Protocol for a mixed methods study to examine social workers' implementation of national guidelines with children in care who self-harm

Background The National Institute for Health and Care Excellence (NICE) guidelines on self-harm (NG225) provide evidence-based recommendations for the assessment, management, and prevention of recurrence of self-harm across all services and settings, including children’s social care. A rapid review of the literature revealed an absence of research on social workers’ implementation of the guidelines and their application to children. This study aims to address this gap in the literature. Children in care (looked after children), defined as those who have been in the care of a local authority for more than 24 hours, including foster and kinship care and residential children’s homes, are at increased risk of self-harm. Although social work professionals are expected to take the NICE guidelines on self-harm fully into account, alongside the individual needs, preferences, and values of the child, it is not known if children’s social workers are aware of and implement the NICE guidelines on self-harm with children in care. This study aims to examine awareness and implementation of NG225 among social workers who have supported children in care who have self-harmed and to identify the barriers and facilitators influencing their use. Methods A mixed-methods approach will be used, consisting of two research phases. Phase 1 involves a large-scale (mainly quantitative) online survey of children’s social workers in England who have recently supported at least one child in care who has self-harmed to assess awareness, self-reported implementation, and associated capability, opportunity, and motivation (COM-B). Phase 2 comprises semi-structured interviews with a purposively selected subsample from phase 1 to explore, in greater depth, the barriers and facilitators to implementation using the Theoretical Domains Framework (TDF). Findings from both phases will be synthesised to inform an integrated interpretation. Quantitative data will undergo both descriptive and inferential analysis, while qualitative data will be examined using a framework analysis approach. Discussion The study will generate novel evidence on the extent to which NG225 are implemented by social work professionals with children in care. The findings will enable systematic mapping of identified barriers and facilitators to intervention functions using the Behaviour Change Wheel. This will inform the development of theoretically grounded behaviour change interventions aimed at improving NG225 implementation with children in care.