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Exploring the feasibility and acceptability of a school‐based self‐referral intervention for emotional difficulties in older adolescents: qualitative perspectives from students and school staff

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Abstract

Background Adolescents with emotional difficulties need accessible, acceptable and evidence‐based mental health interventions. Self‐referral workshops (DISCOVER workshops) were offered to stressed 16‐ to 19‐year olds in 10 Inner London schools. Method Semistructured interviews were conducted with three groups of participants: students who attended a 1‐day workshop (n = 15); students who initially showed interest in the DISCOVER workshop programme, but decided not to take part (n = 9); and school staff who helped organise the programme in their schools (n = 10). Students were purposively sampled to ensure that those from Black and minority ethnic (BME) backgrounds were represented. Data were analysed using thematic analysis. Results The accounts generally indicate that the delivery and evaluation of this intervention is perceived as feasible and acceptable. Students, including those from BME backgrounds, described the setting as suitable and reported that the workshop helped them develop new understandings of stress and how to handle it. They expressed a preference for engaging and interactive activities, and valued a personalised approach to workshop provision. School staff felt that the workshop was in line with school values. They described some logistical barriers to providing the workshops in school settings, and expressed a desire for more information about the workshop in order to provide follow‐up support. The main reason students gave for nonparticipation was limited time. Conclusions Findings are discussed in relation to increasing the feasibility of implementing school‐based psychological interventions and the value of providing access to mental health support in schools.
Exploring the feasibility and acceptability of a
school-based self-referral intervention for emotional
difficulties in older adolescents: qualitative
perspectives from students and school staff
Lynn McKeague
1
, Nicola Morant
2
, Emily Blackshaw
3
& June S. L. Brown
3
1
Department of Psychology, University of Winchester, Winchester, UK
2
Division of Psychiatry, University College London, London, UK
3
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny
Park, London, SE5 8AF, UK. E-mail: june.brown@kcl.ac.uk
Background: Adolescents with emotional difficulties need accessible, acceptable and evidence-based mental
health interventions. Self-referral workshops (DISCOVER workshops) were offered to stressed 16- to 19-year olds
in 10 Inner London schools. Method: Semistructured interviews were conducted with three groups of partici-
pants: students who attended a 1-day workshop (n=15); students who initially showed interest in the DIS-
COVER workshop programme, but decided not to take part (n=9); and school staff who helped organise the
programme in their schools (n=10). Students were purposively sampled to ensure that those from Black and
minority ethnic (BME) backgrounds were represented. Data were analysed using thematic analysis. Results:
The accounts generally indicate that the delivery and evaluation of this intervention is perceived as feasible
and acceptable. Students, including those from BME backgrounds, described the setting as suitable and
reported that the workshop helped them develop new understandings of stress and how to handle it. They
expressed a preference for engaging and interactive activities, and valued a personalised approach to work-
shop provision. School staff felt that the workshop was in line with school values. They described some logisti-
cal barriers to providing the workshops in school settings, and expressed a desire for more information about
the workshop in order to provide follow-up support. The main reason students gave for nonparticipation was
limited time. Conclusions: Findings are discussed in relation to increasing the feasibility of implementing
school-based psychological interventions and the value of providing access to mental health support in schools.
Key Practitioner Message
The DISCOVER ‘How to Handle Stress’ workshop programme is acceptable to both students and school
staff.
Results suggest that school-based group CBT interventions for 16- to 19-year olds should be engaging,
interactive and personalised.
Providing psychological support in the schools makes it more accessible for hard-to-reach groups, such as
BME students.
Collaboration and clear communication between psychologists and school staff, and working closely with
administrative staff to avoid logistical issues are key to workshop delivery in the school setting.
Keywords: Adolescence; depression; anxiety; school; qualitative methods
Introduction
It is estimated that half of all lifetime mental health
problems have their onset by midadolescence (Kessler
et al., 2005). Mood and anxiety disorders are known
to be prevalent at this time (Costello, Mustillo,
Erkanli, Keeler, & Angold, 2003) and are associated
with a range of adverse outcomes, including increased
suicide risk (Gould, Greenberg, Velting, & Shaffer,
2003). Given reluctance to seek help from specialist
services (Rickwood, Deane, Wilson, & Ciarrochi,
2005), there is great potential to provide mental
health support in the school setting (Calear & Chris-
tensen, 2010; Merry et al., 2012). Although efforts to
develop school-based interventions for depression and
anxiety have increased in recent years, studies inves-
tigating their effectiveness have yielded mixed results
(Stallard, 2013). Existing interventions have primarily
been evaluated by measuring quantitative psychologi-
cal outcomes (Corrieri et al., 2013; Spence & Shortt,
2007), with some researchers also collecting data on
participant satisfaction to supplement data on inter-
vention outcomes (e.g. Garmy, Berg, & Clausson,
2015; Taylor et al., 2014).
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and
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Child and Adolescent Mental Health Volume **, No. *, 2017, pp. **–** doi:10.1111/camh.12234
Qualitative methods are of particular value in explor-
ing the experiences of those receiving and delivering ser-
vices, as they allow for the inuence of sociocultural and
contextual factors. This may help elucidate the reasons
for discrepant trial results, or the difculties of imple-
mentation or sustainability of complex interventions
(Campbell et al., 2000). Qualitative approaches have
allowed in-depth explorations of young peoples percep-
tions of mental health services, for example impressions
of professionals who deliver them (Day, Carey, & Sur-
genor, 2006; Donnellan, Murray, & Harrison, 2012).
