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.