Young people’s experiences of social recovery cognitive behavioural therapy and treatment as usual in the PRODIGY trial

Aim: The PRODIGY trial is an ongoing randomised controlled trial of Social Recovery Cognitive Behavioural Therapy (SRCBT), a new intervention designed to improve social functioning in young people at risk of long-term social disability due to severe and complex mental health problems. The aim of this qualitative sub-study was to understand trial participants’ experiences of SRCBT and the control condition, treatment as usual (TAU). Method: Trial participants were aged 16 – 25 with socially disabling severe and complex mental health problems. A purposive sample of trial participants took part in in-depth qualitative interviews which were transcribed verbatim and analysed thematically. Results: Participants from the SRCBT arm valued the relationship with their therapist, the flexibility of intervention delivery and the cognitive and behavioural techniques taught. They viewed SRCBT as challenging but worthwhile. Participants from the TAU arm reported receiving little support, both prior to and during their participation in the trial. Participants from both arms valued opportunities to talk about their difficulties during trial participation. Increased activity was an important goal of participants from both arms and most expressed high motivation and little hopelessness. Conclusions: Currently available services do not meet the needs of some young people with socially disabling mental health problems. Motivation to change appears high at this early stage of disorder, supporting the potential value of intervening early to prevent longer-term social disability. SRCBT was well accepted by participants and so is a promising intervention to meet this objective

Independent advocacy for children and young people: developing an outcomes framework

Advocacy services for vulnerable children and young people began to be provided in the 1980s (Willow, 2013) and have grown as legislation and guidance expanded the range and remit of services (Wood and Selwyn, 2013). Research has followed the development of policy and services, but until recently has not examined the impact and outcomes of advocacy in any depth. In this article we draw on findings from a study of the outcomes and impact of independent advocacy for children and young people to explore how the value of advocacy is understood by them and by advocates, social workers and other professionals, and to consider what differences advocacy can make to the lives of children and young people (Thomas et al., 2016). Our findings indicate that the outcomes of advocacy in children and young people’s lives can be significant and wide-ranging, including both direct effects on the child or young person and wider impact on services. This complex picture has implications for how best to capture and report the outcomes of advocacy, which we explore in the latter part of the article with the aid of a proposed new conceptual framework

Practitioner Review: effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review

Background: Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety. Methods: Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety. Results: Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = 0.34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD=-0.49, 95% CI -0.79, -0.19) immediately post-intervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤12) or long-term (>12 month) follow up. Reductions in anxiety symptoms were not maintained at any follow up. Conclusions: Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately post-intervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence-base. Further high quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety