Background School-based counselling: A review of the evidence Sasha Wolff, Creative Commons Attribution 2.0 Generic Mick Cooper Professor of Counselling Psychology University of Roehampton Overview Mental health problems in young people • 1 in 10 have diagnosable mental • What is school-based counselling? health condition • Does school-based counselling reduce • Mental health difficulties mental health problems? associated with: lower • How might school-based counselling be levels of academic helpful? achievement and • What national developments are there? engagement, ongoing • The ESRC-funded ETHOS trial of school- difficulties into based counselling adulthood • Implications Source: Colman, 2009; WHO, 2006 What is school-based counselling in the UK? Review of the evidence Sasha Wolff, Creative Commons Attribution 2.0 Generic Google search: BACP Scoping Reports 1
Widely disseminated The emergence of school- based counselling for young One of most people in the UK common provisions for mental health problems in young people in the UK 1960 1970 1980 1990 2000 2010 NCB Source: Baginsky, 2004; Cooper, 2013 Source: Cooper, 2013; Hill, 2011; estimated figures Estimated cases per year Dissemination of school-based counselling in UK secondary/post-primary schools Approximately 70,000-90,000 Scotland: 64-80% (approx.) in UK NI: All schools since 2007 England: 61-85% (approx.) Approximately Wales: All schools since 2008 50,000-70,000 in England NCB Source: Cooper, 2013; Hanley, 2012; estimated data for England and Scotland Source: Cooper, 2013 Service modality in UK Cases in England (per year) • Primarily ‘humanistic’/ ‘person - centred’/’integrative’: School-based counselling similar to ‘non -directive (approx. 60,000) supportive therapy’ (approved by NICE for mild depression) • Aims to help young people find own answers through listening, warmth and empathic reflections • Focuses on general emotional Specialist CAMHS (79,966, and interpersonal problems 10-18 year olds, 2008-9) (cf. specific diagnoses) • Generally one-to-one (cf. group/family) NCB Source: CHIMAT, Cooper, 2004, 2006; Cooper, 2013; CAMHS = multi/single disciplinary generic, targeted, dedicated worker in non-CAMHS team, & Tier 4 Source: Cooper, 2009; Hill, 2011; NICE 2015 2
Anya: Dialogue with counsellor, Session 2 Case example: 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 Details of this client have been changed to protect anonymity Referral routes Reported waiting times: relatively brief School staff Self Parents/carers 50% 35% 15% 1 week 1 month Source: Cooper, 2009; Hill, 2011, estimates from approximately 20,000 young people Source: Cooper, 2013; Hill, 2011; as reported by school staff and local authority leads Psychological difficulties at Presenting/developing issues assessment (SDQ) (counselling) 35 30 25 Percentage 20 ‘Abnormal’ ‘Normal’ 15 10 5 0 ‘Borderline’ Source: Cooper, 2009, from 611 young people Source: Cooper, 2009; Hill, 2011; approximate data from over 20,000 cases 3
Gender BME under-represented 60% 2 1.5 Percentage 1 0.5 Counselling clients All Wales 0 40% Source: Hill, 2011; data from 11,043 cases Source: Cooper, 2013 Is school-based Pre-/post-intervention change counselling helpful? Data 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 Sasha Wolff, Creative Commons Attribution 2.0 Generic authority, Welsh School- based Counselling Strategy, Hill, 2011 Source: Hill, 2011; Cooper, 2009; data from 5,575 cases But ‘School -based humanistic counselling’ • Distillation of UK counselling practice • Based on humanistic/person- centred competences • Weekly sessions (max. 10) • 2009-2014: Four pilot Would those improvements randomised trials comparing against usual care ( N s = 32- just happen anyway? 64) Source: Cooper, 2010, 2013; McArthur, 2013, Pybis, 2014; Pearce, 2017 4
RCT combined results (YP-CORE) School-based humanistic counselling: Findings Assessment/ Endpoint Follow-up Associated with: Baseline • Moderate short term reductions in psychological distress and difficulties • Moderate short term improvements in self- esteem and personal Less distress goal attainment 6 weeks ( n =118) 12 weeks ( n =126) 26 weeks ( n =46) ES = 0.47* ES = 0.72* ES = 0.44 Source: Cooper, 2010, 2013; McArthur, 2013, Pybis, 2014; Pearce, 2017 Teachers ’ ratings of helpfulness of counselling for their pupils Pastoral care teachers’ perceptions of helpful aspects of counselling/’added value’ 1. Independence 2. Confidentiality 3. Accessibility 4. Expertise 5. Time n = 125, Source: Cooper, 2009 Extremely Extremely Neither helpful unhelpful helpful or unhelpful k = 7 studies, Source: Cooper, 2009 What might be the process of Pastoral care change? teachers’ perceptions of areas for improvement 1. Greater availability 2. Greater promotion 3. Better communication 4. Greater range of activities k = 7 studies, Source: Cooper, 2009 5
Counsellor activities Client activities Client outcomes Less angry, Relief Actively anxious, etc.* listens Review of Better Communicates Relational skills relationships empathy* * the Self- Facilitates emotional confidence* Explores & expression qualitative expresses Self-acceptance*/ Integrated genuine experiencing Less Trustworthy* concerns, evidence emotionally Solve experiences Friendly distressed* problems/ & emotions Improved Accepting* Understanding ways of living self/ Caring relationships/ situations See situation Independent Better more Guidance educational positively Confidential engagement* Consistent/ dependable Source: Griffiths, 2013; Coping strategies Counsellor qualities Google search: BACP Scoping Reports Cooper, 2016; A relationship that develops... over time An intervention for young people with no-one to talk to? ‘I brought up something that like I’d never told anyone so it just goes to show how much the relationship’s changed over time cos I’ve never trusted anyone with it, and then, I No-one to trusted [ counsellor]’ (Carl) talk to (≈60) …that they’d talk ‘In counselling, I always start with to someone like little things and then, from them little things if I know, like, I about ( ≈ 300) can trust them and they’re helping with the situation and Source: Cooper, 2010; An emotional concern ( ≈ 600) that they didn’t pass judgement Family kids, 2012 on me or anything it then —it’s like a build-up on- the next thing I tell them is more important to me.’ School students ( ≈ 1000) (Annabelle) Source: Gurvitz, 2017 National From research to competences developments 2012: Evidence of effectiveness from pilot RCTs formed basis for developing competences for Sasha Wolff, Creative Commons Attribution 2.0 Generic humanistic counselling with young people 6
From competences to training http://www.bacp.co.uk/ethics/competences_and_curricula/cyp_competences.php E-learning training for child counsellors 45, half-hour sessions Funded by the UK Department of Health minded.org.uk Development New BACP of first CYP curriculum IAPT framework for curriculum for counselling young people counselling, based on including competences, module on incorporating CBT Counselling MindEd 7
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