How clinical and research teams are working together to reduce stress in sixth form students

How clinical and research teams are working together to reduce stress in sixth form students

How clinical and research teams are working together to reduce stress in sixth form students
Over the last few years, rates of mental health disorders among young people have been rising. The latest data from the NHS found that in children aged seven to 16 years, rates rose from one in nine in 2017 to one in six in 2022. Adolescents aged 17 to 19 saw an even greater increase in mental health difficulties, rising from one in 10 in 2017 to one in four in 2022 – this means a quarter of young people in this age group were experiencing a probable mental health disorder.

Dr Stephen Lisk

Trial Manager for BESST at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London

Adolescence is a key period for the prevention and treatment of depression and anxiety, as half of lifetime mental health problems start by age 14. We know that accessible and effective interventions are crucial to combatting these conditions, especially in the lives of adolescents where there are many barriers to help seeking, such as long waiting lists, inconvenient locations, competing time commitments, and fear of stigma. Researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and clinicians at South London and Maudsley NHS Foundation Trust have been working together to develop and test a school-based group workshop programme called DISCOVER to help reduce stress in young people aged 16-18 years.

 

The DISCOVER programme, led by Dr Irene Sclare from South London and Maudsley NHS Trust, uses psychoeducation and cognitive behavioural therapy (CBT) methods to equip sixth form students with tools to better manage their stress. Researchers in four areas of the UK, led by Dr June Brown, Reader in Clinical Psychology at King’s IoPPN, are running a large clinical trial, called the Brief Educational Workshops in Secondary Schools Trial (BESST), to investigate the effectiveness of DISCOVER.

So, what is my role in this project? I am trial manager for BESST, acting as a central coordinator to ensure all the clinical and research elements of this large research project come together as planned. You could therefore say I am a link between all the different teams – so let me explain how this collaboration works!

How did BESST and DISCOVER come together?

Based on an adult workshop model developed by Dr June Brown, Dr Irene Sclare started developing the DISCOVER stress workshops for adolescents. In 2014, they collaborated to run the first pilot study of the workshops in schools in South London. Their teams subsequently ran a slightly larger study in 2019 which showed the DISCOVER workshops were accessible and likely to be effective. However, a larger study was needed to rigorously investigate the effectiveness of the workshops – hence BESST was born.

Understanding the structure of BESST

BESST is a nationwide randomised controlled trial (RCT), funded by the National Institute of Health and Care Research (NIHR), with multiple institutions contributing to the project. There are two sides of BESST – research and clinical. The research side is led by King’s College London, with the IoPPN acting as the trial’s core research institution. However, we also collaborate with other research institutions across England to make this possible, including the Anna Freud Centre in London and Manchester, University of Bath, University of Northampton, and Middlesex University. Our research teams are responsible for all organisation of the trial, recruitment of schools, participants and workshop delivery teams, data collection and management, and data analysis and reporting findings.

On the clinical side of the trial, we continue a long-standing collaboration with the DISCOVER workshop team at South London and Maudsley NHS Foundation Trust, with the DISCOVER team leader, Dr Irene Sclare, as the clinical lead for BESST. The DISCOVER team have provided valuable input into workshop delivery within the trial and have been responsible for ensuring staff are fully trained to deliver the workshop programme. As trial manager, I have been working closely with members of the DISCOVER team to ensure the research and clinical aspects of the trial work together effectively.

What does the trial actually look like?

BESST is a cluster randomised control trial. This means that we recruit a number of students within several ‘clusters’ (in this case, school sixth forms) to participate in the trial. We then randomly allocate half of the sixth forms (and all participating students within them) to receive the DISCOVER programme delivered by a workshop delivery team (intervention arm), and half to receive their usual school care but no workshop (control arm). Our six research workers conduct assessments with all students at the start of the trial, and at three- and six-months after the workshop so we can understand what effect the workshop has on the students.

