Watch Me Play! A pilot feasibility study of a remotely- delivered intervention to promote mental health resilience for children (aged 0-8) across UK early years and children's services.
Year: 2024
Type: book
Abstract: The feasibility of recruiting families, recruitment rates, adherence to the intervention, and retention rates (the number of families remaining on the study at three months).• The feasibility of recruiting and training suitable intervention providers and facilitators to deliver the WMP intervention.• Implementation of WMP (online and face-to-face).• The acceptability of study processes to delivery organisations, delivery staff, and parents/carers.• The acceptability, barriers, and facilitators of the WMP intervention to delivery organisations, delivery staff, parents/carers to inform a future trial.• Intervention receipt and hypothesised mechanisms of action in order to refine the intervention logic model.• Intervention costs and the feasibility of conducting a full economic evaluation in a future definitive effectiveness trial.• Treatment as usual (TAU) as delivered by participating services, how WMP interacts with or is delivered in relation to TAU, and the most appropriate comparator for a definitive trial.• A primary outcome for a future definitive trial. Design and sampleThis was a non-randomised single group study, including a process evaluation, of WMP delivered remotely via an online video platform in the home of parents/carers with children aged 0 to 8 years referred to early years and children's services.We proposed to recruit up to 40 families from early years, children's health services, and some social care, education, or voluntary services.Measures on child and parent/carer outcomes were obtained from the participating parent/carer at baseline and follow-up (three-months (+2/-2 weeks) postrecruitment).Information on the child's status as in contact with a social worker (current and in the past), and reported developmental delay were collected at baseline only.Participants completed questionnaires via an online survey.Qualitative semi-structured interviews were conducted remotely in the context of the process evaluation which aimed to explore the experiences of parents/carers and practitioners who took part in the Watch Me Play! intervention. Findings Recruitment and participationThe recruitment process faced some challenges but ultimately managed to engage a number of families.A total of 37 families were contacted and invited to participate, with 21 families (57%) providing informed consent.Among those families, 20 completed the screening questionnaire, all of whom were eligible to participate in the study.Baseline assessments were completed by 17 families, with 12 families (60%) completing at least one follow-up assessment.Of the families who self-reported their attendance, eight out of nine (89%) had attended at least one WMP session.One key concern emerged around the appropriateness of the Vineland measure for certain age groups.Some parents/carers reported that the questions were not suitable for their young children, highlighting the need to revisit the assessment tools used in the study.Overall, this initial evaluation of the WMP programme provides valuable insights into recruitment challenges, participant engagement, programme fidelity, and implementation barriers and facilitators.The results suggest a positive reception from participants, with notable room for improvement in specific areas, particularly around recruitment timelines, assessment tools, and the flexibility of the programme's delivery model.The health economic analysis aimed to estimate the cost of the Watch Me Play! (WMP) intervention and assess the feasibility of a full economic evaluation in a future effectiveness trial. Cost of WMPThis involved calculating the costs from the provider's perspective, including training, supervision, and delivery.The total cost of training 16 practitioners was £7,986, with each practitioner costing £499.1.Supervision meetings varied, with the average attendance being five meetings at a total cost of £10,645, or £665 per practitioner.The total cost included facilitator's time delivering the sessions, preparing and undertaking administrative duties, and practitioners' time attending the sessions.The cost of delivering the intervention depended on the number of facilitated sessions and the mode of delivery, with a range of £209 to £418 per child, depending on attendance and session type. Cost of healthcare resource useHealthcare resource utilisation was measured using the CA-SUS questionnaire at baseline and follow-up.Response rates for the CA-SUS questionnaire were 50% at both baseline and follow-up.Average resource use cost was £346 at baseline and £859 at follow-up.This estimate included primary care, community care, and emergency care.Most resource use involved NHS services, with a few instances of private healthcare, and costs were reported in 2021/22 GBP. Parent/carer health-related quality of life (HRQL) and quality-adjusted life years (QALYs)The EQ-5D-5L questionnaire was used to assess HRQL at baseline and at three-month follow-up.The analysis calculated QALYs using an area under the curve approach.At baseline, the average HRQL was 0.85, increasing slightly to 0.89 at follow-up.The average QALYs were 0.23, indicating generally high quality of life among participants.The economic analysis highlighted the varying costs of the WMP intervention depending on delivery mode, supervision requirements, and participant attendance.It also showed that most healthcare resource use was within the NHS framework, with parents/carers generally reporting high HRQL and QALYs. Design considerations for future trialsWe set out to describe treatment as usual (TAU) for this population, in order to identify an appropriate comparator for a future trial.Practitioners who participated in semi-structured interviews described how they worked within multidisciplinary teams that interacted with numerous agencies and referral pathways.WMP was therefore being introduced into a complex system but could be offered to families either in addition to, or while waiting for TAU services.We also sought to identify a candidate primary outcome measure for a future definitive trial.Evidence from semi-structured interviews with parents/carers around the needs of this population suggest that the Strengths and Difficulties Questionnaire (SDQ) would be an appropriate primary outcome for a future trial, given it is a well-validated mental health screener widely used in clinical services and research that is brief and normed across a wide age range (2 to 17 years old). Conclusions and implicationsThe initial evaluation of Watch Me Play! in early years and family services shows that the programme was well received by both service providers and families, indicating its value.Despite some challenges with site and participant recruitment, future evaluations can use the insights gained about barriers and facilitators to address these issues.The evaluation also provides guidance on adapting the Watch Me Play! training to reach parents/carers earlier and on modifying the research process to better align with the needs of parents/carers and supporting sites.The feasibility of a health economics evaluation is encouraging, with initial cost analysis showing promise.A proposed hybrid delivery modelwhere families primarily receive remote support (i.e. via an online video platform) with optional in-person sessions based on needwas positively received by parents/carers and service providers, with preliminary evidence suggesting increased acceptability among staff.However, there are still unresolved questions about the acceptability of randomisation and the feasibility of recruiting participants from a broader range of early years and family services.These issues should be further explored in a future feasibility randomised controlled trial.
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7072065381
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