The use of guided self-help to promote emotional wellbeing in high school students

Abstract

Background: The prevalence of mental disorder in children and young people in the UK is \nestimated at 10-20%. The World Health Organisation advocates urgent preventive \nmeasures to reduce the impact of a predicted steep rise in global rates of depression. The \nmental health of young people is therefore a public health issue, nationally and globally. \nThe UK children’s policy agenda proposes that promoting emotional wellbeing is a shared \nresponsibility between children’s agencies at the Tier 1 level of Child and Adolescent \nMental Health Services, but further research is required to develop low intensity, evidence \nbased interventions to promote emotional and mental health. Schools have a remit to \naddress emotional problems in students and evidence exists to support school based \ninterventions to promote emotional wellbeing. However young people encounter barriers \nto help-seeking in primary care, which need to be understood in order to deliver \nappropriate support. There is an emerging evidence base for using guided self-help (GSH) \nto deliver cognitive behaviour therapy-based interventions to adults in primary mental \nhealth care. It is not known whether using GSH in high schools to deliver emotional \nwellbeing interventions to young people would be feasible or acceptable. \nAims: To develop an emotional wellbeing intervention for high schools using GSH, and \nevaluate it for feasibility and acceptability. \nMethods: The Medical Research Council (MRC) Framework for complex interventions \n(MRC 2000) provided the conceptual structure of the research. There were three stages: \nConsultation, Development and Implementation. In the Consultation stage 54 young \npeople aged 11-15 were consulted in 6 focus groups in 3 inner city high schools in the UK. \nThe outcomes supported the development of a GSH intervention, named the ‘Change \nProject’, which was the focus of the Development Stage. Pastoral and Special Educational \nNeeds staff in schools were trained and supported to deliver the intervention. In the \nImplementation Stage the Change Project was piloted in the same 3 high schools. It was \nevaluated for acceptability and feasibility using qualitative interview methods and a survey \nof students. The Rosenberg Self Esteem Scale was used as an outcome measure \nResults: Eight Project workers delivered the Change Project and 21 students used it. They \nwere aged 11-17 years and included male, female, white and non-white students. Self \nreported personal outcomes for students were generally positive. Nine sets of baseline and \npost-intervention RSES scores were collected. There was a general trend for improvement \nin scores. Presenting difficulties included potentially clinical disorders which were \nsuccessfully addressed with support from school nurses. Interviews were conducted with \n23 students and 27 school staff and questionnaire data were collected from 140 students. \nProject worker reports of the Change Project’s acceptability and feasibility were mixed, \nthough also generally positive. The acceptability and feasibility of the RSES is discussed. \nThe ethos of pastoral care, support of senior figures and other contextual factors affected \nimplementation quality in each school. Help-seeking in the young people was driven by \npeer norms of hiding signs of vulnerability. \nConclusions: Acceptability and feasibility of the Change Project were interdependent. The \nintervention has potential for further development. Implementation is enhanced by \nunderstanding school context. Understanding barriers and facilitators of help-seeking in \nyoung people may encourage use of emotional support in school.

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