counselling in uk secondary schools€¦ · (ncb); manchester academic health science centre trials...
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Counselling in UK secondary schools:What we know, what we’re doing,
and what we need to find out
Mick Cooper
Professor of Counselling Psychology
University of Roehampton
Thanks to the many people whose research and feedback contributed to this paper, including Rachel Argent, Michael Barkham, Jenni Beachem, Sal Bennett, Pete Bower, Renee Carman, Jeremy Clarke, Helen Coles, Maya Cooper, Helen Cruthers, CORC, Karen Cromarty, Peter Fonagy, Andy Fugard, Gillian Griffiths, Terry Hanley, Andy Hill, Matthew Hopkinson, Mike Hough, Charlie Jackson, Peter Jenkins, Sylvia Jones, Raph Kelvin, Suky Khele, Ruth Levesley, Rosemary Lynass, Adam McAdam, Katherine McArthur, Polly Morrison, Jamie Murdoch, Susan McGinnis, Susan Pattison, Peter Pearce, Anne O'Herlihy, Sarah Osman, Kathryn Pugh, Jo Pybis, Tiffany Rameswari, Andrew Reeves, Paul Revell, Nancy Rowland, Sheila Spong, Megan Stafford, Cathy Street, Nick Turner, Ralph Weedon, Miranda Wolpert.
BackgroundSa
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Mental health problems in young people
• 1 in 10 have diagnosable mental health condition
• 30% ‘always’ or ‘often’ feel ‘down’
• Mental health difficulties associated with: lower levels of academic achievement and engagement, ongoing difficulties into adulthood
• Some evidence that problems increasing
Anya• 14 year old from central
England• Referred for missing school,
aggressive behaviour• Reported experiencing
periods of ‘depression’• Devastated by father’s
recent stroke • Fighting constantly with
father, regularly grounded• Often triggered by periods
of binge drinking
Details of this client have been changed to protect anonymity
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Mental health problems in young people
A major area of national
and government
concern
November 2014All-Party Parliamentary Health Select
Committee report: Children’s and Adolescents’ Mental Health and CAMHS
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‘The Government’s aspirations are that by 2020 we would
wish to see…’
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Overview• Why are mental health interventions for
young people important?• What is school-based counselling and how is it
delivered?• Who uses school-based counselling?• Is school based counselling helpful? Pre-/post,
pilot RCTs, helpful factors/processes• What developments are happening nationally?
Competences, training, policy• What next? The ETHOS trial
Service provisionSa
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bacp.co.uk/research/publications/
Review of the
evidence
The emergence of school-based counselling for young
people in the UK
1960 1970 1980 20001990 2010
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Widely disseminatedOne of most common provisions for mental health problems in young people
NC
B
Wales: All schools since 2008
NI: All schools since 2007
Scotland: 64-80% (approx.)
England: 61-85% (approx.)
Dissemination of school-based counselling in UK secondary/post-primary schools
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Estimated cases per yearApproximately 70,000-90,000 in UK
Approximately 50,000-70,000 in England
NC
B
Cases in England (per year)
Specialist CAMHS (79,966, 10-18 year olds, 2008-9)
School-based counselling (approx. 60,000)
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Service delivery in UK• Primarily
humanistic, or integrative, practice
• Emphasis on mental wellbeing
• Generally one-to-one (rather than group or family)N
CB
Referral routesSchool staff
Self
Parents/carers
10
1 week 1 month
50%
35%15%
Reported waiting times: relatively brief
Service usersSa
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Psychological difficulties at assessment (SDQ) (counselling)
‘Abnormal’
‘Borderline’
‘Normal’
Psychological difficulties at assessment (specialist CAMHS)
‘Abnormal’‘Normal’
‘Borderline’
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Presenting/developing issues
0
5
10
15
20
25
30
35
Perc
enta
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Gender60%
40%
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BME under-represented
0
0.5
1
1.5
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Counselling clientsAll Wales
Perc
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EvaluationSa
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Pre-/post-intervention change• Do young people’s
levels of psychological distress reduce after school-based counselling?
• Can assess using a range of outcome measures
Pre-/post-intervention changeData from over 5,000 cases indicates that school-based counselling consistently associated with significant and large reductions in psychological distress, equivalent to improvements in adult mental health services
Mean reductions per local authority, Welsh School-based Counselling Strategy
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Anya: Change in levels of psychological distress (YP-CORE)
0
5
10
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25
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s1 s2 s3 s4 s5 s6 s7 s8 s9
Less
dis
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Would those improvements just happen anyway?
