Routine outcome monitoring can support client progress in psychotherapy and provide evidence on population‐level outcomes. However, measures have been almost exclusively nomothetic. Idiographic tools provide a complementary approach, combining individually set outcomes with standardized progress ratings. Evidence suggests that goal‐focused idiographic measures may particularly facilitate client progress, and this systematic review aimed to identify and critically evaluate such measures, as used in psychotherapy. In total, 104 texts were eligible for inclusion in the review, with nine measures identified. These took the form of multidimensional tools, brief rating forms, and goal attainment scaling. Psychometric and clinical evidence suggests that these measures may be appropriate tools for supporting client progress, but there is insufficient evidence to validate their use for population‐level evaluation.
Background About one in seven adolescents have a mental health disorder in England, UK. School counselling is one of the most common means of trying to address such a problem. We aimed to determine the effectiveness and cost-effectiveness of school-based humanistic counselling (SBHC) for the treatment of psychological distress in young people in England, UK. MethodsWe did a two-arm, individually randomised trial in 18 secondary state-funded schools across the Greater London area of the UK. Participants were randomly assigned (1:1) using a centrally secure randomisation procedure with random permuted blocks to either SBHC plus schools' pastoral care as usual (PCAU), or PCAU alone. Participants were pupils aged 13-16 years who had moderate-to-severe levels of emotional symptoms (measured by a score of ≥5 on the Strengths and Difficulties Questionnaire Emotional Symptoms scale) and were assessed as competent to consent to participate in the trial. Participants, providers, and assessors (who initially assessed and enrolled participants) were not masked but testers (who measured outcomes) were masked to treatment allocation. The primary outcome was psychological distress at 12 weeks (Young Person's Clinical Outcomes in Routine Evaluation measure [YP-CORE]; range 0-40), analysed on an intention-to-treat basis (with missing data imputed). Costs were assessed at 24 weeks (Client Service Receipt Inventory and service logs). The trial was registered with ISRCTN, number ISRCTN10460622. Findings 329 participants were recruited between Sept 29, 2016, and Feb 8, 2018, with 167 (51%) randomly assigned to SBHC plus PCAU and 162 (49%) to PCAU. 315 (96%) of 329 participants provided data at 12 weeks and scores were imputed for 14 participants (4%). At baseline, the mean YP-CORE scores were 20•86 (SD 6•38) for the SBHC plus PCAU group and 20•98 (6•41) for the PCAU group. Mean YP-CORE scores at 12 weeks were 16•41 (SD 7•59) for the SBHC plus PCAU group and 18•34 (7•84) for the PCAU group (difference 1•87, 95% CI 0•37-3•36; p=0•015), with a small effect size (0•25, 0•03-0•47). Overall costs at 24 weeks were £995•20 (SD 769•86) per pupil for the SBHC plus PCAU group and £612•89 (1224•56) for the PCAU group (unadjusted difference £382•31, 95% CI £148•18-616•44; p=0•0015). The probability of SBHC being more cost-effective reached 80% at a willingness to pay of £390 for a 1-point improvement on the YP-CORE. Five serious adverse events occurred for four participants in the SBHC plus PCAU group, all involving suicidal intent. Two serious adverse events occurred for two participants in the PCAU group, one involving suicidal intent.Interpretation The addition of SBHC to PCAU leads to small reductions in psychological distress, but at an additional economic cost. SBHC is a viable treatment option but there is a need for equally rigorous evaluation of alternative interventions.
Objectives To determine the demographic profile of clients accessing voluntary and community sector (VCS) counselling services for young people and young adults, and to undertake the first systematic evaluation of outcomes. Design Naturalistic, non‐experimental study design. Methods A total of 2,144 clients were recruited from nine services in England. Data on gender, age, ethnicity, number of sessions, problem descriptions, and initial levels of psychological distress were collected from clients. Calculations of reliable and clinically significant change, repeated measures t‐tests, effect size estimates, and moderation analyses were undertaken to determine whether pre–post change, over an average of 5.1 (SD = 5.3) sessions, was significant and which variables predicted outcomes. Levels of service satisfaction were also recorded. Results The demographic profile of clients accessing VCS services was distinct to those accessing statutory and school‐based counselling services, with a greater representation of females, ‘older’ clients, and clients from Black and Minority Ethnic (BME) groups. Clients accessing VCS counselling services presented with multiple and complex needs. Statistically significant reductions in psychological distress were observed with effect sizes ranging from .64 to .80. High levels of service satisfaction were expressed by clients. Conclusions This study establishes that clinical outcomes in the VCS are comparable to those reported in school‐based and statutory mental health services in the United Kingdom. VCS services were perceived as being highly accessible and appear able to reach marginalized groups who may not be accessing other services. Practitioner points VCS services in the United Kingdom may be more accessible to young people from marginalized groups, such as those from BME backgrounds, compared to statutory and school‐based counselling services. Counselling in VCS services is associated with significant short‐term reductions in psychological distress, at a level comparable with the statutory and educational sectors. Clients accessing counselling in VCS services report relatively high levels of service satisfaction.
Children exposed to multiple adversities are at high risk of developing complex mental health and related problems, which are more likely to be met through integrated interprofessional working. Combining the expertise of different practitioners for interprofessional care is especially pertinent in low-and middle-income countries (LMIC) in the absence of specialist resources. The aim of this study was to work with practitioners who deliver care to vulnerable children in six LMIC (Turkey, Pakistan, Indonesia, Kenya, Rwanda and Brazil) to understand their perspectives on the content of an interprofessional training programme in building resilience for these children. Seventeen participants from different professional backgrounds, who were in contact with vulnerable children were interviewed. A thematic analytic framework was used. Four themes were identified, which were the benefits of a tiered approach to training, challenges and limitations, perceived impact, and recommendations for future training. The findings indicate the importance of coordinated policy, service and training development in an interprofessional context to maximize resources; the need for cultural adaptation of skilled-based training and interventions; and the usefulness of new technologies to enhance accessibility and reduce costs in LMIC.
Low-and middle-income countries (LMIC) are faced with disproportionately high levels of unmet child mental health needs. This study explored through interviews the perspectives of 17 inter-agency service stakeholders from Brazil, Indonesia, Kenya, Pakistan, Rwanda and Turkey on existing supports and challenges. Four themes emerged on the holistic nature of children's mental health needs linked with disadvantage; limited resources and skilled workforce; stigma; and strategies for future implementation, including awareness, parental engagement, skills-based programmes and cultural adaptation. Stakeholder input is essential in conceptualising, developing and evaluating culturally appropriate interventions for vulnerable children in LMIC.
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