Supporting the mental health and wellbeing of mothers at risk of recurrent care proceedings: a realist synthesis

Research question: What works to support the mental health and wellbeing of mothers at risk of recurrent care proceedings, and to prevent care entry of their children?

Background: Around one in four mothers who are subject to care proceedings will return for a subsequent set of proceedings. These mothers have often experienced multiple disadvantages, which are compounded by the trauma of child removal. There is an urgent need to understand how to interrupt these cycles of disadvantage, trauma and child removal.

Aims and objectives: The aim of this realist synthesis is to derive explanatory evidence that describes what works to support the mental health and wellbeing of mothers at risk of recurrent care proceedings, and to prevent care entry of their children. Our objectives are to:

1. Establish initial assumptions about how interventions are most likely to work for supporting the mental health and wellbeing of mothers at risk of recurrent care proceedings and to prevent the care entry of their children.

2. Establish patterns of outcomes, in terms of mothers’ mental health, wellbeing and subsequent care proceedings or otherwise.

3. Establish the underpinning mechanisms of action that are most likely to explain those patterns of outcomes, taking into account contextual variations.

4. Through the previous three objectives, iteratively develop, confirm or inform the initial assumptions, into working theories that take account of contexts, mechanisms and outcomes of interventions. 5. Empirically test these theories through further literature searches.

6. Building on the working theories, carry out collaborative systems mapping of the care pathway for mothers at risk of recurrent care proceedings to identify where levers in the wider system might be optimised to support interventions. 7. Describe what ‘good’ intervention looks like, what may be adapted for local contexts and how.

8. Using our extensive practice and policy links, ensure that those findings inform current and future design, development and commissioning of interventions for birth mothers to be implemented within the health and social care system.

Methods: Owing to the complexity of this issue, we will undertake a realist synthesis of the academic and grey literature with stakeholder engagement throughout. The synthesis will be conducted in four iterative stages over an 18-month period. These are to: i) define the scope and generate initial programme theories; ii) retrieve and review the evidence; iii) test and refine programme theories, and iv) develop a narrative.

We will produce a programme theory for interventions to support the mental health and wellbeing of mothers at risk of recurrent care proceedings. We will apply a systems lens, working with stakeholders to co-produce actionable policy and practice recommendations including system modifications, promoting contextual relevance and practice implementation which are transferrable to local systems and areas.

Anticipated impact and dissemination: This work will co-produce a system-level theory of change as a conceptual framework for interventions to support the mental health and wellbeing of mothers at risk of recurrent care proceedings, and where, how and why these interventions work (or not). An additional anticipated impact is to inform the development of new interventions and prioritise interventions to be evaluated in future research.