Abstract

Executive Summary
The project
The Systemic Integrative Treatment (SIT) programme aims to use therapeutic support for parents and carers to reduce children’s violence, crime, and anti-social behaviour. Developed and delivered by the Brandon Centre for Counselling and Psychotherapy (BC), SIT provides a 12-month intervention to the families and carers of 10-14-year-olds who are absent from school, displaying violent behaviour, misusing substances, or offending andhave typically been referred by NHS Child and Adolescent Mental Health Services (CAMHS). SIT has two phases.During phase one, a therapist works intensively with parents and carers, meeting them several times a weekand aiming to equip families with the tools and confidence to deal with the child’s behaviour. Therapists draw on a range of therapeutic models (including cognitive behavioural therapy and family therapy) to deliver anindividualised intervention for each family that varies in the type and intensity of support. Treatment may takeplace in the family home or in other environments where behavioural difficulties may occur. SIT sometimesincludes direct treatment for the child, but most of the intervention is delivered by the therapist to the parentand carer. Phase two is during the second six months of the programme and is when therapist support tapersoff and parents attempt to independently implement their learning.
YEF funded a feasibility and pilot evaluation of SIT. The feasibility study aimed to ascertain what factors supported or hindered delivery; examined recruitment, retention, and reach; and explored families’ and professionals’ perceptions of the intervention. The evaluation used interviews with six families and two referrers and a focus group with project staff, and analysed monitoring data collected by BC practitioners. Twenty-four families participated in SIT during the feasibility study, which ran from February 2020–July 2021. The pilot study then aimed to assess the potential improvements associated with SIT (as measured by outcomes including the Child Behaviour Check List, the Strengths and Difficulties Questionnaire and the SCORE 15 Index of Family Functioning and Change). It also aimed to describe the referral and screening process more fully, ascertain how many families completed the intervention, explore the potential for delivering SIT at a larger scale, and examine the implementation of the programme. It used interviews and focus groups with families and professionals in addition to analysing project monitoring data. The pilot ran from December 2021–April 2022. Forty-nine families were supported by SIT and were considered within the pilot study. Both the feasibility and pilot studies were undertaken during the coronavirus pandemic, requiring both the delivery and evaluation teams to adapt to challenging circumstances.
Key conclusions
The feasibility study identified the flexibility of support and building trust with families as key enablers of the SIT programme. Referrals were considered appropriate, and referrers from NHS CAMHS were positive about the process. Twenty-four families were initially enrolled in the programme. After three months, 17 parents and carers of 14 children were continuing the intervention.
The six parents and carers interviewed in the feasibility study had positive perceptions of SIT. All would recommend it to other families. They commended the flexible and intensive nature of support and had more positive perceptions of BC compared to alternative services they had previously experienced.
Limitations in data collection prevented the evaluators from confidently commenting on the potential impact of SIT on children’s behavioural outcomes and family functioning. In the pilot phase, no more than 49% of parents provided data at any time point, while only very few children (6/49) completed any of the required measures. The evaluator is cautiously optimistic that the intervention was delivered as intended in the pilot study, despite modifications made due to the COVID-19 pandemic.
In the pilot study, as in the feasibility evaluation, all referrals were accepted, and 49 families were enrolled over the entire course of the feasibility and pilot studies. After six months, 73% of families were continuing with the intervention. This fell to 69% after nine months and 53% by 12 months. Although there were only a small number of families where the child was identified as Black, all five of these families had withdrawn from the intervention by nine months.
Several significant challenges would need to be resolved before proceeding to a randomised controlled trial, most notably, issues with outcome measure data collection.
Interpretation
The feasibility study identified the flexibility of support and building trust with families as key enablers of the SIT programme. Referrals were considered appropriate, and the two referrers interviewed (both NHS Child and Adolescent Mental Health Services [CAMHS] psychiatrists) were positive about the referral process; they noted positive changes in the families and reflected that the flexibility of the SIT programme was beneficial. All referrals made resulted in acceptance to the intervention.
The six parents and carers interviewed in the feasibility study noted that their children presented significant and multiple problems that had led to their referral. They perceived that the support provided by BC was key to ensuring that children made improvements, and their positive views of BC contrasted with their views of other services and agencies. The flexibility of the SIT programmes was particularly praised, including how flexible the BC therapists were about the location and timing of support. They also valued the intensity of support provided by BC therapists (with home visits or online contact two to three times per week and 24/7 on-call support where required). The small number of parents and carers interviewed would recommend the programme to other families. Flexibility was also championed by BC staff, who appreciated being able to work their appointments and support around the specific needs of families.
Limitations in data collection during the pilot phase prevented the evaluators from confidently commenting on the potential impact of SIT on children’s behavioural outcomes and family functioning. Despite a promising start to data collection during the feasibility phase, by the close of the pilot phase, no more than 49% of parents had provided data at any time point, while only very few children (6/49) completed any of the required measures. The evaluator is cautiously optimistic that the intervention was delivered as intended in the pilot study (with some modifications made due to the COVID-19 pandemic). Up to 12 months of intervention were offered in two six-month phases as intended. One of the greatest impacts of the pandemic was the need to adapt some face-to-face interactions into online communication.
Forty-nine families were enrolled over the course of the feasibility and pilot study, and all referrals were accepted during both phases. After six months, 73% of families were continuing with the intervention. This fell to 69% after nine months and 53% by 12 months. By nine months, of those families that had dropped out (without formally completing the intervention), there was little difference in the ages of the children, their gender, or the referral source. However, all five of the families where children were identified as Black had withdrawn from the intervention.
The parents interviewed in the pilot study were positive about the SIT, indicating that the delivery of the programme was helped by the building of a therapeutic alliance and that they did not feel judged by the BC therapists. Two of them suggested that the changeover of therapists between the two phases (as a new practitioner is assigned to families at this point) may have impacted retention. Practitioners suggested that adapting or reducing the data collection requirements of the evaluation may support better retention in future.
Several significant challenges would need to be resolved before proceeding to a randomised controlled trial, most notably issues with core outcome measure data collection. For these reasons, YEF is not currently planning on funding further evaluation of the programme.
Original languageEnglish
PublisherYouth Endowment Fund
Commissioning bodyYouth Endowment Fund
Number of pages110
Publication statusPublished - 28 Jul 2023

Keywords

  • youth justice, delinquency, young offenders, young offender interventions.
  • parent support

Fingerprint

Dive into the research topics of 'Evaluation Report Brandon Centre for Counselling and Psychotherapy for Young People: Systemic Integrative Treatment: Feasibility and pilot study report'. Together they form a unique fingerprint.

Cite this