They have also allowed better understanding of factors
that promote or undermine effective delivery of class-
room-based Cognitive Behaviour Therapy (CBT) inter-
ventions (Taylor et al., 2014). Finally, use of qualitative
approaches gives students and school staff opportuni-
ties to recommend changes for further intervention
development (Boyle, Lynch, Lyon, & Williams, 2011).
The DISCOVER How to Handle Stressworkshop pro-
gramme is a self-referral school-based group interven-
tion designed for stressed students in sixth form (16
19 years). The programme aims to provide early inter-
vention for adolescents with emotional difculties,
applying cognitive-behavioural strategies within a broad
stress-coping paradigm. The programme does not
specically screen for anxiety or depression; partici-
pants self-refer owing to self-perceived need for psycho-
logical support in managing common adolescent
stressors. The self-referral system was based on the
work of Brown, Boardman, Whittinger, and Ashworth
(2010) which showed that people referring themselves
often had high levels of symptoms and were more repre-
sentative of the population, in terms of ethnicity, than
GP referrals. The programme comprises a 1-day work-
shop, for up to 15 students, codelivered by two clinical
psychologists and one assistant psychologist, with a
supporting workbook and personalised telephone fol-
low-up. The workshop was adapted from self-referral
psycho-educational CBT workshops originally devel-
oped for adults in the community (Brown, Cochrane, &
Hancox, 2000). The version for teenagers was adapted
(Michelson et al., 2016; Sclare, Michelson, Malpass,
Coster, & Brown, 2015) to focus on the stresses of older
adolescence. In the workshop, CBT techniques are out-
lined and practised, using presentations, videos, role-
play and a goal-setting task. The DISCOVER workshop
is designed to normalise common emotional difculties
and to provide accessible support by addressing barri-
ers that typically deter adolescents from presenting at
services, such as concerns about stigmatisation (Sclare
et al., 2015). Pilot study results were promising, with
high levels of uptake among hard-to-reachgroups,
such as Black and minority ethnic (BME) students and
those with no previous experience of formal mental
health help-seeking (Sclare et al., 2015). The suitability
of the workshop programme for these groups is impor-
tant, given that these young people may be more likely
to experience barriers (e.g. stigma) to seeking profes-
sional help, compared to their peers (Bradby et al.,
2007; Lamb, Bower, Rogers, Dowrick, & Gask, 2012).
The current study is the qualitative component of a
cluster randomised controlled trial (RCT) investigating
the feasibility of the DISCOVER workshop programme
for students in UK sixth forms (aged 1619) in 10 Inner
London schools, described in Brown et al. (2017).
Schools were randomised into experimental and control
groups.
Methods
Aims
This qualitative study aimed to investigate the feasibility and
acceptability of the DISCOVER workshop programme. Descrip-
tions of the methods and ndings below follow the COREQ
checklist (Tong, Sainsbury, & Craig, 2007).
Participants and setting
The RCT was conducted in Inner London state secondary
schools (nine mixed, one single sex). Eligibility criteria for the
DISCOVER trial were that students were in Year 12 or 13, that
they were over 16 years old, had uent English, wished to
receive psychological help for emotional difculties, were willing
and able to attend a 1-day psychological workshop on school
premises, and were able to provide informed written consent to
participate (as described in Michelson et al., 2016). The areas in
which the research was conducted are considered economically
deprived and ethnically diverse (Lambeth Council, 2014; Lon-
don Borough of Southwark, 2013). The referral pathway was
self-referral; those who took part in the intervention self-
selected. School staff did not attend the workshop, nor did they
inform intervention content. They were however asked to
approach vulnerable individuals and encourage them to attend
and to organise logistical aspects of running the programme
within the school. Students were eligible to participate regard-
less of whether they had ever been diagnosed with depression/
anxiety and were not screened before taking part.
Participants
(1) Workshop attenders, (2) students who showed interest in DIS-
COVER workshops but did not participate, and (3) school staff
who helped organise the DISCOVER workshop in their school.
Sampling and recruitment
Participants were primarily recruited via telephone, having pro-
vided their contact details to the DISCOVER team in the initial
stages of recruitment for the workshop programme. Partici-
pants were interviewed on one occasion only during school
term-time.
(1) Workshop attenders. Purposive sampling was used to
obtain a sample of respondents who reected the overall group
of workshop attenders in terms of gender, ethnicity and past
experience of seeking mental health support. In total, 21 stu-
dents from the experimental group schools were contacted, until
the sample size reached 15 participants. Non-White students
were oversampled as we had a particular interest in exploring
intervention acceptability for this group. Interviews with work-
shop attenders were conducted approximately 4 months after
the DISCOVER workshop, after the RCT follow-up.
(2) Nonparticipants. Nonparticipants were recruited (n=9)
on a rolling basis as soon as possible after they decided they did
not want to take part, with 26 students contacted in total.
Efforts were made to contact and recruit at least one participant
from each experimental and control group school, but this did
not prove possible.
(3) School staff. Staff were recruited from experimental group
schools. Fifteen individuals were invited to be interviewed and
10 agreed. Interviews were conducted at a time suitable to par-
ticipant availability approximately 5 months after the work-
shop, after the RCT follow-up.
