our new way of working, and half will be offered normal care.
Outcomes: The purpose of this study is to find out whether it is possible to conduct a large-scale study, and to identify any obstacles to doing so. We will share our findings with the families taking part in the study, and with managers who run NHS services, with the ultimate aim of improving the quality of life of children in care.