Adult-caregiver Supported Positive psychology intervention to Increase Resilience (ASPIRE): Developing and refining a caregiver-delivered positive psychology intervention to increase the resilience of children who have experienced multiple adversities

Background: Adverse Childhood Experiences (ACEs) are traumatic or stressful events that occur before age 18 that have been linked to increased risk of a wide range of negative health outcomes across the life course.

Both retrospective and prospective studies confirm a strong and consistent dose-response relationship between the number of ACEs a person is exposed to and their odds of developing a mental health disorder. The key moderator of the relationship between ACEs and later psychopathology is resilience.

Resilience is not a static trait and, therefore, intervening to increase the resilience of children exposed to multiple ACEs has the potential to decrease the rate of mental ill health.

Aim: To develop and refine a caregiver-delivered positive psychology intervention to enhance the resilience to mental health difficulties of children who have experienced multiple ACEs. Positive psychology interventions focus on enhancing the factors that allow individuals and communities to thrive.

Though still a relatively new field, there is growing evidence that positive psychology interventions are effective in increasing resilience.

A consistent positive relationship with at least one adult caregiver has been shown to be among the strongest protective factors against the adverse effects of ACEs.

Therefore, to maximise potential benefits by strengthening existing attachments, we will develop an intervention that supports caregivers to implement positive psychology principles in their child s daily life, rather than a health professional working with the child directly.

Research design: A prototype intervention will be developed by a Stakeholder Research Team comprising children, caregivers, health and social care professionals and researchers.

The design of the prototype will be informed by component analysis of existing evidence-based positive psychology interventions for children, and semi-structured interviews and focus groups with a range of stakeholders.

In the next stage of the research, we will evaluate the acceptability, feasibility and safety of the prototype intervention via a waitlist-controlled pilot study involving 12 families.

All participating families will receive the intervention, either immediately or after a delay equivalent to the length of the intervention.

Quantitative and qualitative data will be gathered to assess feasibility and fidelity of intervention delivery, potential benefits and adverse effects, and acceptability from the perspective of children, caregivers and professionals.

Outputs and dissemination: The Stakeholder Research Team will use the findings to refine the intervention and inform the design of future research.

If the pre-specified progression criteria are met, we plan to progress directly to a multi-site feasibility randomised controlled trial.

If these criteria are not met, the Stakeholder Research Team will consider whether modifications can be made to the intervention to improve the feasibility, safety or acceptability of the intervention.

If so, the intervention will be refined accordingly before progressing to a multi-site feasibility randomised controlled trial.

The findings of the current study will be disseminated to relevant audiences, including children, caregivers, social care providers and commissioners, and researchers, through peer-reviewed publications, a short video, and informally through the team s established networks.