Data collection
Semistructured interviews were conducted in participating
schools by the rst author, who had no involvement in delivery
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
2Lynn McKeague et al. Child Adolesc Ment Health 2017; *(*): **–**
of the intervention, but was part of the DISCOVER research
team. Interviews focused equally on positive and negative
aspects of participantsexperiences, and explored the follow-
ing topics, using primarily open questions, with some closed
questions: the recruitment process; experiences of participat-
ing in the workshop; self-perceived impact of the workshop;
the feasibility of DISCOVER as a school-based intervention;
and the workshops ability to meet young peoples needs.
Demographic information was also collected. For student
interviews, a teenage advisory group, comprising eight teen-
agers not involved in the study, helped provide views on the
appropriateness of topics and question wording. Interviews
were conducted in a quiet room in the participants school.
Interview schedules differed for the three participant groups.
Workshop attenders were asked about their experiences of par-
ticipating in the DISCOVER programme. Interviews with non-
participants focused on reasons for deciding not to proceed with
the intervention. School staff interviews explored the process of
hosting the programme, and the impact of the programme on
participating students. Interviews ranged in length from 6 min
52 s (nonparticipant) to 52 min 42 s (staff member). Brief eld
notes and interview summaries were compiled after each
interview.
Ethical considerations
Ethics approval for the DISCOVER Project was granted by the
Health Research Authority NREC Committee London Camber-
well St Giles: ref 14/LO/1416. All participants provided written
informed consent and consent for their interview to be audio-
recorded.
Analysis
Data were transcribed verbatim and analysed in line with
Braun and Clarkes approach to thematic analysis (Braun &
Clarke, 2006, 2013). Analysis was primarily data-driven,
with a priori concerns to explore feasibility and acceptability
of the intervention, and was not conducted from a particular
theoretical standpoint. For each subsample, three research-
ers (LM, NM and EB) read a sample of interviews and met to
discuss possible codes and themes. Coding frames were
devised by the rst author who used NVivo V.10 to code the
data. The second and third authors reviewed the coding.
Queries about coding decisions were discussed and the analy-
sis continued through to the write-up of study ndings. Direct
quotes from participant interviews are used to give voice to
themes that were evident in the data. Both commonalities
and variations within and between the subgroups were
explored.
Results
Participants
The study included three subsamples, workshop atten-
ders (n=15), nonparticipants (n=9) and staff (n=10).
Workshop attenders and nonparticipants were predomi-
nantly from BME groups, female and had not previously
sought support, with an average age of 17.59 years and
17.44 years respectively (see Table 1). Characteristics of
these participants were reective of the larger population
of workshop attenders, with the majority (over 70% in
both subsamples) from BME groups.
School staff were also predominantly female and 50%
of the sample identied as White British. The majority of
school staff held senior school roles (such as heads of
sixth form), while two held administrative positions.
Presentation of results: Overview
Results are presented in two sections. The rst examines
studentsexperiences of actually participating in the
DISCOVER workshop, and the perceived benets or
problems in taking part. The second section focuses on
the acceptability and feasibility of delivery of the DIS-
COVER workshop in schools, drawing on the perspec-
tives of workshop attenders, nonparticipants and school
staff.
Section 1: Experiences of participating in the
DISCOVER workshop and perceived impacts
Understanding and managing stress. All 15 students
indicated that the workshop had helped them to under-
stand their stress or made them aware of stress manage-
ment techniques. In terms of academic outcomes, many
(n=9) said that their time management or planning had
improved since taking part in the workshop.
I think its made me think more about where the stress came
from and that there are ways to deal with it rather than just
freaking out. [P005]
Table 1. Demographic details for study subsamples
Workshop attenders
N=15
Nonparticipants
N=9
School staff
N=10
Mean age (years) 17.59 17.44 38.28
Age range (years) 16.5819.33 16.4218.33 28.0055.58
Gender (female) 12 (80.0%) 5 (55.56%) 8 (80%)
Ethnicity
Black British, African 6 (40%) 4 (44.44%) 0 (0%)
Black British, Caribbean 3 (20%) 0 (0%) 3 (30%)
White British 4 (26.67%) 2 (22.22%) 5 (50%)
Other BME group 2 (13.33%) 3 (33.33%) 2 (20%)
Previously received help for mental health
(i.e. counsellor; school counsellor; GP; teacher;
youth club counsellor; the DISCOVER programme; therapist)
5 (33.33%) 3 (33.33%)
Position in school
Head/Director of Sixth Form ––3 (30%)
Deputy Head of Sixth Form ––2 (20%)
Sixth Form Administrator/Manager ––2 (20%)
Student Support Officer ––1 (10%)
Lead Teacher High Achievers ––1 (10%)
Head of year 13 ––1 (10%)
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
doi:10.1111/camh.12234 Qualitative evaluation of a self-referral intervention 3
...DISCOVER helped me with considering different ways of
handling stress...[P004]
Im not as stressed as I used to be, em, and I dont, like nd
myself needing to be worried about anything as much. Except
for exams obviously...[P014]
As part of the workshop programme, students were
encouraged to set a personal goal and were offered fol-
low-up telephone reviews with a workshop leader to
monitor goal progress. All White British students
(n=4) who were interviewed described the process of
setting a goal in positive terms or said that it was easy
to decide on a goal. In contrast, negative perceptions of
goal setting were apparent among some of the BME
students (n=4). One [005] described setting a goal as
worrying, because of the anticipation that she might
not achieve it. Another student [P008] found the goal-
setting task difcult because his goals were constantly
changing: ...with me Ive gotta keep changing mine.Of
the students who reported experiencing difculty with
the goal-setting exercise, none had previous experience
of seeking formal support for mental health issues.