Working with clinical teams to run DISCOVER in schools

We’ve had a lot of interest and enthusiasm from students and staff to take part in BESST. We recruited 57 sixth forms across Greater London, Southwest England, Midlands, and Northwest England, with a total of 900 students taking part in the trial. With this trial being nationwide, it was far too large in scope for all workshops to be delivered by the core DISCOVER team at the Trust. We therefore recruited 16 Mental Health Support Teams (MHSTs) from 11 NHS Trusts across England to deliver DISCOVER in the sixth forms allocated to receive it. MHSTs are teams of mental health professionals that are already embedded within schools in England, making them ideal to be trained to deliver the workshop programme. The DISCOVER team ran a series of two-day training sessions with all MHSTs to ensure all staff were ready to deliver the workshops, as well as providing ongoing supervision sessions throughout BESST. It was then my role to ensure the schools were ready to receive the workshops being delivered by these MHSTs.

What happens next with BESST?

By the end of 2022, the last workshop had been delivered in the trial; in fact, every single workshop that was due to be delivered was completed according to plan, which is a fantastic achievement for everyone involved in the trial. We have now finished following up with students after the workshops, with the last students followed up in May 2023, and have been busy performing the analyses to understand how effective the workshop was. The results will be ready to publish soon – we hope they will inform our approach to early intervention and lead to wider roll-out to provide highly accessible support for as many young people as possible, giving them the resources they need to combat mental health difficulties during a highly vulnerable period.

Please do check out the BESST twitter account to follow along with our progress.

You can also read more about how DISCOVER was developed in Dr June Brown’s blog.

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Children and Families Policy Research Unit awarded £5.5m by NIHR

Children and Families Policy Research Unit awarded £5.5m by NIHR

Children and Families Policy Research Unit awarded £5.5m by NIHR

The Children and Families Policy Research Unit (CPRU) has been awarded funding worth an estimated £5.5M by the National Institute of Health and Care Research (NIHR), to continue its operations for the next five years, starting from January 2024. Dr Johnny Downs, an NIHR Clinician Scientist at the IoPPN, King’s College London, has been named a co-investigator of the CPRU.

The CPRU is a collaboration between UCL and the universities of Bristol, Oxford, Manchester, Newcastle, King’s College London, Bradford Institute for Health Research, Anna Freud Centre, and Institute of Fiscal Studies. The aim of the CPRU is to conduct high-quality research which enables policymakers and practitioners to make informed decisions which affect the nation’s health and wellbeing. The announcement builds on the work done by the CPRU over a decade, and further strengthens its commitment to support evidence based policy-making at a local and national level.

Under the co-directorship of Professor Ruth Gilbert, GOS Institute of Child Health, Institute of Education, and Dr Jenny Woodman, Institute of Education (IOE), Social Research Institute, and Thomas Coram Research Institute, the CPRU has worked to deliver groundbreaking research programmes into addressing health inequalities, supporting vulnerable children and families, and improving health outcomes for children with disabilities and long-term conditions. The CPRU works closely with children and families to put their experiences at the heart of research and ensure that they can inform and influence policy decisions.

Dr Jenny Woodman said: “With this important funding, we will be able to work with analysts and policy colleagues at the Department of Health and Social Care and other government departments to generate and present high quality evidence at the right time to support their decisions. We research what makes children healthier, taking into account the environments in which they live, the places they spend time, the health of their parents and carers and siblings and the health, education and other services they and their families use.”

 

It is a great privilege to join the NIHR Children and Families Policy Research Unit at UCL which has such a wonderful track history in creating data resources, developing research methods and delivering high quality evidence that impacts policy and practice for children and families. Between 2024-2029, the policy research programme will be examining how public, primary and specialist physical and mental health interventions can best deliver effective health and social care for vulnerable children and families and reduce health disparities. The Unit has put together a great interdisciplinary team and I am delighted that its work has such a strong emphasis on engaging young people, their families, mental health clinicians and researchers. I’m really looking forward to getting started.
Dr Johnny Downs

NIHR Clinician Scientist at the Department of Child & Adolescent Psychiatry at King's IoPPN and co-investigator on the NIHR Children and Families Policy Research Unit

The funding will enable a further five years of research on priority policy areas for child and family health for the Department of Health and Social Care, such as health inequalities, early years support for children and parents, support from health, education and social care for children and young people affected by chronic physical or mental health conditions, and services to address family violence.

The award is part of a package of funding for Policy Research Units across England & Wales announced by NIHR worth an estimated £100M.

 

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New parenting app reduced child emotional difficulties during COVID-19 pandemic

New parenting app reduced child emotional difficulties during COVID-19 pandemic

New parenting app reduced child emotional difficulties during COVID-19 pandemic

New research finds a novel parenting smartphone app, developed by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and South London and Maudsley NHS Foundation Trust, reduced child emotional problems during the COVID-19 pandemic.

Published in the Journal of Medical Internet Research (JMIR), the Supporting Parents And Kids Through Lockdown Experiences (SPARKLE) trial – a collaboration between King’s and the University of Oxford – investigated whether Parent Positive was effective in reducing child emotional and conduct problems and improving parents’ own wellbeing, and whether improvements were achieved in a cost-effective way.

Researchers followed 646 parents with children aged between four and 10 between May and July 2021, with 320 receiving access to Parent Positive compared with 326 who did not. They found that Parent Positive reduced child emotional problems after both one and two months of access to the app, compared to not having app access at all. This was found to be a cost-effective way of reducing children’s emotional problems.

We believe our study is the first clinical trial of a parenting support app designed specifically to support parents during the COVID-19 pandemic. In response to the pandemic and subsequent lockdowns, we quickly developed Parent Positive to help mitigate the impact on children’s emotional and conduct problems. We found that, on average, families who had access to the app reported reduced child emotional problems compared to those who did not. The findings highlight that, if implemented across the general UK population, Parent Positive could have the potential to make a significant contribution to reducing child emotional problems.

Dr Melanie Palmer

Postdoctoral Research Associate at King’s IoPPN and first author of the JMIR article

The COVID-19 lockdowns presented parents with some extraordinary challenges. Getting face-to-face support to them using traditional approaches was very challenging during this period. The results from the SPARKLE trial highlight the potential of digital approaches as a way of disseminating advice and support to parents that can produce tangible results. We are hopeful that this approach can have many uses in the post-COVID world in providing a resource to families in underserved or marginalised communities or utilised as part of first-line interventions in hard pressed services.

Professor Edmund Sonuga-Barke

Professor of Developmental Psychology, Psychiatry & Neuroscience at King’s IoPPN and Principal Investigator on SPARKLE

Contrary to the researchers’ expectations, access to the app did not lead to significant improvements in child conduct problems, despite the advice on managing difficult behaviours it provided. Researchers also found no evidence that those who had access to the app experienced less parent psychological distress, parental child-related worries, or family conflict than those who did not. In fact, there was an increase in child-related parental worries after two-months. The researchers explain that this may be due to the difficulties related to changing parenting styles and routines, or the increase in awareness of good parenting practices leading to insecurity about their parenting skills.

The researchers collaborated with parents of young children across all aspects of the study to better understand their views on how the app could address their support needs. They are now co-developing the app further to improve usability, increase engagement and improve the positive effects for parents and their children.

SPARKLE was funded by the UK Research and Innovation Economic and Social Research Council (UKRI-ESRC).

‘The effectiveness of a universal digital parenting intervention designed and implemented during the COVID-19 pandemic: Evidence from a rapid implementation randomised controlled trial within a cohort’ (Melanie Palmer, Nicholas Beckley-Hoelscher, James Shearer, Katarzyna Kostyrka-Allchorne, Olly Robertson, Marta Koch, Oliver Pearson, Petr Slovak, Crispin Day, Sarah Byford, Kimberley Goldsmith, Polly Waite, Cathy Creswell & Edmund J S Sonuga-Barke) was published in the Journal of Medical Internet Research (DOI: 10.2196/44079).

For more information, please contact Amelia Remmington (Communications & Engagement Officer).

