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 estimated at 10-20%. The World Health Organisation advocates urgent preventive measures to reduce the impact of a predicted steep rise in global rates of depression. The mental health of young people is therefore a public health issue, nationally and globally. The UK children’s policy agenda proposes that promoting emotional wellbeing is a shared responsibility between children’s agencies at the Tier 1 level of Child and Adolescent Mental Health Services, but further research is required to develop low intensity, evidence based interventions to promote emotional and mental health. Schools have a remit to address emotional problems in students and evidence exists to support school based interventions to promote emotional wellbeing. However young people encounter barriers to help-seeking in primary care, which need to be understood in order to deliver appropriate support. There is an emerging evidence base for using guided self-help (GSH) to deliver cognitive behaviour therapy-based interventions to adults in primary mental health care. It is not known whether using GSH in high schools to deliver emotional wellbeing interventions to young people would be feasible or acceptable. Aims: To develop an emotional wellbeing intervention for high schools using GSH, and evaluate it for feasibility and acceptability. Methods: The Medical Research Council (MRC) Framework for complex interventions (MRC 2000) provided the conceptual structure of the research. There were three stages: Consultation, Development and Implementation. In the Consultation stage 54 young people aged 11-15 were consulted in 6 focus groups in 3 inner city high schools in the UK. The outcomes supported the development of a GSH intervention, named the ‘Change Project’, which was the focus of the Development Stage. Pastoral and Special Educational Needs staff in schools were trained and supported to deliver the intervention. In the Implementation Stage the Change Project was piloted in the same 3 high schools. It was evaluated for acceptability and feasibility using qualitative interview methods and a survey of students. The Rosenberg Self Esteem Scale was used as an outcome measure Results: Eight Project workers delivered the Change Project and 21 students used it. They were aged 11-17 years and included male, female, white and non-white students. Self reported personal outcomes for students were generally positive. Nine sets of baseline and post-intervention RSES scores were collected. There was a general trend for improvement in scores. Presenting difficulties included potentially clinical disorders which were successfully addressed with support from school nurses. Interviews were conducted with 23 students and 27 school staff and questionnaire data were collected from 140 students. Project worker reports of the Change Project’s acceptability and feasibility were mixed, though also generally positive. The acceptability and feasibility of the RSES is discussed. The ethos of pastoral care, support of senior figures and other contextual factors affected implementation quality in each school. Help-seeking in the young people was driven by peer norms of hiding signs of vulnerability. Conclusions: Acceptability and feasibility of the Change Project were interdependent. The intervention has potential for further development. Implementation is enhanced by understanding school context. Understanding barriers and facilitators of help-seeking in young people may encourage use of emotional support in school