Counselling in UK secondary schools: What the research is telling us

1. Counselling in UK secondary schools: What the research is telling us BACP CCYP 2011 Mick Cooper Professor of Counselling

2. Background • Rapid growth of interest in school-based counselling in UK • Services now rolled out across all secondary schools in Wales and Northern Ireland • Discussions with English and Scottish governments • But where is evidence…

3. Aims of talk • To present a state-of-the-art review of what we know about school-based counselling in the UK: • Who uses the services, and how? • What are the outcomes like? • Draw from three sources…

4. Cooper, M. (2009). Counselling in UK secondary schools: A comprehensive review of audit and evaluation studies Counselling and Psychotherapy Research, 9(3), 137-150. Source 1 2009 Review of 30 audit and evaluation studies of school-based counselling in UK secondary sector: >10,000 episodes (demographics); 2,164 episodes (outcomes)

5. To download report and executive summary, search “BACP Welsh evaluation” Source 2 2011 Evaluation of the Welsh school-based counselling strategy 11,043 episodes (demographics) 3,613 episodes (outcomes)

6. Cooper, M., Rowland, N., McArthur, K., Pattison, S., Cromarty, K., & Richards, K. (2010). Randomised controlled trial of school-based humanistic counselling for emotional distress in young people: Feasibility study and preliminary indications of efficacy. Child and Adolescent Psychiatry and Mental Health, 4(1), 1-12.Download from: www.capmh.com/content/4/1/12 Source 3 Two randomised controlled trials of school-based counselling (and one on the way)

7. What is the orientation of school-based counselling?

8. Therapy orientation

9. Therapy orientation

10. Practice: summary • School-based counselling in the UK tends to be person-centred/ humanistic • Though many counsellors integrate elements of other approaches (particularly in Wales)

11. 1. CLIENTS

12. How are young people referred in to school-based counselling?

13. Referral source by dataset (2009 review) (Max. N = 18 datasets)

14. Welsh evaluation: Referral

15. Referral: Summary • Teaching/pastoral staff most common: involved in about 2/3rds of all referrals • About 1/4 young people self-refer

16. How many sessions do clients attend for?

17. Number of sessions • Mean (2009 review) = 6.35 sessions • Mean (Welsh eval.) = 3.7 sessions • Across datasets, majority of clients attend for four or less sessions, with a small minority 10+

18. Number of sessions attended by clients (From Glasgow III dataset)

19. Number of sessions: Summary • Clients in school-based counselling tend to attend for 2-6 sessions • A few attend for much longer

20. Who attends most, males or females?

21. Gender 2009 Review Welsh evaluation

22. Gender: Summary • Ratio of females to males in school-based counselling is about 60:40

23. How old are clients?

24. Age (2009 review) • Mean age = 13.86 • Year 9 most common

25. School year (Welsh evaluation)

26. Age: Summary • Middle school years (year 8 – year 11) most commonly attend school-based counselling

27. Ethnicity?

28. Ethnicity (2009 Review) • 3% of clients from BME backgrounds • One study compared this against school-wide representation, and found that BME young people somewhat under-represented, especially Pakistani

29. Ethnicity (Welsh evaluation)

30. Ethnicity: Summary • Emerging evidence that BME young people are under-represented in school-based counselling • Particularly those from Asian backgrounds • (Welsh review also suggested that clients with SEN/disabilities, and looked after children, under-represented)

31. What problems do clients bring to counselling, and discuss?

32. Presenting issues (2009 Review) (Max. N = 23 datasets)

33. Presenting issues (Welsh evaluation) percentage

34. Issues: Summary • Most common issue in school-based counselling, by long way, is ‘family’ (about 1/3 of clients) • Anger and behaviour-related issues also very common (particularly for boys) • (Issues discussed tend to be relatively similar to those presented)

35. How distressed are young people who come to school-based counselling?

36. Comparative levels of pre-counselling distress

37. Comparative levels of pre-counselling distress

38. Levels of distress: Summary • Young people coming to school-based counselling are experiencing relatively high levels of distress, not dissimilar to those attending CAMHS services

39. 2. Outcomes

40. Studying therapeutic outcomes • Clients completed measures of psychological wellbeing at the beginning of counselling … and again at the end

41. YP-CORE: Principal outcome measure for school-based counselling in UK    Higher total scores = More distress

42. Changes in distress Got better? Got worse?

43. Is counselling associated with improvements in wellbeing?

44. ‘Yes’ (2009 Review) • Every evaluation dataset (N = 16) shows significant reductions in distress from pre- to post-counselling

45. 2009 Review

46. ‘Yes’ (Welsh evaluation) • Every evaluation dataset (N = 42) shows significant reductions in distress from pre- to post-counselling

47. Welsh evaluation

48. Qualitative responses match quantitative data ‘Service is brilliant. I am glad I accepted the counselling. It has been a great help.’ ‘It really helped me. It’s, it’s really the best thing I’ve ever done’ ‘It was really good, really helpful. I was loads better’ (2009 Review)

49. Clients’ perspectives (from Welsh eval.) “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 ‘embut 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.”

50. Outcomes: Summary • School-based counselling is consistently associated with reductions of levels of psychological distress: as assessed both ‘objectively’ and ‘subjectively’