A small number of students described experiencing dif-
culties in using the techniques following the workshop, for
example, due to challenges posed by increasing academic
pressure and impending exam season. Two students
thought that the workshop may not have a lasting impact.
...in the beginning [...] it was more helpful, because [...]it
would have been fresh in my mind. [P011]
When asked specically, all 15 said that they would
recommend the DISCOVER workshop to friends, and
several suggested it would be suitable for those who were
stressed or studying for exams. In sum, the workshops
were perceived as helpful to recognising sources of stress
and identifying ways to deal with it, even though difcul-
ties sustaining changes were reported.
Preference for engaging and interactive content. Several
students (n=8) described the workshops as engaging,
interactive or different(in terms of including new ideas
or techniques). They liked the variety of techniques used,
the use of PowerPoint presentations and the workshop
booklet. They preferred the more active and interactive
components of the workshop day, with all participants
commenting that they liked the videos used and/or
could relate to the video character(s).
... the ones [techniques] that the workshop delivered were
quite different and quite unique so they sort of made it easier
to deal with things because theres stuff that you havent
really done before. [P007]
It [the workshop day] was great, we did, it was a whole day,
we did so many activities, we learnt so many things, we tried
new things, it was really fun. [p015]
...there was loads of different activities, not just reading and
listening and sitting down, so it was interactive. [P009]
Interviewees were asked to comment on specic tech-
niques or topics included in the workshop that they
found helpful or unhelpful. The techniques and topics
most commonly described favourably were: sleep
(n=10), time management (n=9), mindfulness (n=8)
and relaxation (n=7). Although some students said they
found certain techniques unhelpful, 14 out of the 16
techniques/topics were liked or considered helpful by at
least one student and 10 were reported to have been
used by at least one of the students following the work-
shop. There were no clear patterns across participants
in techniques that were disliked or the reasons given for
this, which included not nding them novel, not under-
standing them, nding them hard to use in practice or
not enjoying them.
Participants generally liked receiving a follow-up
phone call from one of the psychologists, describing this
primarily as a means for the psychologists to check-up
on them, and an opportunity to request additional sup-
port.
The importance of an individualised approach. Students
valued a personalised approach to workshop provi-
sion, for example, when the psychologists asked
them to describe their lived experience of stress.
Over one third of the sample (n=6) were content
with the level of interaction between themselves and
the psychologists.
[the workshop was] really interactive and because there
wasnt a really large group of people, there was about 12 of us,
it was quite individual as well. So personally I feel like that I
got, got quite a good amount of attention and my questions
were answered in quite detail [sic] because we had the time to
do it. [P007]
However, a further third (n=5) thought the workshop
was not individualised enough or that there was not
enough opportunity for one-to-one interaction with the
psychologists. They thought that the interactive nature
of the workshop could be strengthened by, for example,
more one-to-one opportunities, and working in smaller
groups.
...helping young people that are feeling stressed, the best
thing to do would be talk to them about their individual cir-
cumstance if theyre willing to tell you their personal lives,
cause if they do then you know, you sort of know what angle
to talk to them from...[P012]
Section 2: Acceptability and feasibility of delivery
in the school setting
Section 2.1: Perspectives of workshop attenders. Attending
a workshop in the school setting. Six students described
the convenience of workshops being held at school, and
a further six described the setting as familiar, comfort-
able, safe and/or secure.
...it was quite good doing it in school, cause were all comfort-
able with our surroundings [...] whereas if we done it in a
place weve never been to before, wed be a bit, like, on edge.
[P010]
A smaller number (n=3) described a conict between
attending the workshop and missing lesson time. They
felt that, lasting a full school day, the workshop took up
too much of their time and recommended ways of alter-
ing the timescale of the workshop, such as spreading its
content over two half-days.
I think it just took a lot of time. It took a whole school day and
for me thats really a lot of information that I missed and had
to catch up on. [P001]
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
4Lynn McKeague et al. Child Adolesc Ment Health 2017; *(*): **–**
Two students suggested that a different location might
be benecial, with one expressing the concern that pri-
vacy and condentiality might not be fully assured in the
school setting.
Experience of a group-based workshop. Several stu-
dents (n=6) said they benetted from hearing peers
sharing information about themselves which led to real-
ising that other people shared similar experiences and
increased reassurance and reduced feelings of isolation.
Some students (n=4) described feeling more comfort-
able about sharing personal information as the day pro-
gressed. A small number (n=3) commented that the
size of the group was important in determining how will-
ing they were to make these disclosures.
It was nice to see what other people thought and how they
dealt with stress and what they felt stress was like. [P001]
... since it was a small group, we wouldnt feel intimidated to
just tell people stuff. It was more condential in a sense.