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Working with students and teachers to evaluate secondary school stress workshops

Working with students and teachers to evaluate secondary school stress workshops

Working with students and teachers to evaluate secondary school stress workshops
Dr June Brown is Reader/Associate Professor in Clinical Psychology at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and the lead for Brief Educational workshops in Secondary Schools Trial (BESST). In this blog she describes how a small pilot with schools in South London has now led to a national clinical trial funded by the National Institute for Health and Care Research (NIHR) with 900 students across 57 schools.
Dr June Brown

Dr June Brown

Reader/Associate Professor in Clinical Psychology at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London

I have always had a longstanding interest is how we reach people who do not or can not access services for depression and anxiety, especially as evidence suggests only about 30% of people with mental health problems actually receive help and 70% never get the support they need.

To try and rectify this number at a grass roots level I started running workshops for adults in Southwark, in everyday settings such as leisure or community centres. These workshops covered stress, depression/self-confidence, insomnia, and anger. They aimed to be effective as well accessible to the general public who would normally not access help from clinical services.

Key to their accessibility was the use of a self-referral system, so those who felt they needed this help could simply come along to the workshop. We found this approach attracted large numbers of minoritised groups and also those who had not previously sought help from their GPs.

From small beginnings to a national clinical trial

Dr Irene Sclare, a clinical psychologist at South London and Maudsley who works with adolescents, shared my thinking about this need for accessible interventions, especially for young people who encounter significant barriers to help from the NHS because of long waiting lists, inconvenient appointment times and locations (often during school hours and in clinics), and the prioritisation of care for those with very severe problems.

Irene started developing stress workshops for adolescents and, in 2014, we first ran a very small pilot study of the workshops (known as DISCOVER) in schools in South London. We subsequently ran a slightly larger study in 2019 which showed the DISCOVER workshops were accessible and likely to be effective. However, a larger study was needed to rigorously investigate the effectiveness of the workshops.

In July 2019 we received a grant from the NIHR Heath Technology Assessment (HTA) for just under £1.7m to run this clinical trial which covers four regions of England: London, Midlands, Southwest, and Northwest. Our target was to recruit 900 students in 60 schools across these 4 regions – half of which would receive the workshop.

BESST – the trial

When we started the trial in January 2020, we had to pause for a year as lockdown was put in place on 26th March 2020, a week after our trial manager began work! A year later we re-started the trial and recruited our research workers in anticipation of a start in September 2021, despite various scares about schools not letting us in (and maybe even having to change to an online intervention!)

Once we re-started the trial in April 2021 and decided that we would stick to face-to-face workshops, we recruited 19 schools and 6 services to deliver the workshops. We did succeed in recruiting 379 students in September 2021 and then had to work extremely hard the following year to make up the difference. In year 2, we recruited 11 services and 38 schools, enrolling 521 students into the trial.

Now we have reached our target of 900 students across 57 schools and are getting over 90 per cent follow-up rates, which we’re very happy about. A really interesting (and important) finding is that just under half of the students are from diverse backgrounds and that 80 per cent have not previously received help. This demonstrates the key element of accessibility that we hoped to build into these workshops and the research.

What has led to this success? So many things …

The workshop delivery teams have been very enthusiastic about getting trained in our approach. The school staff have also been really keen for the workshops to be offered to their students.

We think we have reached so many students because they believed that they needed the workshops even though they knew there was a 50 per cent chance they wouldn’t receive them. As in those first workshops I ran in Southwark in 2004 I think the self-referral system has really helped in reaching so many students. It has allowed them to feel an element of control about enrolling where they did have the choice, and weren’t required to go through a formalised diagnostic process.

“I think that the study was really helpful when it comes to stress and depression in students….they taught us really useful ways to help deal with that kind of stuff, especially stress about relationships and exams… I think that the best way BESST could help more students is by doing this workshop in more schools, all schools if possible. By offering this experience to everyone would bring more of an awareness to how to deal with mental health problems such as depression and stress.”
Aiden

BESST participant

Alongside this, the collaboration in our team has been brilliant. The BESST trial management team has helped to work through the challenges of the pandemic as well as running this exciting trial. The research workers have also been a fantastic group who have worked really hard to make the trial a success. And last but not least, our trial manager, Steve Lisk, has been superb, empathetically leading the research workers and calmly handling the difficulties that have arisen so we could reach our targets.

