My View

A therapeutic intervention for unaccompanied asylum-seeking children

My View

Highlights

This report reviews the effectiveness, implementation and costs of the My View programme, which is designed to stabilise the psychological and emotional wellbeing of unaccompanied asylum-seeking children.

The report has numerous findings including:

  • My View decreased psychological destress and increased wellbeing in children who received the programme
  • Even a small amount of sessions (up to 3) could have a positive impact but the optimal amount was around 7 to 9 sessions
  • A large amount of young people disengaged early from the intervention. This was mainly because they were feeling better. However, some dropped out due to other factors such as struggling to balance therapy and their asylum claim or finding housing.

The recommendation is that The Refugee Council continues to deliver My View, due to the positive evidence shown in this evaluation.

Report

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Research protocol

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Summary

This report presents findings from a randomised controlled trial of My View, a specialist therapeutic intervention for unaccompanied asylum-seeking children (UASC), delivered by the Refugee Council and evaluated by Ipsos and CEI.

Despite clear evidence of need in relation to mental health support for unaccompanied asylum-seeking children, there is a notable gap in evidence on the effectiveness of therapeutic services and interventions for this group, resulting in services being delivered in the absence of a robust evidence base. This evaluation aimed to help fill this gap by assessing the effectiveness, implementation, and costs of My View, a programme designed to stabilise the psychological and emotional wellbeing of unaccompanied asylum-seeking children.

Aims

The evaluation sought to assess the effectiveness, implementation, and costs of My View.

  • The RCT aimed to assess the impact of My View on the psychological distress and mental wellbeing of unaccompanied asylum-seeking children, in comparison to children who did not receive My View
  • The IPE aimed to capture the views and experiences of the delivery staff, young people, and wider stakeholders, seeking to provide further insight into the programme, its implementation during the evaluation, and contextual knowledge for future evaluations
  • The cost analysis aimed to explore the costs associated with delivering My View, including estimated costs per child.

Method

The evaluation consisted of three elements:

  • A randomised controlled trial (RCT) in which unaccompanied children were individually randomised to an intervention group or waitlist control group
  • An implementation and process evaluation (IPE), consisting of in depth interviews with therapists, stakeholders and young people
  • A cost analysis

The evaluation collected data from June 2021 to July 2023. In total, the evaluation included randomising 510 young people, analysing endline outcome data for 289 young people, and conducting 66 interviews with young people, staff, and stakeholders.

Key Findings

Impact evaluation findings:

  • Most young people had not accessed support elsewhere – due to lack of options and/or waiting lists – which demonstrated the need and demand
  • My View significantly reduced psychological distress, as measured by the YP-CORE, among young people
  • The evaluation also found that young people who received My View had significantly better wellbeing, as measured by the SWEMWBS, compared to young people who had not received My View.

Implementation and process evaluation (IPE) findings:

  • The impact findings were supported by evidence in interviews. Young people and stakeholders described how My View helped improve their mood, hopes for the future, sleep and eating habits, and ability to manage their emotions, among others.
  • Surprisingly, even a small number of sessions (one to three) appeared to make a positive difference, though the optimal number of sessions appeared to be between seven and nine sessions.
  • Most young people attended therapy remotely or through a mix of remote and face-to-face sessions. This suggests that remote delivery is not only feasible but effective in improving outcomes for young people.
  • The addition of a case worker helped support young people with practical issues alongside therapy. It also helped improve therapists’ capacity.
  • Regular supervision, check-ins, safeguarding meetings and peer supervision were key to supporting My View therapists and staff in their roles. This supports staff in their practice while also providing them with autonomy to tailor their expertise and skills with young people.
  • Large numbers of young people disengaged or dropped out of the intervention early. In most cases, this was because they were feeling better; however, others were for less positive reasons – for example struggling to focus on therapy while simultaneously dealing with their asylum claim and housing and education needs.

Cost analysis findings

  • The average cost per session is around £309 (this includes any set up fees even for those that do not attend any sessions so the additional cost of a session will be lower)
  • The average cost per child was £1,737. It should be noted that the cost of delivery and the number of young people/sessions served vary depending on the location.

Implications for Policy

  • The Refugee Council should continue to deliver My View – this evaluation provides confidence that it results in improved outcomes for children and young people
  • A stable funding stream for the provision of specialist mental health support for unaccompanied children and young people is needed
  • The Refugee Council should continue providing My View therapists and staff with regular supervision, check-ins, safeguarding meetings, and peer supervision
  • Organisations delivering these services should pay careful attention to stable leadership and staffing
  • Refugee Council and other similar services should consider more specific training, such as working with interpreters, delivering short-term therapy, and dealing with trauma, as well as more in-house sharing of expertise.
  • Similar interventions should consider the addition of a case worker to support young people with practical issues alongside therapy and improve therapists’ capacity
  • Other services should consider both face-to-face and virtual options for delivery to offer flexibility for young people – the evidence suggests that remote delivery is not only feasible but effective in improving outcomes for young people
  • The Refugee council and other similar services should consider maintaining and expanding their remote service offer, to ensure that young people can access therapeutic support that is appropriate to their needs, regardless of where they live in the UK
  • To mitigate against early disengagement, referring organisations should ensure young people are interested, rather than making referrals without their knowledge
  • Stakeholders that make referrals should take the time to explain and answer questions about My View, and therapists should also cover this again during the initial assessment and as needed to help young people have a better idea of what to expect
  • The evaluation found improvements in outcomes despite the number of sessions attended – even a small number of sessions can have benefits.

Implications for future research

The following recommendations are for researchers conducting further research and evaluation on mental health interventions for unaccompanied children:

  • The findings of this trial should be replicated
  • Collecting baseline data prior to randomisation would strengthen future evaluations and should be implemented where feasible
  • In order to overcome concerns around the independence of data collection, future evaluations should prioritise more objective options for administering outcome measures
  • Where possible, future researchers should carefully pilot measures, conduct extensive data collection training, and continue to emphasise the protocols on implementation and ethics
  • Evaluations of similar interventions should consider piloting an RCT on a smaller scale to test processes and assumptions
  • To further explore implementation effectiveness, a ‘Hybrid 2’ trial would be a valuable addition as it simultaneously determines the effectiveness of an intervention and tests hypotheses regarding one or more implementation strategies. This could enable the opportunity to explore differences in outcomes for young people based on elements of implementation
  • Time to build and maintain strong working relationships – including incorporating activities to improve understanding of the evaluation approach, scope, and requirements – should be built into timelines for future evaluations.
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Cost ratings:

Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.

Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.

Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.

Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.

Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.

Set up and delivery cost is not applicable, not available, or has not been calculated.

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Child Outcomes:

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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing obesity and promoting healthy physical development: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Evidence ratings:

Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.

Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.

Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.

Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.

Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.

Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.

Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.

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