[p002]
Section 2.2: Perspectives of nonparticipants. Barriers to
attending a school-based intervention. Nonparticipants
outlined why they decided not to enrol in the DISCOVER
workshop, with some individuals citing more than one
reason. The main reason (n=8) was that students did
not feel able to give up the amount of time that was
required. Some (n=4) reported feeling able to cope with
stress by themselves or that the workshop was not nec-
essary for them because they were not particularly
stressed. Two students said that they decided not to
enrol for the workshop due to their impression of the
workshop content.
It was just about missing the lessons, I thought that that was
kind of going to add to the stress rather than take it away
because just more to juggle with and I just thought at the time
it was on I wasnt really ready for missing lessons or anything
like that. [NP004]
I would say the time thing was the main reason. [...] and then
the fact that I wasnt super super stressed then did come into
it. It wasnt an urgent priority. [NP005]
I wasnt really 100% sure what the project involved so I didnt
really want to commit to something that I wasnt entirely like
convinced about at the time. [NP001]
Section 2.3: Perspectives of school staff. Fit with school
values and existing school support. All staff intervie-
wees reported that the workshop was in line with their
school values, particularly in terms of student welfare
and pastoral care. Three participants commented that
the DISCOVER workshop tted well with the aims of
their role (two of these had an exclusively pastoral role in
their school).
...rather than having 200 students knocking on my door
because theyre feeling overwhelmed and need support, Ill
only have 100 students. [T002]
All staff valued the DISCOVER workshop at their
school, often commenting that it addressed a gap in the
support that they were able to provide. Having an exter-
nal agency come to the school to provide additional men-
tal health support was viewed favourably (n=5).
...its quite nice to have people come in, and take some of
those students who are really stressed and kind of give them
that support that they dont, they cant always get 24/7 with,
with us. [T004]
Some staff members (n=3) highlighted the impor-
tance of helping students to become self-managers of
their mental health, and felt that DISCOVER workshops
were in keeping with their aims to support studentsper-
sonal and emotional development. Some (n=3) also
highlighted the value of the preventative nature of the
workshop:
I think the more preventative work we can do the better,
really, because I think young people do need to learn to be
more resilient and develop skills to develop that resilience,
cause you know, life is difcult and theres no getting away
from that, but I think we just need to make young people
realise that that is normal and how to actually handle it.
[T005]
Staff found it difcult to determine the impact of the
workshop on students, but one mentioned that the
workshop had led to increased peer support. Four staff
described the value of normalising mental health prob-
lems and creating a culture of openness about stress
and/or related psychological difculties.
So I was walking past two students that were sat in a class-
room looking like they were in a very deep and meaningful
conversation [...] The student was kind of going through the,
had been through the programme, was going through, em,
techniques on how that they [the other student] could deal
with this [personal problem] and trying to help them to prob-
lem solve and helping them to feel, to realise that, actually this
isnt the end of the world, and lets put this into perspective.
Em, could I have seen this student do that with another stu-
dent before theyd been through the programme? Absolutely
not. Because I dont think that student really knew what emo-
tion they were feeling at any particular time or how to deal
with that, they were quite kind of angry and frustrated at the
time, theyre denitely a lot more compassionate and wanting
to share their kind of experience... Which I think is really pos-
itive thing. [T002]
Role in recruitment. School staff (n=8) played a role in
reminding students to attend various aspects of the pro-
gramme. Most accepted this responsibility, but many
(n=7) felt it was helpful when the DISCOVER team
called or sent text messages to prompt students to turn
up at the required times. Overall, staff were content with
the amount of time required of themselves and their col-
leagues:
...it will not require that much time and effort but will give a
great opportunity to students. [T006]
Because the DISCOVER workshop featured a self-
referral entry route, staff from three of the ve
schools described putting considerable time and effort
into recruitment of particular students to the work-
shop. They were more comfortable in encouraging
groups of students to enrol, with few (n=2)
approaching students individually. Allowing students
to opt-in or self-refer to the workshop was viewed as
important.
...they have to make that decision. That they want to take
part in it. I dont think it should be forced upon them, because
some students are quite laid back and they dont feel they
need it. [T009]
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
doi:10.1111/camh.12234 Qualitative evaluation of a self-referral intervention 5
Conversely, two participants said that they had
rushed to ll spaces at the last minute. In these cases,
recipients of the intervention were not necessarily those
who were most in need of support.
Staff views on improvements: Clarity regarding
workshop remit. Most staff (n=7) felt they did not
receive enough information about the workshop remit
and/or expressed a desire to learn more about the speci-
c techniques that were introduced during the work-
shop. These participants felt that they should have been
better informed about the workshop content from the
beginning.
Staff (n=4) were keen to provide follow-up support
after the workshop ended. Some felt they would be better
equipped to provide this support if they had received
training or resources from the DISCOVER team, which
would enable them to remind students of useful stress
management techniques after the workshop had ended.
...it would be benecial for us to be able to have some
acknowledgment of what particular strategies work well so
that we can reinforce that with students. [T003]
...would quite like to have seen some of the materials that
were used [...] so that they could kind of continue to use
them, or use the right language with them. [...] we [staff] dont
know quite what happened in those workshops so it, its dif-
cult to follow-up...[T007]
Overcoming barriers to running the workshop in the
future. In response to a specic question about running
further DISCOVER workshops, all staff participants said
they would want the workshops to return to their school
in the future. However, several described some logistical
barriers to delivering a workshop programme in the
school setting. Most signicant of these were timetables
and shortage of available classrooms, although none of
the logistical issues were described as insurmountable.
