This feasibility trial demonstrates that a home-based, parent-coached programme for adolescents with learning disabilities can be delivered in everyday UK practice, that families engage with it, and that a hybrid home telehealth format is workable. We reached families through special schools, most started therapy, almost four in five booked sessions were attended, and parents reported a strong working alliance with therapists. Endpoint data were obtained for the majority of participants treated, and measures of changes on self-rated parenting stress and satisfaction, parent-rated behaviour, including their child’s level of compliance, and functional performance moved in the expected direction. Goal-attainment modelling suggested that dose matters. Around seven sessions were linked to meeting expected goals and closer to ten to exceeding them. This study provides feasibility work focussing on uncertainties, context, and helping to develop a programme theory that would support larger scale evaluation of effectiveness. As such, it accords with guidance to prioritise feasibility before effectiveness and to design evaluations that explicitly consider setting, logistics, and burden [22, 30].

With regard to implementation considerations, ACHIEVE required a flexible hybrid model, with substantial contact beyond scheduled sessions (calls, texts, and emails) alongside home and video appointments. For scale-up, key practical considerations include workforce (experienced OT/SLT able to work trans diagnostically), protected supervision time, travel/lone-working arrangements for domiciliary visits, and maintaining flexibility around family availability. A hybrid delivery option may improve access while reducing travel burden, but services will need systems for scheduling, safeguarding escalation routes, and materials provision to support family-tailored strategies.

This study has recognised that the context in which families of young people with learning disabilities live is important and cumulative exposure to social disadvantage further increases the risk of psychiatric disorder and limits participation in routine services [31]. This makes parent-facing support at home both necessary and pragmatic. Our findings suggest that it is feasible to deliver allied health professional expertise to families and coach parents on goals they nominate that fit everyday life without requiring time-consuming clinic attendance [21].

The ACHIEVE study directly addresses the focus of Integrated Care Systems ensuring joined up care [32]. It was delivered by allied health clinicians within NHS pathways with pupils recruited directly from diverse special schools. Its targets (self-care, communication, and behaviour in everyday routines) align closely with children’s health and social care priorities for promoting participation and independence and preventing escalation to high-cost provision. Delivery in family homes, coaching parents on their nominated goals, and hybrid scheduling to fit caregiving demands reflect the needs of families (family-centred, context-first, capacity-building). Importantly, recruitment via special schools, key multi-agency nodes, demonstrated that families can be identified and supported without additional clinic attendance, a practical fit for family centred, health, and social care commissioned support that occurs around school and home.

Reviews of programmes for parents of adolescents with learning disability report positive effects on parenting and parent-adolescent relationships, while simultaneously calling for stronger designs and better reporting [33]. Our specification of ACHIEVE using TIDieR and our fidelity plan respond directly to those gaps, increasing replicability and paving the way for scale-up.

ACHIEVE adds three elements that are often missing: first, the focus on adolescents, a group under-represented in parent-mediated trials compared with younger children, despite more complex school and social demands in readiness for adulthood; second, it works with families in their homes and local communities, through parent-nominated goals, which improves ownership and acceptability; third, it answers feasibility questions that are often unclear: how many sessions are needed, how families prefer to meet, how often staff can travel, and how to assist families without burdening households.

Interpretation of our clinical signals remains cautious, as it should in a feasibility phase. Parent-rated indices improved across the sample, and the dose–response data from goal attainment will help in future session scheduling. However, the single-arm design of the study does not allow us to establish the effects of the intervention. Our feasibility data hence tentatively allows power analysis for sample size calculations and our exploratory findings will help refine therapy delivery (i.e. number of sessions), select, and sequence assessments so that the next trial is more likely to successfully complete and report.

Our feasibility records also informed a process evaluation describing modifications made during the study, for example offering consent and baseline assessments at home visits instead of sending them by post to reduce queries and improve data completeness. In future studies, we will pre-specify progression criteria, standardise a minimum dose, publish materials and core components via TIDieR, and use a fidelity checklist.

