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

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.