Discussion
This study explored student and school staff perceptions
of a school-based workshop programme (DISCOVER)
designed to provide early intervention for adolescents
with emotional difculties. Perceptions of the workshop
programme were generally positive, highlighting the
acceptability of delivering this type of intervention in the
school setting. These ndings are promising, as interven-
tions that are viewed favourably by key stakeholders are
more likely to be sustainable (Rapee et al., 2006). By
allowing key intervention stakeholders to describe their
views of the workshop, this study supports an emerging
trend to make use of qualitative methods to evaluate com-
plex interventions (Campbell et al., 2000), including pro-
grammes focusing on classroom CBT (Boyle et al., 2011).
Schools offer a highly accessible setting for mental
health interventions (Masia-Warner, Nangle, & Hansen,
2006). Students who participated in the DISCOVER
workshops described the school as a safe and convenient
location. While there were some concerns about con-
dentiality and fears about making personal disclosures
in front of fellow students, students appeared to benet
from being part of a group as it provided opportunities to
share and compare experiences with peers. The value of
adolescents discussing their problems in a group setting
is also noted in a recent study of a Swedish school-based
mental health programme (Garmy et al., 2015).
The UK Department of HealthsFuture in Mindreport
(Department of Health [DoH], 2015) advocates increased
collaboration between the National Health Service (NHS)
and UK schools to improve access to mental health sup-
port for young people. The present study highlights that
some school staff felt collaborations with NHS psycholo-
gists could be strengthened by more opportunities to ask
questions, share information or learn more about CBT
techniques. The importance of clear communication
between key stakeholders in delivering interventions has
been highlighted by others (Stewart, 2008; Taylor et al.,
2014). Both our ndings and previous research suggest
that stakeholder interactions can be complex, and
teachers often want a more active role in developing or
delivering workshops (Taylor et al., 2014). Overall, how-
ever, school staff who participated in the present study
were generally positive about the intervention, perhaps
because it provided additional support in contexts of
high levels of unmet needs. In fact, many were keen to
continue to provide follow-up support to students after
the intervention ended. Given cuts to already stretched
child and adolescent mental health services (Young-
Minds, 2015), it may be increasingly appropriate for
mental health practitioners to upskill and support
school staff to respond to common low-levelmental
health problems within schools, or support students
during and following externally delivered interventions.
Studentspreferences for workshop content that is
interactive and engaging, preferences for shorter inter-
ventions, and school staff requests to be more involved
or better informed mirror ndings from a process evalua-
tion of a classroom-based CBT intervention in UK sec-
ondary schools (Taylor et al., 2014). The present study
adds to the literature by exploring barriers to participa-
tion. Reasons for nonparticipation included not having
enough time to commit, and being unsure about work-
shop content. A further contribution is that we explored
the views of hard-to-reachgroups. BME groups experi-
ence an array of problems in accessing and engaging
with suitable psychological services (Lamb et al., 2012).
The current ndings add to this literature by indicating
that BME young people may struggle to engage with
interventions even after overcoming barriers associated
with accessing them. In comparison to White British
workshop participants and those who had previously
sought help for emotional difculties, BME students
who had no previous experience of accessing mental
health support had particular difculty with the goal-
setting component of the workshop programme, and
were more likely to voice concerns about their ability to
achieve their goal. Perceptions of self-competence may
vary between different cultural groups (Schmitt & Allik,
2005) and it is possible that past experience of help-
seeking could increase condence in working towards a
goal. This suggests that clinicians delivering interven-
tions with a goal-setting component should be particu-
larly attentive to the needs of BME students, and aware
that those who have not previously sought help may
require additional guidance and encouragement. In par-
ticular, individuals from hard-to-reach groups may not
understand their problems in the same way as service
providers, leading to difculties in communicating the
problems that they are facing (Lamb et al., 2012). This
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
6Lynn McKeague et al. Child Adolesc Ment Health 2017; *(*): **–**
may impact on studentsability to talk about the issues
that they face and recognise which techniques and goals
might help them to overcome these.
Research and clinical implications
This study supports the use of qualitative methods to
explore aspects of school-based interventions that
could not have been investigated using quantitative
outcome measures alone. In particular, the qualitative
methodology provided insights into nuances of the
acceptability of group-based mental health support
for older adolescents.
Findings suggest that delivery of similar interventions
may benet from ensuring that stakeholders (school
staff and students) fully understand the nature of the
intervention and the value of participation. This may
have important implications for recruitment, acceptabil-
ity and the effectiveness of such interventions. Key chal-
lenges raised by school staff relate to logistical issues
(e.g. room bookings; scheduling). A longer planning
phase, where the intervention team liaises closely with a
designated member of school administrative staff, may
be benecial. The ndings of this study suggest that clin-
ical psychologists (and other specialist external provi-
ders) involved in school-based interventions may need to
rethink the nature of their partnerships with school
staff, with greater focus on sharing expertise and build-
ing capacity among staff with pastoral roles who have an
appetite and will to learn from them. A further challenge
is that staff were comfortable in encouraging groups of
young people to participate, but less willing to approach
students on a one-to-one basis.
