Innovations in Practice: CUES-Ed: an in-service evaluation of a new universal cognitive behavioural early mental health intervention programme for primary school children.

Abstract

Earlier childhood interventions to reduce mental health vulnerability are a global health priority yet poorly implemented. Barriers include negotiating health/education interfaces, and mixed outcomes, particularly for vulnerable children. CUES-Ed aimed to address these barriers, comprising a cognitive behavioural early intervention targeting mental health vulnerability in 7-10year-olds, with integrated evaluation, delivered through close liaison with stakeholders. Following 2years of ad hoc delivery, relationship-building, and refining the intervention and evaluation, we report on implementation and in-service outcomes for local schools completing the standardised CUES-Ed programme. We evaluated delivery from 01/2017 to 07/2017 across n=12 schools (n=23 classes, n=638 pupils, n=35 teachers). Eight one-hour weekly sessions (S1-S8) were delivered by mental health professionals with teachers present. Pupil-reported wellbeing/distress and emotional/behavioural difficulties were assessed at S1 and S8; pupil free text feedback/ratings and teacher ratings at S8. Two classes (n=60) completed outcomes whilst awaiting CUES-Ed, forming a naturalistic waitlist. At S8, pupil-reported outcome data were obtained from 535 and feedback/ratings from 577 pupils, respectively. Thematic analysis of feedback indicated positive subjective impact. Vulnerable children (defined as self-rated borderline/clinical cut-off baselines scores on the wellbeing/distress and emotional/behavioural difficulties measures) improved with medium pre-post effect sizes (d=0.46-0.65), and small, but consistent, effects compared to waitlist. In-service evaluation suggests a feasible model of delivery, good acceptability and potential to improve outcomes for vulnerable children. Controlled evaluation is now indicated.