Project title:
Mixed Methods Evaluation of Interpersonal Counselling Pilot
Type of research:
Qualitative and quantitative evaluation of single arm pilot treatment study
Background & Scientific Rationale:
UK Child and Adolescent Mental Health Services (CAMHS) are delivered in a multi-tiered service(1). NHS specialist CAMHS services are in tiers 3/4. The majority of cases are mild and are treated by tier 1 (universal/local authority/school services), and tier 1 has the majority of funding. Most tier 1 staff have minimal/no training in delivering treatments for people with emotional problems, and there is no evidence base as to what treatments to use. It is not appropriate for them to deliver the same evidence-based treatments as staff in tier 3 due to lower training levels, and relatively long length of treatment courses.
Interpersonal psychotherapy (IPT) is a NICE-recommended first line treatment for adults and adolescents with depression(2, 3). It has been proven to be more effective than standard school counselling in depressed adolescents(4). Interpersonal counselling (IPC) is an adaptation of IPT with three main differences:
- it can be delivered by staff without mental health training following a brief training course;
- it is for clients with sub-threshold/mild depression;
- it is shorter than IPT
It is therefore likely to be appropriate for tier 1 CAMHS staff working with adolescents with sub-threshold/mild depression. A recent RCT proved IPC to be more effective than antidepressants in adults with mild depression in primary care(5), but has not been tested in adolescents.
- NHS_Health_Advisory_Service (1995) Together We Stand: Commissioning, Role and Management of Child and Adolescent Mental Health Services (Stationery Office Books)
- NICE (2005) Depression in Children and Young People
- NICE (2009) Depression in adults. The treatment and management of depression in adults
- Mufson L, et al. (2004) Arch Gen Psychiatry 61(6):577-584
- Menchetti M, et al. (2014) Br J Psychiatry 204(2):144-150
Research questions:
- Does IPC (delivered by youth workers) lead to a reduction in depressive symptoms in adolescents with low mood?
- Is IPC delivered by youth workers acceptable to adolescents with low mood?
- Do youth workers find IPC an acceptable treatment to train in and deliver?
- What improvements should be made to IPC training and delivery for future trials?
Research methods:
Quantitative questionnaires were completed by all consenting adolescents during therapy sessions, as part of standard treatment.
- Mood and Feelings Questionnaire at beginning and end (to aid comparison with international research)
- Revised Children’s Anxiety and Depression Scale (RCADS) at beginning and end (to evaluate symptoms of anxiety and OCD, and to aid comparison with national CYP-IAPT dataset)
- RCADS depression section at all sessions (consistent with national CYP-IAPT)
- Progress against goals at all sessions (consistent with national CYP-IAPT)
- Endpoint CHI Experience of Service Questionnaire
Qualitative
- Interview with consenting young people after therapy, using purposive sampling to have a range of gender, outcomes and attendance at sessions. Questions on what worked well, what did not work well, and suggestions for improvements
- Interviews with all consenting therapists on their experiences of and opinions on training, supervision, delivery of the therapy, perceived effectiveness compared to their previous treatment approach, opinions on which clients it does/does not work well for; and suggestions for improvements
Analysis used thematic analysis, based on grounded theory.
A single arm pilot study was conducted to test the effectiveness and acceptability of IPC. Six youth workers in Suffolk County Council Child and Family Services were trained, using a two day training course followed by regular supervision. IPC was delivered to 23 adolescents with depressive symptoms.
Key findings and outputs:
Publication: Wilkinson PO, Cestaro V, Pinchen I Pilot mixed-methods evaluation of interpersonal counselling for young people with depressive symptoms in non-specialist services. Evidence-Based Mental Health. 2018. 21:134-138. https://doi:10.1136/ebmental-2018-300028
There was a mean reduction of depressive symptoms of 9.8 (RCADS depression scale, which has a range of 0-30). At the start of the study, 20/23 (87%) adolescents were above the RCADS depression threshold; at the end 3/23 (13%) were above threshold.
Qualitative interviews with counsellors (n=5) and young people (n=5) indicated that they liked IPC.
Young People:
- Liked having someone to talk to
- Liked goal setting
- Found session by session mood rating helpful
- All interviewed said they would recommend it to a friend
‘I think it’s really good and I would…I’ve recommended it to some mates. Because I found that it helped me a lot more than I’d (imagined) … as I said, I would never picture myself the way I am now without it. It was so useful.’
Counsellors:
- Liked clear structure
- Liked that it was time limited
- Liked that it was focused with clear goals
- Liked that it offers practical help, unlike most ‘talking’ therapies
Impact and added value:
The success of this pilot has helped to persuade Suffolk County Council to train 12 more youth workers in IPC. Two of the initial therapists are also being trained to become supervisors. The project team are applying for NIHR funding for a pilot randomised controlled trial of IPC vs treatment as usual.
For further information on this project, contact Dr Paul Wilkinson, University Lecturer and Honorary Consultant in Child and Adolescent Psychiatry, pow12@cam.ac.uk
