Brief Educational Workshops in Secondary Schools Trial (BESST trial), a school-based cluster randomised controlled trial of the DISCOVER workshop for 16-18-year-olds: recruitment and baseline characteristics.

BACKGROUND: The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16-18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants. METHOD: We enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation. RESULTS: Schools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward. CONCLUSION: The BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected. TRIAL REGISTRATION: ISRCTN registry ISRCTN90912799. Registered on 28 May 2020.

Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioural therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK.

BACKGROUND: Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief accessible stress workshop programme for 16-18-year-olds. We aimed to investigate the clinical effectiveness and cost-effectiveness of the DISCOVER cognitive behavioural therapy (CBT) workshop on symptoms of depression in 16-18-year-olds at 6 months compared with treatment-as-usual. METHODS: We conducted a multicentre, cluster randomised controlled trial in UK schools or colleges with sixth forms to evaluate clinical effectiveness and cost-effectiveness of a brief CBT workshop (DISCOVER) compared with treatment-as-usual. We planned to enrol 60 schools and 900 adolescents, using a self-referral system to recruit participants. Schools were randomised in a 1:1 ratio for participants to receive either the DISCOVER workshop or treatment-as-usual, stratified by site and balanced on school size and index of multiple deprivation. Participants were included if they were 16-18 years old, attending for the full school year, seeking help for stress, and fluent in English and able to provide written informed consent. The outcome assessors, senior health economist, senior statistician, and chief investigator were masked. People with lived experience were involved in the study. The primary outcome was depression symptoms measured with the Mood and Feelings Questionnaire (MFQ) at 6-month follow-up, in the intention-to-treat population of all participants with full covariate data. The trial was registered with the ISRCTN registry (ISRCTN90912799). FINDINGS: 111 schools were invited to participate in the study, seven were deemed ineligible, and 47 did not provide consent. Between Oct 4, 2021, and Nov 10, 2022, 933 students at 57 schools were screened for eligibility, seven were not eligible for inclusion, and 26 did not attend the baseline meeting and assessment, resulting in 900 adolescents participating in the study. The DISCOVER group included 443 participants (295 [67%] female and 136 [31%] male) and the treatment-as-usual group included 457 participants (346 [76%] female and 92 [20%] male). 468 (52%) of the 900 participants were White, and the overall age of the participants was 17·2 years (SD 0·6). 873 (97%) adolescents were followed up in the intention-to-treat population. The primary intention-to-treat analysis (n=854) found an adjusted mean difference in MFQ of -2·06 (95% CI -3·35 to -0·76; Cohen's d=-0·17; p=0·0019) at the 6-month follow-up, indicating a clinical improvement in the DISCOVER group. The probability that DISCOVER is cost- effective compared with treatment-as-usual ranged from 61% to 78% at a £20 000 to £30 000 per quality-adjusted life-year threshold. Nine adverse events (two of which were classified as serious) were reported in the DISCOVER group and 14 (two of which were classified as serious) were reported in the treatment-as-usual group. INTERPRETATION: Our findings indicate that the DISCOVER intervention is modestly clinically effective and economically viable and could be a promising early intervention in schools. Given the importance of addressing mental health needs early in this adolescent population, additional research is warranted to explore this intervention. FUNDING: National Institute for Health and Care Research Health Technology Assessment Programme.

Engaging Older Adolescent Boys Into School-Based Mental Health Workshops: Testing Theory-Based Facilitators and Barriers in Focus Groups.

Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This original research study aimed to explore four areas of interest around facilitating engagement of adolescent boys to a stress workshop intervention for adolescents in U.K. schools. The areas explored were male role models, destigmatizing language, trust building, and using a transparent and collaborative approach. We also sought to understand the main barriers to engagement. To explore these areas of interest, two focus groups were run, with a total of 12 young men, over two regional sites (London and Bath). Content analysis was used to analyze the data. Participants particularly valued transparency and collaboration as strong facilitators to engagement. Building of trust was the next most popular. Use of role models and destigmatizing language were the joint third most popular methods. The main barrier to help-seeking identified was perceived threat to masculine identity (self and social stigma). Given these novel findings, the factors of transparency and collaboration and building trust as facilitators merit further research, among both adults and adolescents.

Brief Educational Workshops in Secondary Schools Trial (BESST): protocol for a school-based cluster randomised controlled trial of open-access psychological workshop programme for 16-18-year-olds.

Anxiety and depression are increasingly prevalent in adolescents, often causing daily distress and negative long-term outcomes. Despite the significant and growing burden, less than 25% of those with probable diagnosis of anxiety and depression are receiving help in England. Significant barriers to help-seeking exist in this population, with a scarcity of easily accessible, effective, and cost-effective interventions tailored specially for this age group. One intervention that has been shown to be feasible to deliver and with the promise of reducing stress in this age group is a school-based stress workshop programme for 16-18-year-olds (herein called DISCOVER). The next step is to rigorously assess the effectiveness, and cost-effectiveness, of the DISCOVER intervention in a fully powered cluster randomised controlled trial (cRCT). If found to be clinically and cost-effective, DISCOVER could be scaled up as a service model UK-wide and have a meaningful impact on the mental health of adolescents across the country.Trial registration: ISRCTN registry ISRCTN90912799. Registered with ISRCTN 28 May 2020.

Feasibility randomized controlled trial of a one-day CBT workshop ('DISCOVER') for 15- to 18-year-olds with anxiety and/or depression in clinic settings.

BACKGROUND: 'DISCOVER' one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes. AIMS: The current study aimed to test the model for clinically referred adolescents, in real-world settings. METHOD: A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being. RESULTS: n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size. CONCLUSIONS: DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.