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Randomised controlled trial (RCT)
EndpointAssessment/Baseline
Counselling
Randomallocation
Not counselling
Follow-up
‘School-based humanistic counselling’
• Distillation of UK counselling practice
• Weekly sessions (max. 10)• Based on humanistic
competences• 2009-2014: Four pilot
RCTs comparing against usual care (Ns = 32-64)
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RCT combined results (YP-CORE)
EndpointAssessment/Baseline
Follow-up
Less
dis
tres
s
6 weeks (n=118) ES = 0.47*
12 weeks (n=126) ES = 0.72*
26 weeks (n=46) ES = 0.44
might counselling be helpful?
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Helpful factors(meta-analysis of nine qualitative
interview studies with clients)
1. Having an opportunity to talk and be listened to
2. Counsellors’ strategies and guidance
3. Getting things off one’s chest
4. Counsellors’ personal qualities
5. Problem solving
Change processesRelief
Increasing self-worth
Insight Enhanced coping
strategiesImproved
relational skills
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‘Relief’ change pathway(McArthur et al., 2015)
Helpful factorsTeachers’ perceptions
1. Accessibility
2. Independence of counsellor
3. Confidentiality
4. Specialist training
5. Capacity to spend extended time with young people
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‘Extremelyunhelpful’
‘Extremelyhelpful’
‘Neither helpful or unhelpful’
Teachers’ ratings of helpfulness(N = 125 pastoral care teachers)
National developments
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From research to competences
2012: Evidence of effectiveness from pilot RCTs formed basis for developing competences for humanistic counselling with young people
http://www.bacp.co.uk/research/resources/cyp_competences.php
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From competences to training
E-learning training for child counsellors
45, half-hour sessions
Funded by the Department of Health
minded.org.uk
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Current work to develop new
curriculafor counselling children and young people (BACP and CYP IAPT) based on counselling competences and incorporating Counselling MindEd
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From research to policy
1. Definitive evidence of effectiveness is still lacking, particularly at follow-up
2. Even if it is effective, is it cost-effective?3. How does it work: and how can we improve it?
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The ETHOS Trial
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Since 2005, have submitted four different bids for a fully-powered RCT of school-based counselling
Background
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Effectiveness and cost-effectiveness Trial of Humanistic cOunselling in Schools: Individual RCT (ETHOS)
Research team: Mick Cooper, Chris Kelly, Meg Stafford, Jac Hayes (University of Roehampton); Michael Barkham (University of Sheffield); Peter Bower (University of Manchester); Karen Cromarty, Charlie Jackson (BACP); JenniBeachem (LSE), Andy Fugard (UCL); Peter Pearce (Metanoia); Cathy Street (NCB); Manchester Academic Health Science Centre Trials Co-ordination Unit
Participants: 18 schools (with no current counselling service), 325 young people (13-16) experiencing moderate to high emotional symptoms
Randomisation: School-based Humanistic Counselling or Pastoral Care as Usual (with option for counselling at end)
Outcomes (6 weeks, 12 weeks/endpoint, 6 month follow-up): Differences in psychological wellbeing, academic engagement and attainment, cost-effectiveness, perceptions of impact and helpful/unhelpful aspects (young people, teachers, parents/carers)
Requested funding from ESRC: £835,000
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Effectiveness and cost-effectiveness Trial of Humanistic cOunselling in Schools: Individual RCT (ETHOS)
2016 2017 2018 2019Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Jan
Preparation
Set-up
Data collection
Analysis
Write-up
Dissem-enation
Effectiveness and cost-effectiveness Trial of Humanistic cOunselling in Schools: Individual RCT (ETHOS)
We are looking to recruit 20 English secondary schools that do not currently have an established counselling provision to participate in the study. Eligible schools will receive a high quality professional,
counselling service at no cost to the school for two years. Counselling sessions will be recorded for audit purposes and this material will be anonymized and held securely, in line with information governance
good practice.
Contact Mick Cooper: [email protected]
Peter Pearce (school recruitment): [email protected]
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Summary
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SummaryMany young people in the UK experience psychological difficulties
School-based counselling is one of the most common means of trying to address this
Initial indications are that it can reduce that distress
This evidence has led to developments in training and policy
But we need to find out more: Is it really effective? Is it good value for money? And, if it does help, how can it help better?
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Thank you
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Mick [email protected]
Schools interested in involvement in ETHOS should contact:
If you would like to stay updated about the ETHOS trial, please email: