Supporting a child with maltreatment associated psychiatric problems (MAPP): Exploration of parent and professional experiences using multi-perspectival Interpretative Phenomenological Analysis

BACKGROUND: Maltreatment associated psychiatric problems (MAPP) in children and adolescents can be highly variable and commonly include both trauma related difficulties and neurodivergence. Treatment guidelines for this population require further development. The Relationships in Good Hands Trial (RIGHT) is a multi-site randomised controlled trial comparing Dyadic Developmental Psychotherapy (DDP) with services as usual (SAU) for children with MAPP in permanent foster or adoptive care. This qualitative study is a part of the RIGHT process evaluation. OBJECTIVE: To understand the experience of supporting a child with MAPP, considering both parent and professional perspectives. PARTICIPANTS AND SETTING: Parents and professionals (social workers, therapist and teachers) supporting children with MAPP within the RIGHT trial. METHODS: Six case-studies were identified representing both trial arms at different trial sites. Qualitative interviews with parents and professionals supporting each child were conducted and interpreted using multi-perspectival Interpretative Phenomenological Analysis (IPA). RESULTS: Six themes were interpreted from the data: the nature and far-reaching impact of MAPP; experiences navigating and building parent - professional relationships; trying to flexibly meet the child's needs despite an inflexible system; frustration and disappointment in statutory services; constantly facing difficult decisions; and apprehension with hope for the child. CONCLUSIONS: There is significant interaction between the child, parent and the wider context including statutory services. This is explored within a syndemics framework, whereby the effects of maltreatment and neurodivergence co-occurring within their context increases overall difficulties beyond that of comorbidity. Supporting the child therefore requires supporting the whole system around the child.