Pragmatic hybrid delivery, home plus video, appeared workable for families and clinicians, matching evidence that telehealth can maintain fidelity and reduce barriers to access in older cohorts. Harms monitoring recorded no serious adverse events. The CONSORT Harms recommendations call for explicit reporting of all unintended effects, even minor ones (such as needing to reschedule school attendance for home sessions). We will incorporate this fully into the reporting procedures for the full trial.

Publishing ACHIEVE’s core components, tailoring rules, and fidelity approach will make replication and commissioning easier. Embedding an implementation lens will yield results that are not only clinically credible but also actionable for commissioners and service leaders weighing scale-up across diverse NHS and education settings.

Our feasibility trial has a number of limitations. First, this was a single-region feasibility study without a control group or randomisation, reliant on parent-report outcomes and with limited scope for blinded assessment given the home-based delivery. This means effectiveness cannot be inferred and observed changes may reflect non-specific effects or natural variation. Second, although fidelity was supported through documentation and supervision, we did not undertake independent fidelity assessment, limiting certainty about consistency of delivery. Third, recruitment through participating schools constituted convenience sampling and may limit generalisability beyond similar settings. Finally, we did not quantify baseline concomitant interventions or parent expectations in a way that allows adjustment, although this is an underserved population with limited access to interventions.

School-mediated identification was efficient and resulted in a varied and representative sample but may have narrowed reach. Future studies could widen recruitment through agencies such as voluntary sector partners. Our choice of measures proved burdensome for some families resulting in some incomplete data, which has impacted our ability to assess progress. Future studies that incorporate families with very variable language backgrounds, SES and literacy should anticipate providing translation and interpreting services, and more direct support for families, with financial incentives for data completion. None of these constraints undermines the aim of the phase: to test delivery, engagement, and measurement and to learn what to fix or standardise before a definitive, comparative evaluation.

ACHIEVE sits within current debates about how health, education, and social care services can provide earlier, practical support to families of adolescents with severe learning disabilities. Families often provide most long-term care, and unmet need during adolescence can affect wellbeing, participation, and transition to adulthood. Previous research has shown the impact on families when community support is insufficient and needs escalate to residential provision [7], and transition studies highlight the complexity experienced by families as young people with intellectual disability move toward adult services [34]. The evidence base for parent-focussed interventions in adolescents with intellectual disabilities is promising but limited: a recent systematic review reported benefits for parenting, parent–adolescent relationships, and wellbeing but also highlighted mixed study quality and little cost-effectiveness evidence [21]. ACHIEVE therefore contributes feasibility, acceptability, dose, and implementation evidence for a home-based, parent-coached OT/SLT model. These findings should inform a future controlled trial with process and economic evaluation rather than be interpreted as evidence of effectiveness.

Building on ACHIEVE’s feasibility signals, future studies should consider two-arm, multi-school randomised controlled trials with a wait-list control. A controlled design is important to estimate effectiveness and to mitigate biases such as secular change and expectancy effects. Therapists and families would be unblinded to allocation, but outcome assessors should remain blinded, with a detailed pre-published protocol specifying intention-to-treat analyses. Our data suggest that a nominated primary outcome could measure parental empowerment, control, and confidence within their family and local community, e.g. the Family Empowerment Scale. Other measures could be retained such as the child-focussed measures (DBC) and parent outcomes (Parental Stress Scale, HSQ). The therapist completed measures: COPM and goal attainment scaling were valuable in tracking goal-level change. Study designs could consider wait-list control, pragmatic cluster, or stepped-wedge design while preserving blinded assessment and consistent outcome timing.

To conclude, a home-based, parent-coached programme for adolescents with learning disabilities was feasible in UK practice. We found high attendance, strong alliance, and acceptable data capture, with exploratory improvements that help set dose and measurement for a larger study. The next step is a definitive, comparative evaluation that proceeds with clear progression criteria, fidelity checks, broader and more equitable recruitment, transparent harm reporting, and an explicit implementation framework for scale-up.