Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS): a randomised controlled trial

Abstract

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.

‘They need somebody to talk to’: Parents' and carers' perceptions of school‐based humanistic counselling

“…Whilst school‐based counselling is widely delivered in the UK, research that examines parents' and carers' perceptions remains limited. Broadly speaking, our findings triangulate with evidence for the effectiveness of humanistic counselling (Cooper et al., 2021), with parents and carers seeing it as enhancing their child's sense of self (e.g. increased self‐knowledge, self‐confidence and willingness to be open), and improved academic performance and relationships (Brännlund et al., 2017; Durlak et al., 2011; Timulak & Creaner, 2010; Wells et al., 2003).…”

“…This, in turn, introduces area‐level variations and may, therefore, limit the wider transferability of findings to differing socio‐demographic backgrounds. This may be reflected in ETHOS's relatively small intervention effects, which may be indicative of the sample's high levels of poverty and chronicity of distress (Cooper et al., 2021). It is therefore suggested that parents' and carers' perceptions require further investigation for a deeper understanding of multiple experiences, particularly among a wider and diverse sample with differing backgrounds and experiences.…”

“…This study used a qualitative research design and was conducted as part of the wider effectiveness and cost‐effectiveness trial of school‐based humanistic counselling (ETHOS), a two‐arm, parallel‐group, individually randomised controlled trial (RCT). The aim of the ETHOS study was to evaluate the effectiveness and cost‐effectiveness of SBHC for psychological distress in young people (typical age range 11–18 years) compared to access to a school's usual pastoral care provision, using a representative sample of 18 secondary schools across Greater London, UK (Cooper et al., 2021). All schools in the ETHOS study were state funded: 11 academies, six community schools and one foundation school.…”

Helpful aspects of counselling for young people who have experienced bullying: a thematic analysis

“…or integrative form; and has shown evidence of positive effects (Cooper et al, 2013(Cooper et al, , 2021. The Department for Education (DfE, 2018) estimated that 61% of the schools in England provide this service.…”

Psychological implications and rehabilitation programmes due to football‐related injuries

“…Kolt, 2000;Podlog et al, 2014). Due to their close contact with injured athletes, sport medicine professionals and sport psychologists are ideal front-liners to promote and support effective goal-setting practices (Arvinen-Barrow & Walker, 2013), which are not only beneficial, but also easily transferable (Taylor & Taylor, 1997) (Cooper et al, 2021), educators (Rae et al, 2017), employees (Collins et al, 2012) and leaders (Crawford et al, 2014). Therefore, counsellors can contribute effectively as footballers would also feel more comfortable approaching them if they are present in clubs.…”