The future

We are expecting the results of the trial to be analysed in 2 months’ time, so we are very excited – and a bit anxious – about what we will find!

Whatever the outcome we are extremely grateful for everyone who took part in the research: the delivery teams, the school staff and of course the students. Their commitment to the process and the workshops has been essential to conducting an authentic evaluation across so many schools.

We are now impatiently waiting for the results. If they show the workshops are effective, we could be rolling them out across the whole of the UK which would mean many more students will benefit from this one trial!

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IoPPN researchers awarded Wellcome funding for mental health research

IoPPN researchers awarded Wellcome funding for mental health research
£2.45 million Wellcome funding has been awarded to research programmes at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) for children and young people’s mental health research.

The programme, led by IoPPN principal investigator Dr Daniel Michelson a received Wellcome Mental Health Award, alongside two other programmes at the IoPPN. The awards sit under the umbrella of Wellcome’s new Mental Health Challenge programme.

Dr Daniel Michelson has been awarded £2.45 million to undertake a ‘Mechanistic trial of problem-solving and behavioural activation for youth depression’ (METROPOLIS). This programme, which is part of the King’s Maudsley Partnership for Children and Young People, will investigate the effectiveness and mechanisms of brief, first-line psychotherapies to reduce symptoms of depression among disadvantaged university students in New Delhi, incorporating an innovative peer-to-peer counselling approach.

I’m delighted to receive this award on behalf of an outstanding international team. The funding will enable us to conduct one of the largest-ever mental health intervention trials for young people in India, which is home to 20% of all 18-24-year-olds worldwide. Scalable early interventions are urgently needed during this key developmental period when many mental health problems first occur. University settings pose unique challenges and stresses, especially for ‘first-generation’ learners who make up a significant part of the student population across India.

Dr Daniel Michelson

Clinical Senior Lecturer at the Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN)

Dr Michelson is a Clinical Senior Lecturer in the Department of Child and Adolescent Psychiatry at the IoPPN. The new Award builds on Dr Michelson’s experience as Clinical Academic Director for the ‘Premium for Adolescents’ school mental health programme in India, also funded by Wellcome (2016-22). Dr Michelson additionally works on developing and evaluating psychosocial interventions for under-served children, young people and families in the UK and is an Honorary Consultant Clinical Psychologist at South London and Maudsley NHS Foundation Trust.

Daniel Stahl, Professor of Medical Statistics and Statistical Learning at the IoPPN, will work with Dr Michelson on the programme alongside co-investigators from Sangath, India’s leading mental health research non-governmental organisation; O.P. Jindal Global University, a top-ranked research-intensive university in New Delhi; Youth for Mental Health, a youth-led social enterprise focused on student mental health in India; and Brighton and Sussex Medical School. Dr Michelson’s team is supported by a wider group of international collaborators from the USA (Harvard Medical School, Loma Linda University & UCLA) and India (the National Institute of Mental Health and Neurosciences).

Young people with relevant lived experience will be front and centre in the leadership and delivery of the programme, including a variety of youth-led activities to engage students from marginalised groups.

Dr Daniel Michelson

Clinical Senior Lecturer at the Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN)

The grant is funded under the Wellcome ’Looking Backwards, Moving Forward: understanding how interventions for anxiety, depression, and psychosis work’ grant scheme which is part of their new strategic focus on mental health as a key global health challenge. This call focuses on investigating the causal mechanisms underpinning the ‘active ingredients’ of effective interventions for anxiety, depression and psychosis. Active ingredients are those that drive resolution or reduction of symptoms, are well-defined and link to specific hypothesised mechanisms of action. Wellcome have awarded more than £47 million to research teams to investigate what makes interventions for anxiety, depression and psychosis effective.

For more information, please contact Amelia Remmington (Communications & Engagement Officer).

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