Pushkin

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Keynote speech by Mick Cooper at the European Association for Counselling conference in St Petersburg Sept 26th - 28th 2013 "The effectiveness of school-based counselling with young people"

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  • Actually, really not at all. Without humanistic counselling over a 12 week period really didn’t do well, while those who received it improved very substantially
  • Pushkin

    1. 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. 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. 3. The emergence of schoolbased counselling for young people in the UK 1960 1970 1980 1990 2000 2010 Source: Baginsky, 2004; BACP 2012
    4. 4. Widely disseminated • Today, school-based counselling is one of the most common mental health and wellbeing provisions for young people in the UK Source: BACP 2012; Hill, 2011; estimated figures
    5. 5. Dissemination of school-based counselling in UK secondary schools Scotland: 64-80% (approx.) NI: All schools since 2007 England: 61-85% (approx.) Wales: All schools since 2008 Source: BACP 2012; estimated data for England and Scotland
    6. 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 developing relatively quickly into an integral part of the education system in many parts of the world‟ (Harris, 2013)
    7. 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. 8. Referral routes School staff Self Parents/carers Source: Cooper, 2009; Hill, 2011, estimates from approximately 20,000 young people
    9. 9. Reported waiting times: relatively brief 50% 35% 1 week 15% 1 month Source: BACP, 2012; Hill, 2011; approximate data, as reported by school staff and local authority leads
    10. 10. Psychological difficulties at assessment (SDQ) (counselling) „Normal‟ „Abnormal‟ „Borderline‟ Source: Cooper, 2009, from 611 young people
    11. 11. Presenting/developing issues 35 Percentage 30 25 20 15 10 5 0 Source: Cooper, 2009; Hill, 2011; approximate data from over 20,000 cases
    12. 12. BME under-represented Percentage 2 1.5 1 0.5 0 Counselling clients All Wales Source: Hill, 2011; data from 11,043 cases
    13. 13. Effectiveness Effectiveness
    14. 14. Pre-/postevaluation
    15. 15. YP-CORE: Principal outcome measure for school-based counselling in UK    Higher total scores = More distress
    16. 16. Change from pre- to postcounselling Counselling consistently associated with significant reductions in psychological distress from beginning to end Meta-analyses, ES= 0.81 – 1.09 from pre- to postOutcome measure score (higher scores mean more distress) Welsh Strategy evaluation 25 20 15 10 5 Pre-counselling Post-counselling Source: Hill, 2011; Cooper, 2009; data from
    17. 17. In “real” terms… Over the last week… „My problems have felt too much for me‟ After counselling av. = 1.05 Before counselling av. = 1.87 0 1 2 3 4 Not at all Only occasionally Sometimes Often Most or all of the time
    18. 18. Randomised controlled trials (RCTs)
    19. 19. The randomised controlled trial „baseline‟ ‟endpoint‟ Counselling Random allocation Not counselling (e.g., wait-list)
    20. 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. 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. 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. 23. Qualitative data from service users
    24. 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. 25. Do teachers think counselling is helpful for clients?
    26. 26. Helpfulness: Teachers‟ ratings (N = 125 pastoral care teachers) „Extremely unhelpful‟ „Neither helpful or unhelpful‟ „Extremely helpful‟
    27. 27. Teachers‟ open-ended responses • In general, very positive about the helpfulness of counselling: „I was sceptical to begin with…but it‟s 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. 28. Educational impact
    29. 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. 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. 31. Long term outcomes
    32. 32. Follow-up data: YP-CORE 25 counselling 20 15 10 6 months endpoint midpoint startpoint 5 n = 17
    33. 33. Case controlled data: YP-CORE 25 counselling 20 15 10 6 months endpoint midpoint startpoint 6 weeks pre 12 weeks pre 5 n = 11 (n = 5 at 6 months)
    34. 34. How might school-based counselling help to bring about individual change?
    35. 35. Helpful aspects: young people 1. 2. 3. 4. Opportunity to talk and being listened to Getting things off one‟s chest Confidentiality Counsellors‟ personal qualities (e.g., accepting) 5. Independence of counsellor 6. Directive therapeutic interventions (e.g., relaxation exercises)
    36. 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. 37. Summary 1. School-based counselling is major area of development internationally 2. Increasing evidence that significantly reduces young people‟s 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. 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

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