Nurturing environments for shaping trauma-responsive care and recovery: a realist coproduction study protocol.
8 affiliations
- 1Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
- 2Pennine Care NHS Foundation Trust, Manchester, United Kingdom.
- 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
- 4Faculty of Health & Education, Manchester Metropolitan University, Manchester, United Kingdom.
- 5Stockport Metropolitan Borough Council, Greater Manchester, United Kingdom.
- 6The Care Leavers' Association, Manchester, United Kingdom.
- 7Manchester Metropolitan University, Manchester, United Kingdom.
- 8University of Cumbria, Ambleside Campus, Cumbria, United Kingdom.
Abstract
Background/rationale
Children and young people in residential care often face multiple, complex traumas, including the distress of being removed from familiar environments. Trauma-responsive care (TRC) offers a framework for understanding and responding to these experiences, yet there is no standardised TRC intervention specifically designed for children's homes in the UK. This lack of tailored guidance contributes to inconsistent care quality and limited support for staff and service providers.Objectives/aims
The NEST Study aims to co-produce, pilot, and evaluate a trauma-responsive care intervention for children's homes through co-production and realist methods. NEST seeks to understand how, when, and why TRC interventions work for cared-for children and to develop an implementation toolkit that supports sector-wide improvement.Study design overview
This multi-phase realist co-production study comprises three workstreams: 1. A Rapid Realist Review to develop an initial programme theory of TRC in residential settings. 2. Experience-Based Co-Design (EBCD) with children, staff, and stakeholders to co-create the intervention, in alignment with the programme theory. 3. A Realist Evaluation of the intervention across six children's homes in Northern England, followed by refinement of the implementation toolkit.Methods
Up to 150 children and young people, 60 staff, and 30 stakeholders will participate. Mixed methods will include qualitative interviews, creative participatory techniques, and validated and adapted quantitative measures (e.g., SDQ, RCADS, ProQOL). Quantitative data will be analysed using descriptive statistics and regression modelling. All data will be analysed using realist logic to identify, refine and test context-mechanism-outcome configurations. The intervention will be piloted over 12 months. The interpretation of emerging findings will be supported by a Lived Experience Advisory Group and Stakeholder Advisory Board.Key outcomes and analyses
Anticipated outcomes include a refined realist programme theory of TRC in homes for cared for children and an implementation toolkit for care providers to use. Wellbeing and quality of life measures will provide insights into the impact of the pilot for the children, young people and staff who experience the trauma-responsive care pilot throughout the evaluation process.Clinical trial registration
identifier ISRCTN17921858.
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BibTeX
@article{parry2026nurturing,
title = {{Nurturing environments for shaping trauma-responsive care and recovery: a realist coproduction study protocol.}},
author = {Sarah Parry and Geoff Wong and Steven Ariss and Sadie Rodell and Elaine Craig and Emma Ford and David Graham and Zarah Eve and Joy Duxbury},
journal = {Frontiers in child and adolescent psychiatry},
year = {2026},
month = oct,
doi = {10.3389/frcha.2026.1816036},
url = {https://europepmc.org/article/MED/42923167},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nurturing environments for shaping trauma-responsive care and recovery: a realist coproduction study protocol.
AU - Sarah Parry
AU - Geoff Wong
AU - Steven Ariss
AU - Sadie Rodell
AU - Elaine Craig
AU - Emma Ford
AU - David Graham
AU - Zarah Eve
AU - Joy Duxbury
PY - 2026
DA - 2026/10/08
JO - Frontiers in child and adolescent psychiatry
DO - 10.3389/frcha.2026.1816036
UR - https://europepmc.org/article/MED/42923167
AB - Background/rationale Children and young people in residential care often face multiple, complex traumas, including the distress of being removed from familiar environments. Trauma-responsive care (TRC) offers a framework for understanding and responding to these experiences, yet there is no standardised TRC intervention specifically designed for children's homes in the UK. This lack of tailored guidance contributes to inconsistent care quality and limited support for staff and service providers.Objectives/aims The NEST Study aims to co-produce, pilot, and evaluate a trauma-responsive care intervention for children's homes through co-production and realist methods. NEST seeks to understand how, when, and why TRC interventions work for cared-for children and to develop an implementation toolkit that supports sector-wide improvement.Study design overview This multi-phase realist co-production study comprises three workstreams: 1. A Rapid Realist Review to develop an initial programme theory of TRC in residential settings. 2. Experience-Based Co-Design (EBCD) with children, staff, and stakeholders to co-create the intervention, in alignment with the programme theory. 3. A Realist Evaluation of the intervention across six children's homes in Northern England, followed by refinement of the implementation toolkit.Methods Up to 150 children and young people, 60 staff, and 30 stakeholders will participate. Mixed methods will include qualitative interviews, creative participatory techniques, and validated and adapted quantitative measures (e.g., SDQ, RCADS, ProQOL). Quantitative data will be analysed using descriptive statistics and regression modelling. All data will be analysed using realist logic to identify, refine and test context-mechanism-outcome configurations. The intervention will be piloted over 12 months. The interpretation of emerging findings will be supported by a Lived Experience Advisory Group and Stakeholder Advisory Board.Key outcomes and analyses Anticipated outcomes include a refined realist programme theory of TRC in homes for cared for children and an implementation toolkit for care providers to use. Wellbeing and quality of life measures will provide insights into the impact of the pilot for the children, young people and staff who experience the trauma-responsive care pilot throughout the evaluation process.Clinical trial registration identifier ISRCTN17921858.
SN - 2813-4540
ER -