1.The effectiveness of school-based counselling with young people Mick Cooper, Professor of Counselling EAC, Pushkin 2013 Thanks to: Jo Pybis, Katherine McArthur, Karen Cromarty, Andy Hill, Nancy Rowland, Jamie Murdoch, Nick Turner, Ruth Levesley, Peter Pearce, Sarah Osman, Ros Sewell Contact: mick.cooper@strath.ac.uk

2. Aims of talk 1. Review evidence from UK on school-based counselling and its effectiveness 2. Explore pathways by which school-based counselling might bring change about 3. The emergence of schoolbased counselling for young people in the UK196019701980199020002010 Source: Baginsky, 2004; BACP 2012 4. Widely disseminated Today, school-based counselling is one of the most common mental health and wellbeing provisions for young people in the UKSource: BACP 2012; Hill, 2011; estimated figures 5. Dissemination of school-based counselling in UK secondary schools Scotland: 64-80% (approx.) NI: All schools since 2007England: 61-85% (approx.)Wales: All schools since 2008Source: BACP 2012; estimated data for England and Scotland 6. International prevalence 39 countries around globe mandate school-based counselling (inc. Czech Republic, Slovakia and Romania) 24 countries: well-established but not compulsory (inc. Georgia, England) Overall, school counselling is developingrelatively quickly into an integral part of the education system in many parts of the world (Harris, 2013) 7. Service delivery in UK Delivered by qualified counsellors Primarily humanistic/integrative, orientation: relational, supportive, nondirective practice Generally one-to-one, confidential Orientation to mental wellbeing Mainly for young people: 11-18 Source: Cooper, 2009; Hill, 2011 8. Referral routes School staff Self Parents/carersSource: Cooper, 2009; Hill, 2011, estimates from approximately 20,000 young people 9. Reported waiting times: relatively brief 50%35% 1 week15% 1 monthSource: BACP, 2012; Hill, 2011; approximate data, as reported by school staff and local authority leads 10. Psychological difficulties at assessment (SDQ) (counselling)NormalAbnormal BorderlineSource: Cooper, 2009, from 611 young people 11. Presenting/developing issues 35Percentage3025 20 15 105 0Source: Cooper, 2009; Hill, 2011; approximate data from over 20,000 cases 12. BME under-represented Percentage2 1.5 10.5 0Counselling clientsAll WalesSource: Hill, 2011; data from 11,043 cases 13. Effectiveness Effectiveness 14. Pre-/postevaluation 15. YP-CORE: Principal outcome measure for school-based counselling in UK Higher total scores = More distress 16. Change from pre- to postcounselling Counselling consistently associated with significant reductions in psychological distress from beginning to endMeta-analyses, ES= 0.81 1.09 from pre- to postOutcome measure score (higher scores mean more distress)Welsh Strategy evaluation252015105Pre-counsellingPost-counsellingSource: Hill, 2011; Cooper, 2009; data from 17. In real terms Over the last week My problems have felt too much for me After counselling av. = 1.05Before counselling av. = 1.8701234Not at allOnly occasionallySometimesOftenMost or all of the time 18. Randomised controlled trials (RCTs) 19. The randomised controlled trial baselineendpoint CounsellingRandom allocationNot counselling (e.g., wait-list) 20. Global data School-based therapeutic interventions significantly reduce psychological distress (107 studies, mean effect size = 0.45 = medium effect) But evidence comes mainly from US studies, CBT/psycho-educational, often group-based Is counselling, as delivered by UK counsellors, effective? 21. School-based humanistic counselling Developed as distillation of UK practice Based on humanistic competences: relational, supportive approach, Rogerian foundations Four pilot RCTs comparing against waitlist 22. School-based humanistic counselling Reduced psychological distress Combined data from three RCTs with 53 clients in counselling, and 57 in waiting list Large effect Up to 10 weeks ES = 0.78 of SBHC Audited for adherence to humanistic competences 23. Qualitative data from service users 24. Service user perspectives It really does help you to concentrate better in class cos all your problems are like, sorted, so the teachers probably think it's good. I was sad when I went in there cos I lost my grandmother.. She says it goes she says it goes on in my life, she says she knows how hard it is ...The more and more I do learn from her, the more and more I get happier.Yeah it's changed my behaviour a lot.. I can walk away from situations instead of swing punches. Before, if I was fighting and one of my friends would grab me I'd hit em but now if they grab me I'll get off. I have recommended it to my friend, I said it really, really helps, you can talk about anything doesn't have to be a really big problem, just any problem you have -- bullying, relationships, friendships, anything - and she always tries to understand everything you say and even if she doesn't understand you can tell her off and just say, No you got it wrong, and she listens to everything you're saying, and what I'm describing -- it really helps. 25. Do teachers think counselling is helpful for clients? 26. Helpfulness: Teachers ratings (N = 125 pastoral care teachers)Extremely unhelpfulNeither helpful or unhelpfulExtremely helpful 27. Teachers open-ended responses In general, very positive about the helpfulness of counselling: I was sceptical to begin withbut its been great, excellent, superb This is an excellent service which has been of huge benefit to pupils on a short/long term basis Excellent resource which pupils find very valuable 28. Educational impact 29. Global data School therapeutic interventions significantly improve academic work (83 studies, overall effect size = 0.38) Class behaviour (teacher-rated): ES = 0.26 Academic achievement: ES = 0.36 Environmentally-related: ES = 0.26 Self-reported academic outcomes: ES = 0.59 30. Educational impact: UK data Self- and teacher-rated impact on: Motivation to attend / Ability to concentrate / Motivation to study / Willingness to participate in class Clients: Improved: 60-70% Same: 25-35% Worse: 5-10% Teachers Improved: 75-90% Same: 5-20% Worse: 2-3% 31. Long term outcomes 32. Follow-up data: YP-CORE 25counselling20 15 106 monthsendpointmidpointstartpoint5n = 17 33. Case controlled data: YP-CORE 25counselling20 15 106 monthsendpointmidpointstartpoint6 weeks pre12 weeks pre5n = 11 (n = 5 at 6 months) 34. How might school-based counselling help to bring about individual change? 35. Helpful aspects: young people 1. 2. 3. 4.Opportunity to talk and being listened to Getting things off ones chest Confidentiality Counsellors personal qualities (e.g., accepting) 5. Independence of counsellor 6. Directive therapeutic interventions (e.g., relaxation exercises) 36. Helpful aspects: school staff 1. 2. 3. 4. 5. 6.Accessibility of service Independence Confidentiality Specialist training Available for extended time periods Non-stigmatising 37. Summary 1. School-based counselling is major area of development internationally 2. Increasing evidence that significantly reduces young peoples levels of psychological distress, and their ability to engage with education 3. Gives young people an opportunity to talk through problems and feel better about selves 38. Summary School-based counselling is a widely disseminated intervention, but rigorous evidence of effectiveness is limited Emerging body of evidence suggests that it does bring about significant reductions in psychological distress Matches many clients experiences of counselling and cohort data