School-based early intervention for anxiety and depression in older adolescents: A feasibility randomised controlled trial of a self-referral stress management workshop programme ("DISCOVER").

INTRODUCTION: Schools may provide a convenient intervention setting for young people with mental health problems generally, as well as for those who are unwilling or unable to access traditional clinic-based mental health services. However, few studies focus on older adolescents, or those from ethnic minority groups. This study aims to assess the feasibility of a brief school-based psychological intervention for self-referred adolescents aged 16-19 years. METHODS: A two-arm cluster randomised controlled trial was conducted in 10 inner-city schools with block randomisation of schools. The intervention comprised a one-day CBT Stress management programme with telephone follow-up (DISCOVER) delivered by 3 psychology (2 clinical and 1 assistant) staff. The control was a waitlist condition. Primary outcomes were depression (Mood and Feelings Questionnaire; MFQ) and anxiety (Revised Child Anxiety and Depression Scale; RCADS-anxiety subscale). Data were analysed descriptively and quantitatively to assess feasibility. RESULTS: 155 students were enrolled and 142 (91.6%) followed up after 3 months. Participants were predominantly female (81%) and the mean age was 17.3 years, with equal numbers enrolled from Year 12 and Year 13. Over half (55%) of students were from ethnic minority groups. Intraclass correlations were low. Variance estimates were calculated to estimate the sample size for a full RCT. Preliminary outcomes were encouraging, with reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at follow-up. CONCLUSIONS: Results support the feasibility of a school-based, self-referral intervention with older adolescents in a definitive future full-scale trial (Trial no. ISRCTN88636606).

Early intervention for depression and anxiety in 16-18-year-olds: Protocol for a feasibility cluster randomised controlled trial of open-access psychological workshops in schools (DISCOVER).

Adolescence is a vulnerable period for the development of mental health problems. The DISCOVER intervention aims to provide accessible, acceptable and cost-effective psychological support for stressed adolescents in inner-city secondary schools. The intervention uses age-appropriate cognitive-behavioural therapy (CBT) methods and materials, delivered in an interactive 1-day workshop with additional telephone support. An open-access entry route allows students to self-refer. This protocol describes a feasibility cluster randomised controlled trial (RCT) comparing DISCOVER with a waitlist control condition. The study will run across 10 clusters (secondary schools) in the inner London Boroughs of Southwark and Lambeth. Participants are students aged over 16years who are seeking help with anxiety and/or depressive symptoms. Key feasibility parameters relate to the proportion of students willing to participate in the research following publicity events; the proportion of students who complete the intervention; and response rates for outcome measures. Outcome variance estimates and intra-cluster correlations will be obtained for future power calculations. Qualitative methods will be used to explore the acceptability of the intervention and research procedures for students and school staff. The feasibility of an economic evaluation will also be examined. The results will (i) determine the appropriateness of proceeding to a definitive full-scale trial; and (ii) inform the development of an optimised version of the DISCOVER intervention that can be tested within feasible parameters.

Innovations in Practice: DISCOVER CBT workshops for 16-18-year-olds: development of an open-access intervention for anxiety and depression in inner-city youth.

BACKGROUND: Anxiety and depression are common in adolescence but access to effective intervention is limited. METHOD: Open-access CBT workshops were developed in consultation with 16-18-year-olds. Rates of uptake, pre-post outcomes and acceptability of workshops were assessed in an uncontrolled study. RESULTS: Participants (N = 31) were predominantly from black and minority ethnic groups and three quarters had not previously sought psychological support. Improvements were observed in self-reported anxiety, depression and self-esteem at 12-week follow-up. High levels of satisfaction were reported along with suggestions for further programme development. CONCLUSIONS: Community-based CBT workshops show promise in terms of accessibility and acceptability for older adolescents who may not otherwise engage in mental health services.

Understanding the experiences and emotional needs of unaccompanied asylum-seeking adolescents in the UK.

For adolescents who flee to the UK seeking asylum, the experience of leaving their home country puts them at risk of developing mental health problems. Although there is a research base exploring the mental health of asylum-seeking children and adolescents who arrive with their families, there is in contrast very little focusing on the mental health needs of children and adolescents who arrive in the UK alone. There has been ongoing debate about whether current theoretical models for understanding reactions to trauma and loss are helpful in supporting unaccompanied asylum-seeking children and adolescents with complex psychological and social issues as a result of fleeing their home countries. This article draws on young people's own understanding of their experiences of seeking asylum in the UK using a qualitative semi-structured interview. It attempts to develop a more contextually relevant understanding of their emotional reactions to adversity and to consider the sorts of support required. Interpretative Phenomenological Analysis was used to provide an in-depth understanding of six young asylum seekers' experiences, exploring themes of loss, negotiating a new life, psychological distress and the process of adjustment. Psychological interventions and future service provision for this group are discussed.

Psychological needs, service utilization and provision of care in a specialist mental health clinic for young refugees: a comparative study.

This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed.

The Role and Value of a Paediatric Specialist Neurodevelopmental Diagnostic Service: Parental Perceptions.

BACKGROUND: This study was undertaken to explore parental perceptions of the role and value of a specialist service for children and families. This service offers assessment and diagnosis of children with neurodevelopmental disorders of the kind that are not evident at birth. METHOD: Information was collected from 37 families on expectations and experience of clinic attendance, user satisfaction and outcome through interviews and questionnaires, once before and twice after clinic attendance. RESULTS: 87% of parents found clinic attendance worthwhile, with most expecting to be provided with a diagnosis and advice on education. Parents perceived that the clinic was best able to meet their diagnostic needs and they reported that they were more able to obtain a diagnosis and a specialist opinion at a regional centre than at local clinics. Parent satisfaction with the parent-child relationship improved following clinic attendance and parents' self-identified concerns about their child decreased.