The struggle to address the mental health needs of
adolescents is widely acknowledged by parents, educa-
tors, psychologists and health professionals. The DIS-
COVER workshop programme was designed to offer a
way to address this need in UK schools. The present
study suggests that a group-based intervention, deliv-
ered in a familiar setting, with content that is engaging,
interactive and personalised, may offer an appealing
alternative to the traditional one-to-one therapeutic rela-
tionship for this age group. Wider dissemination of this,
or similar interventions, would not only reduce demand
on traditional NHS mental health services but also
would potentially normalise help-seeking for mental
health issues in the school setting, thus helping young
people to reach out when they need support.
Strengths and limitations
Our study triangulated the perspectives of three stake-
holder groups (participating and nonparticipating stu-
dents, and school staff), enabling a rounded picture of
intervention acceptability to be obtained. The inclusion
of nonparticipants allowed us to capture key barriers to
participation that can be considered in future iterations
of this and similar programmes. However, despite inten-
sive recruitment efforts, in the case of the nonparticipant
sample, there were some schools where no young people
agreed to be interviewed. More female than male stu-
dents participated in this study, reecting the gender
ratio of those attending the workshops overall. The nd-
ings therefore reveal more about femalesexperiences of
accessing services for emotional difculties. Further
efforts are required to develop mental health interven-
tions for males, and to help address gender-specic
access issues. Although data were collected by a
researcher who was not involved in delivery of the work-
shop, for some study participants, knowing that she was
afliated with workshop psychologists may have
impeded open expression of their views. Due to the dura-
tion of time between the workshop day and the collection
of interview data given constraints posed by the RCT fol-
low-up, aspects of student and staff accounts may have
been misremembered or inaccurate.
Conclusion
This paper outlines some of the successes and limita-
tions of delivering a self-referral school-based mental
health intervention to older adolescents. Qualitative
evaluation of the DISCOVER programme indicated that
running a workshop with telephone follow-up is feasible
in Inner London schools, accessible to students, includ-
ing those from BME groups, and was considered accept-
able by participating students and involved school staff.
This study has various practical and clinical implica-
tions, including the value of designing and delivering
school-based interventions that are interactive and per-
sonalised. Such ndings can help to inform future itera-
tions of the DISCOVER programme, and provide useful
insights for others looking to develop or strengthen simi-
lar interventions.
Acknowledgements
This paper presents independent research funded by the
National Institute for Health Research (NIHR) under its
Research for Patient Benet (RfPB) Programme (Grant Refer-
ence PB-PG-0213-30072). In addition, funding for the clinical
costs of the intervention and funding to help disseminate the
intervention was provided by Guys and St. ThomasCharity.
The views expressed are those of the authors and not necessar-
ily those of the NHS or NIHR.
The rst author had full access to all of the data collected
and analysed in the study, and takes responsibility for the
integrity of the data and the accuracy of the data analysis.
The authors thank the involved schools and students for
their enthusiasm. The authors acknowledge the work of Dr
Irene Sclare who devised the DISCOVER programme and led
the process of engagement, delivery and goal review within
the 10 schools. The authors thank Dr Irene Sclare and Dr
Tessa Crombie for working with staff in each school and
delivering the workshops. The authors thank Lisa Fennelly
for her work as an Assistant Psychologist on this project and
in particular for her role in providing follow-up telephone
support to participating students. The authors also thank Dr
Daniel Michelson for his comments on this manuscript. The
authors have declared that they have no competing or poten-
tial conicts of interest.
References
Boyle, C., Lynch, L., Lyon, A., & Williams, C. (2011). The use
and feasibility of a CBT intervention. Child and Adolescent
Mental Health,16, 129135.
Bradby, H., Varyani, M., Oglethorpe, R., Raine, W., White, I., &
Helen, M. (2007). British Asian families and the use of child
and adolescent mental health services: A qualitative study of
a hard to reach group. Social Science & Medicine,65, 2413
2424.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psy-
chology. Qualitative Research in Psychology,3,77101.
Braun, V., & Clarke, V. (2013). Successful qualitative research:
A practical guide for beginners. London: Sage.
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
doi:10.1111/camh.12234 Qualitative evaluation of a self-referral intervention 7
Brown, J.S.L., Blackshaw, E., Fennelly, L., McKeague, L.,
Sclare, I., & Michelson, D. (2017). School-based early inter-
vention for depression and anxiety in older adolescents: A fea-
sibility randomised controlled trial (RCT) of open-access
Stress workshop programme. Manuscript in preparation.
Brown, J.S.L., Boardman, J., Whittinger, N., & Ashworth, M.
(2010). Can a self-referral system help improve access to psy-
chological treatments? British Journal of General Practice,60,
365371.
Brown, J.S., Cochrane, R., & Hancox, T. (2000). Large-scale
health promotion stress workshops for the general public:
A controlled evaluation. Behavioural and Cognitive Psy-
chotherapy,28, 139151.
Calear, A.L., & Christensen, H. (2010). Systematic review of
school-based prevention and early intervention programs for
depression. Journal of Adolescence,33, 429438.
Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A.L., San-
dercock, P., Spiegelhalter, D., & Tyrer, P. (2000). Framework
for design and evaluation of complex interventions to improve
health. British Medical Journal,321, 694.
