Abstract
BackgroundOne in ten children in Britain have been identified as experiencing a diagnosable mental health disorder. School-based humanistic counselling (SBHC) may help young people identify, address, and overcome psychological distress. Data from four pilot trials suggest that SBHC may be clinically effective. However, a fully powered randomised controlled trial (RCT) is needed to provide a robust test of its effectiveness, to assess its cost-effectiveness, and to determine the process of change.Methods/designThe Effectiveness and Cost-effectiveness Trial of Humanistic Counselling in Schools (ETHOS) is a two-arm, parallel-group RCT comparing the clinical and cost-effectiveness of SBHC with Pastoral Care as Usual (PCAU) in school settings. Eligibility criteria for young people include being between 13 and 16 years of age and experiencing moderate to severe levels of emotional distress. Participants are randomised to receive either SBHC or PCAU. SBHC is delivered in up to 10 weekly, individual sessions in their school with a qualified, experienced counsellor who has also received training using a clinical practice manual. Adherence to the SBHC model is assessed by a sub-team of auditors and in clinical supervision. PCAU consists of the schools’ pre-existing systems for supporting the emotional health and well-being of students. The primary outcomes are psychological distress measured using the Young Person’s Clinical Outcomes in Routine Evaluation (YP-CORE) and costs evaluated using the Client Service Receipt Inventory (CSRI). Secondary outcomes include psychological difficulties, levels of depression, anxiety and self-esteem, well-being, school engagement, educational outcomes and achievement of personal goals. Qualitative interviews with participants, parents and school staff will look to identify the mechanisms of change in SBHC. Researchers administering the measures are blind to allocation. The trial requires n = 306 participants (n = 153 in each group), with 90% power to detect a standardised mean difference (SMD) of 0.5. An intention-to-treat analysis will be undertaken.DiscussionThis RCT is powered to detect clinically meaningful differences, and will make a major contribution to the evidence base for mental health provision for adolescents. It will have implications for all stakeholders, including policy-makers, statutory advisory bodies for child welfare, head teachers, children and young people practitioners, child welfare and parenting organisations, and young people.Trial registrationControlled Trials International Standard Randomised Controlled Trial Number (ISRCTN) Registry, ID: ISRCTN10460622. Registered on 11 May 2016.
Highlights
One in ten children in Britain have been identified as experiencing a diagnosable mental health disorder
Evidence primarily comes from trials of cognitive behaviour therapy (CBT), which is an established intervention for clinical presentations such as anxiety and depression in children and young people (e.g. National Institute for Health and Care Excellence [19])
Many young people referred to school counselling services do not present with specific clinical disorders [20]
Summary
School-based humanistic counselling (SBHC) may help young people identify, address, and overcome psychological distress. One in ten children in Britain have been identified as experiencing a diagnosable mental health disorder [1]. A study conducted by The Prince’s Trust [2] reported that 30% of young people aged between 16 and 25 years reported ‘always’ or ‘often’ feeling ‘down’ or ‘depressed’, and 21% felt that they did not receive the support they needed from school. There is some evidence that levels of mental health problems in children and young people are increasing [9]. Research has indicated that children with persistent behavioural or emotional difficulties are more likely to be excluded from school, and more likely to leave schools without obtaining their educational qualifications [1, 10], whereas emotional, behavioural, social and school well-being predict higher levels of academic achievement and engagement in school [11]
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