Investigators Perspective on Patient Recruitment

Alkistis Saramandi

Alkistis Saramandi

Author

We had the pleasure of interviewing a research fellow from the Anna Freud Centre (AFC), Dr Saul Hillman, who used Neucruit (formerly known as CT-X) for participant recruitment. Dr Hillman is an honorary lecturer at UCL and a clinical tutor in the MSc in Psychoanalytic Developmental Psychology. He also works as a researcher within the Child Attachment and Psychological Therapies (ChAPTRe)  unit – a unit that bridges UCL and the AFC. He has carried out extensive research on adoption and foster care, attachment in early childhood and adolescence, bereavement, and trauma and through his involvement with UCL and the AFC for over 20 years he has taught and supervised numerous students in the program. Dr Hillman has also been involved in several research projects, including a longitudinal Attachment and Adoption research project in collaboration with the Anna Freud National Centre for Children and Families, Coram Family, and the Institute of Child Health and is actively engaged in the development of research tools. We recently helped Dr Hillman find some adult volunteers for a study exploring linguistic markers in social media and how they relate to mood. 

 

Here, we interviewed him to find out more about his experiences with participant recruitment during his career, his opinions on streamlining scientific recruitment, and conclude with some insight into his most impactful work, and hopes for the future.

Dr Hillman reflecting on his recruitment experiences

I do not have huge amounts of experience trying to collect clinical data and doing NHS ethics applications; it has not been an area I have had to be involved with, but I know that it is  becoming more and more challenging and time-consuming. So, we tend to stay away from those applications.’ In fact, this is a frustration shared by many researchers, and clinicians, who are wishing to take on meaningful projects with clinical populations, or to trial new treatment options, but the bureaucracy and difficulty in receiving approval often hinders opportunities.

Instead, Dr Hillman and his group have looked into the benefits of different study designs and sampling opportunities (e.g., collecting community data from adolescents or children). For other studies, such as the one promoted via Neucruit, he has had to resort to online recruitment platforms and hope sample size targets are met on time.


However, recruitment has not always been easy and successful – instead, recruitment is usually delayed, sample size targets might not be met on time, in turn hugely affecting research outcomes and implications. ‘At the AFC, through UCL, we have always had some sort of links; for example, if you are trying to recruit through schools or other organisations. But I think it is becoming more and more problematic to recruit; I think schools in particular are getting saturated with requests from people like me.

’ With an increased need to conduct impactful research unless efficient recruitment methods are put in place, researchers are unable to meet their targets and they often need to bend or change their study’s aims. ‘I have been told [that when trying to approach people] that my research is interesting, but they are already involved in a couple of studies and just cannot take any more on. And so much research benefits from collecting data from a big population of children and adolescents, and there is no better way in doing that than trying linking with the schools. I think it has become harder – there are more challenges to find the right person, more bureaucracy in schools,

They way forward for efficient recruitment and impactful research 

 

Imagine getting a study approved at the end of January, and needing data by May – ‘that sounds like a good amount of time, but it really is not, especially when there is a pandemic. So, I guess it is something a lot of supervisors I know have staved away from – they have ensured that their students either have data to analyse, or they have avoided going down those routes where the student needs to collect data. So it does feel like we need a quicker, more accessible way of getting data – representative data, big numbers if we want to do something meaningful.

 

’With research practices having changed significantly over the past few months, many researchers have had to put a halt to their research, or as Dr Hillman mentioned, drastically change their expectations. Such recruitment drawbacks and changes in research practices will be influencing the quality and quantity of robust and novel outcomes we will be seeing in the following years. Dr Hillman highlighted the need to create a large pool of participants so studies with niche criteria can successfully have direct and vigorous contributions with implications for the academic-research communities, but also for the general public.

Anna Freud Centre Children Families Recruitment

Dr Hillman’s most impactful work

Having extensive experience in the clinical and research worlds, Dr Hillman has successfully managed to design and conduct research that has allowed us to better understand the mechanisms of attachment. As a researcher he has been involved in numerous projects, with diverse outcomes, but we decided to focus on his singularly most influential project.

 

Dr Hillman has designed and currently coordinates a tool called Story Stem – ‘Story Stem is an attachment, narrative tool used to access a child’s internal world. We used it with maltreated late-placed adopted children, when they were placed and one and two years later to see what happened in their internal world. This was the selling point of the tool, in which I train people in, but also very informative as it allows us to explore what happens if a child has had a bad start in life. It is quite realistic – it does not always get rose-y and perfect the next year. The positive themes often go up, some of the negative things go down, the child is less avoidant but they’re less incoherent and negative. And of course,

 

two years later they have improved, but it is still organised in an incoherent internal world. If we are talking about a 6-year-old child who has had years of adversity, of course even if placed in the most stable, loving new home, we could not possibly expect all the issues from the past to be eradicated.’ This area of research is paramount – understanding how early experiences shape us, and how adversity impacts our development and personality will enable us to better support those in need. 

Future outlook

Even though I am in the world of academia, have a PhD, write papers, analyse data, I struggle a lot with how we disseminate. We disseminate things in ways which of course are written in very academically, articulate ways but they are not accessible. We have a responsibility in academia to make sure that we open people up to all those things, in all areas. I think possibly, up until now it has just not been made relevant and digestible enough. And I know if it is an area outside my field, and I do try to engage, I quite often find it is not presented in a way that is clear.’

 

Although science needs people’s support more than ever, people are unaware of research opportunities, they drop out of trials, or participate in a short online survey and then completely disengage. Among the factors influencing this, is the huge gap between the general population and the science world. Researchers like Dr Hillman are seeking support, but unless science is made accessible to all, and communicated in interactive and educational ways, interest is lost. At Neucruit, our mission is to bridge this gap between people and science, ultimately contributing to our understanding of human behaviour, interaction and pathology, while helping researchers practice the science they love. 

 

We thank Dr Hillman for his time and insights. 

 

Disclaimer: All posts and information shared here are Neucruit members’ opinions and there is no intention to harm or mislead any individual. Where needed appropriate credit or source of information is provided. Finally, none of the material (e.g., blogposts, studies) is intended to substitute for professional advice, diagnosis, pharmacological or psychological treatment. Please seek the advice of a healthcare professional should you have any questions regarding any mental and/or physical symptom. Do not use Neucruit material to disregard any professional psychological or medical advice you have received, and do not delay in seeking professional advice and help if you need to. 

 

Dr Hillman’s most impactful work

Having extensive experience in the clinical and research worlds, Dr Hillman has successfully managed to design and conduct research that has allowed us to better understand the mechanisms of attachment. As a researcher he has been involved in numerous projects, with diverse outcomes, but we decided to focus on his singularly most influential project.

Dr Hillman has designed and currently coordinates a tool called Story Stem – ‘Story Stem is an attachment, narrative tool used to access a child’s internal world. We used it with maltreated late-placed adopted children, when they were placed and one and two years later to see what happened in their internal world. This was the selling point of the tool, in which I train people in, but also very informative as it allows us to explore what happens if a child has had a bad start in life. It is quite realistic – it does not always get rose-y and perfect the next year.

The positive themes often go up, some of the negative things go down, the child is less avoidant but they’re less incoherent and negative. And of course, two years later they have improved, but it is still organised in an incoherent internal world. If we are talking about a 6-year-old child who has had years of adversity, of course even if placed in the most stable, loving new home, we could not possibly expect all the issues from the past to be eradicated.’ This area of research is paramount – understanding how early experiences shape us, and how adversity impacts our development and personality will enable us to better support those in need. 

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