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Outcomes of school-based person-centred counselling for psychological distress in young people

Outcomes of school-based person-centred counselling for psychological distress in young people. WAPCEPC 2012. Mick Cooper Katie McArthur Rosemary Lynass.

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Outcomes of school-based person-centred counselling for psychological distress in young people

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  1. Outcomes of school-based person-centred counselling for psychological distress in young people WAPCEPC 2012 Mick Cooper Katie McArthur Rosemary Lynass Thanks to Karen Cromarty, Nancy Rowland, Jo Pybis, Susan McGinnis, Jamie Murdoch, Nick Turner, Ruth Levensley, and all colleagues who have helped with the collection and analysis of data

  2. RATIONALE

  3. Mental distress • Levels of mental health problems in children and young people are increasing • One in ten children in the UK now experiencing a diagnosable mental disorder

  4. Person-centred counselling in UK schools • Approximately 33% of counselling provided in UK schools is person-centred • Remaining 66% is based around a person-centred/humanistic core, with elements integrated from other therapies • Generally one-to-one, open-ended • Delivered by trained counsellors • Evidence for effectiveness very limited

  5. School-based humanistic counselling (SBHC) • Formalisation of person-centred/humanistic counselling in schools • Aim is to help young people find more satisfying ways of being by becoming aware of, and acting on the basis of, their genuine feelings, needs and experiences • Provides an empathic, non-judgmental and trustworthy relationship • Core practices include reflections, summaries, inviting client to explore – and make sense of – lived-experiences • ‘Manualised’ through core competences for humanistic psychological therapies • Audited using the Person-centred & Experiential Psychotherapy Scale

  6. Effectiveness of SBHC • Cohort studies indicate school-based counselling in the UK is associated with significant improvements in psychological health from pre- to post-counselling

  7. Changes in levels of mental distress from pre- to post-counselling across 16 counselling in UK secondary schools evaluations (Cooper, 2009) Overall effect size (d) = 0.81

  8. But… • Need controlled evidence to evaluate whether SBHC is bringing about improvements

  9. Objectives of initial pilot • ‘To test the feasibility of a procedure for undertaking a randomised controlled trial assessing the clinical effectiveness of SBHC for emotionally distressed young people in schools’ • An opportunity to: • Identify any ethical issues and other problems • Evaluate the suitability of measures • Identify likely recruitment rates • Obtain preliminary indication of efficacy

  10. Principal experimental hypothesis • For children and young people (13 – 16 years old) experiencing emotional distress, weekly counselling will be more effective than waiting list conditions after six weeks

  11. DESIGN

  12. ‘Post-test’ Counselling Not counselling (e.g., wait-list) Random allocation Pilot RCT Assessment/‘Pre-test’ Screening Check pastoral care/ parents

  13. Counselling • Standard SBHC • Up to six weeks • Experienced and qualified practitioner • Delivered according to Skills for Health humanistic competences • Sessions recorded and audited using PCEPS

  14. Waiting list • No formal intervention (but young people can contact established school counselling service/pastoral care at any time)

  15. Principal pre- and post-test measures • Strengths and Difficulties Questionnaire (SDQ) Emotional Symptoms subscale – emotional distress • YP-CORE – general difficulties (also every session) • Moods and Feelings Questionnaire (MFQ) – depression • Adapted Change Interview – qualitative measure of process/outcomes

  16. Recruitment • Project based in five secondary schools: two in North East England, three in Scotland • All schools currently have school-based counselling service : RCT service runs alongside • Aim to recruit 32 participants: 16 counselling, 16 wait-list • Key inclusion criteria: SDQ-ES > 4

  17. Randomisation • Undertaken as participants accepted into trial • Allocation by independent computer software, accessed by internet • Student told either: • ‘counselling straight away’ • ‘counselling in six weeks’

  18. Results

  19. Screened n = 379 Not interested in participating n = 288 Assessed for eligibility n = 58 (15.3%) Do not meet inclusion criteria n = 26 Randomised n = 32 (8.4%) Counselling n = 16 Waiting list n = 16 Withdrew n = 3 Analysed n = 13 Withdrew n = 1 Wrongly allocated n = 1 Analysed n = 14 Recruitment 27 participants completed (7.1%)

  20. Feasibility of protocols • Recruitment rate feasible: approx. 3 participants/school/term (based on screening of approx 2 classes/school) • Attrition rate acceptable: 12.9% • No major ethical obstacles • Participation in trial generally described as positive and worthwhile by clients and professionals • Mean sessions attended: 4.54

  21. No significant differences on principal outcome measure (SDQ emotional symptoms)

  22. No significant differences on principal outcome measure (SDQ emotional symptoms)

  23. Effect sizes and 95% confidence intervals on primary and secondary outcome measures large effect med effect small effect

  24. ‘Depressed’ young people (MFQ ≥ 29) did significantly better in counselling (vs. waiting list) than non-depressed Less psychological distress

  25. Qualitative data (from Lynass, Pykhtina and Cooper, 2012)

  26. Results – Helpful Aspects

  27. Helpful Aspects

  28. Helpful Aspects

  29. Helpful Aspects

  30. Results

  31. More Direction? Differing Client Needs & Expectations

  32. Pilot II: SUPPORT

  33. SUPPORT trial • McArthur, Cooper and Berdondini, 2011 • Revisions from initial pilot: • No screening. Intake through standard pastoral care • Longer intervention: 12 weeks • Higher cutpoint for distress • YP-CORE as primary outcome • Use of goal-based outcome measure

  34. Pilot III: RELY

  35. RELY trial • Replication of SUPPORT trial, except added 6 months follow-up • Conducted with large provider of school-based counselling: Relate

  36. What did we learn?

  37. Ethics • It is possible to conduct RCTs of person-centred interventions – no major ethical or philosophical issues emerged • Most participants seemed to benefit, and no evidence that any suffered from the experience (see McArthur, 2011) • Data emerging from even a small scale RCT can have a significant political impact

  38. A programme of research • Developing RCT evidence needs to be part of a programme of study: we learnt from the first study to develop a more effective second and third study; now onto fourth trial and building to large-scale funding bid • RCT provides an opportunity to conduct associated, qualitative research: case studies, qualitative interview studies • Potential to combine data, with bigger n…

  39. Design issues • Importance of trained counsellors and researchers • Essential to have an effective and skilled coordinator

  40. Improving the intervention • Qualitative evidence indicates that non-directivity was unhelpful for some clients: suggests more active intervention may be of benefit • Weekly monitoring of outcomes seems part of effective therapy

  41. mick.cooper@strath.ac.uk

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