Corrieri, S., Heider, D., Conrad, I., Blume, A., K
onig, H.H., &
Riedel-Heller, S.G. (2013). School-based prevention pro-
grams for depression and anxiety in adolescence: A system-
atic review. Health Promotion International,29, 427441.
Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A.
(2003). Prevalence and development of psychiatric disorders
in childhood and adolescence. Archives of General Psychiatry,
60, 837844.
Day, C., Carey, M., & Surgenor, T. (2006). Childrens key con-
cerns: Piloting a qualitative approach to understanding their
experience of mental health care. Clinical Child Psychology
and Psychiatry,11, 139155.
Department of Health [DoH] (2015). Future in Mind: Promoting,
Protecting and Improving our Children and Young Peoples
Mental Health and Well-Being. Available from: https://
www.gov.uk/government/publications/improving-mental-
health-services-for-young-people [last accessed 6 May 2016].
Donnellan, D., Murray, C., & Harrison, J. (2012). An investiga-
tion into adolescentsexperience of cognitive behavioural
therapy within a child and adolescent mental health service.
Clinical Child Psychology and Psychiatry,18, 199213.
Garmy, P., Berg, A., & Clausson, E.K. (2015). A qualitative
study exploring adolescentsexperiences with a school-
based mental health program. BMC Public Health,15,
1074.
Gould, M.S., Greenberg, T.E.D., Velting, D.M., & Shaffer, D.
(2003). Youth suicide risk and preventive interventions: A
review of the past 10 years. Journal of the American Academy
of Child & Adolescent Psychiatry,42, 386405.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas,
K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-
onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication. Archives of General Psychia-
try,62, 593602.
Lamb, J., Bower, P., Rogers, A., Dowrick, C., & Gask, L. (2012).
Access to mental health in primary care: A qualitative meta-
synthesis of evidence from the experience of people from hard
to reachgroups. Health,16,76104.
Lambeth Council (2014). State of the borough report. London:
Lambeth Council.
London Borough of Southwark (2013). Southwark health sum-
mary. London: Lambeth and Southwark Public Health.
Masia-Warner, C., Nangle, D.W., & Hansen, D.J. (2006). Bring-
ing evidence-based child mental health services to the
schools: General issues and specic populations. Education
and Treatment of Children,29, 165172.
Merry, S.N., Hetrick, S.E., Cox, G.R., Brudevold-Iversen, T., Bir,
J.J., & McDowell, H. (2012). Cochrane Review: Psychological
and educational interventions for preventing depression in
children and adolescents. Evidence-Based Child Health:
A Cochrane Review Journal,7, 14091685.
Michelson, D., Sclare, I., Stahl, D., Morant, N., Bonin, E.M., &
Brown, J.S. (2016). Early intervention for depression and
anxiety in 1618-year-olds: Protocol for a feasibility cluster
randomised controlled trial of open-access psychological
workshops in schools (DISCOVER). Contemporary Clinical
Trials,48,5258.
Rapee, R.M., Wignall, A., Shefeld, J., Kowalenko, N., Davis, A.,
McLoone, J., & Spence, S.H. (2006). Adolescentsreactions to
universal and indicated prevention programs for depression:
Perceived stigma and consumer satisfaction. Prevention
Science,7, 167177.
Rickwood, D., Deane, F.P., Wilson, C.J., & Ciarrochi, J. (2005).
Young peoples help-seeking for mental health problems.
Australian e-Journal for the Advancement of Mental Health,4,
218251.
Schmitt, D.P., & Allik, J. (2005). Simultaneous administration
of the Rosenberg Self-Esteem Scale in 53 nations: Exploring
the universal and culture-specic features of global self-
esteem. Journal of Personality and Social Psychology,89,
623.
Sclare, I., Michelson, D., Malpass, L., Coster, F., & Brown, J.
(2015). Innovations in Practice: DISCOVER CBT workshops
for 1618-year-olds: development of an open-access interven-
tion for anxiety and depression in inner-city youth. Child and
Adolescent Mental Health,20, 102106.
Spence, S.H., & Shortt, A.L. (2007). Research Review: Can we
justify the widespread dissemination of universal, school-
based interventions for the prevention of depression among
children and adolescents? Journal of Child Psychology and
Psychiatry,48, 526542.
Stallard, P. (2013). School-based interventions for depression
and anxiety in children and adolescents. Evidence-Based
Mental Health,16,6061.
Stewart, D. (2008). Implementing mental health promotion in
schools: A process evaluation. International Journal of Mental
Health Promotion,10,3241.
Taylor, J.A., Phillips, R., Cook, E., Georgiou, L., Stallard, P., &
Sayal, K. (2014). A qualitative process evaluation of class-
room-based cognitive behaviour therapy to reduce adolescent
depression. International Journal of Environmental Research
and Public Health,11, 59515969.
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria
for reporting qualitative research (COREQ): A 32-item check-
list for interviews and focus groups. International Journal for
Quality in Health Care,19, 349357.
YoungMinds (2015). Widespread cuts in children and young
peoples mental health services. Available from: http://www.
youngminds.org.uk/news/blog/2942_widespread_cuts_in_c
hildren_and_young_people_s_mental_health_services [last
accessed 16 May 2016].
Accepted for publication: 20 June 2017
©2017 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
8Lynn McKeague et al. Child Adolesc Ment Health 2017; *(*): **–**
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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.ResultsParticipants (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.