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

by | Sep 4, 2023 | Blog Post, News

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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Results Day: The Day After

Results Day: The Day After

by | Aug 18, 2023 | Blog Post, News

Results Day: The Day After

It’s the day after results day and hopefully your young person has had some time to start processing things. Their attention may have turned to the next steps, all of which may bring new worries and challenges.

a young girl holding a leaf

Thinking Traps

Our minds can very quickly fall into what we call ‘negative thinking traps’, even about seemingly positive situations, like positive exam results.

We can all be hard on ourselves at times, especially in a situation like this. Here are three examples that you may notice in yourself or your young person.

  1. You might notice catastrophising, which means predicting worst-case scenarios about the future and underestimating one’s ability to cope (e.g. “I didn’t get the grades I needed so I’ll never get to do my dream job.”). Remind them that they have coped with lots of challenges before and that the future has many possibilities!
  2. Many of us find ourselves generalising from one scenario that the same will happen again in similar future scenarios (e.g. “If I found GCSE/A-Levels tough, there’s no way I’ll manage a degree/apprenticeship/job”). Instead, encourage them to ask themselves “am I jumping to conclusions?” Remind them of what they have achieved so far and the things they can achieve in the future.
  3. It’s also human nature to compare ourselves to others and see them as doing better than we are (e.g. “Everyone else seems to know exactly what they’re doing next and I don’t”). The truth is, we don’t know exactly what others are thinking, feeling, or dealing with 24/7, and everyone goes at their own pace.

We’re more likely to fall into these, and other negative thinking traps when we’re stressed.

Choosing kindness

At a potentially challenging time like this, our inner voice, or thoughts, can become more self-critical and we’re often our own worst enemy. You can remind them that, even though they can’t go back and change things, they can decide how to respond to themselves and the situation – with kindness rather than blame.

Ask your young person to consider what they’d say to you, or a friend, in the same situation. Encourage them to offer themselves the same kindness that they would offer their friend.

If you feel that a young person’s mental health is struggling with the impact of results day, it’s important to remind them that they are not alone. Although it’s not always easy from them to open up, it may be helpful to speak with a GP – they can support and guide them towards longer-term support.

Kooth and The Mix are also available as free, online, chat-based counselling platforms for young people.

We wish you and the young people in your lives all the best with whatever comes next.

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Results Day

Results Day

by | Aug 17, 2023 | Blog Post, News

Results Day

Results day is finally here. It’s bound to be an emotional day, whatever the outcome. Many young people will experience a mixture of excitement, anxiety, and countless other emotions. GCSEs and A-Levels are important milestones in the UK education system, as they tend to determine what happens next for many students. We’re here to help you support the young people in your life.

a young girl holding a leaf

If things have gone well

Your young person may have met or even exceeded their targets – in which case, congratulations! Encourage them to enjoy the moment. It’s tempting for you or them to start worrying about what comes next and getting into planning mode. They may start comparing to others and downplaying their achievements.

Everyone has different goals and versions of success and remind them that theirs is every bit as worthy of celebrating!

Try and plan something exciting to celebrate, such as seeing family or friends, going out for their favourite meal or doing something that is special to them.

If things haven’t gone to plan

On the other hand, it’s possible that things didn’t go to plan. Your young person may be feeling disappointed, upset, or anxious, and may be trying to push these feelings away. Remind them that these emotions are completely natural.

Try talking to them about their feelings. They may not want to discuss immediately but reassure them you’re there if they want to talk, need advice or company.

If they start panicking, support them to take a mental pause. Not everything has to be decided at once. Try deeper, relaxed breathing – a proven way to relax your mind and body, allowing greater clarity of thought in the process.

Most importantly, whilst today is bound to be a significant one, these results don’t define them as person. Support them to remember that they have all sorts of interests, passions, and abilities that make them the person they are – their results won’t change that.

It may be that a new path suits them better than the one originally planned. Encourage them to be open to new opportunities and reassure them you’ll support them through this period.

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A-Level Results Day: The Day Before

A-Level Results Day: The Day Before

by | Aug 16, 2023 | Blog Post, News

A-Level Results Day: The Day Before

Tomorrow is results day, and it’s completely natural for young people to be feeling worried. This day can carry a lot of significance as it often determines the next steps in their education and career paths. However, your young person may be feeling about it, it’s important that they know they’re not alone. Whether they are feeling stressed, anxious, fearful, angry, or confused, these are all completely natural human responses, and a sign that they care about their results.

a young girl holding a leaf

We know that these feelings can also be uncomfortable, so, here are some tips to help you support and reassure the young people in your life ahead of results day.

Worries outside of their control

It may be that they have worries about things going wrong that keep going round and round in their head, causing anxiety to build. Most of these worries are likely to be about things that are outside of their control.

Here are three techniques that can help young people create some distance from these types of worries:

  1. Thought switching.

They can try switching their attention away from worries by shifting their mind to something unrelated. Both of you can try and pick a category like a sports team or a country and think of something from that category for every letter of the alphabet, A through to Z. Or you could both focus on what’s going on around you by counting how many things you can see of a certain colour or shape, or things you can hear around you.

  1. Having a plan for the day

Secondly, try and encourage them to distract themselves from worries by planning to do something enjoyable, such as:

  • Seeing or speaking to friends or family
  • Going on a walk or run
  • Eating something they like
  • Leaning into their hobbies
  1. Relaxation breathing

Thirdly, calmer slower breathing can reduce stress and calm their busy minds too.

While sitting together, both take a deep breath in for approximately 5 seconds, and then breathe out for another 5 seconds, repeating several times. Try to imagine that you’re both breathing in calmness and breathing out the stress.  

Worries inside your control

What about worries connected things that are inside their control?

It’s helpful to direct as much energy as possible towards addressing these worries. This will help young people feel less anxious and more empowered ahead of tomorrow.

Results day is undoubtedly nerve-wracking, but it’s important to recognise that there are always options and opportunities available, even if the immediate outcome isn’t what was expected. Here are a few tips for the night before:

  1. Help them prepare by ensuring all the necessary contact details are ready, such as for their chosen universities, apprenticeships, clearing or otherwise.
  2. Try to get a good night’s sleep! Suggest that they wind down least an hour before bed to switch off their busy mind and aim for a time that allows them to get 8-9 hours of sleep. This could involve reading, listening to calming music, or having a shower or bath.

Reminder: Results day is just a moment in time, and the journey continues regardless of the outcome. Let young people know that it’s okay to feel nervous but try not to let those feelings overshadow the potential for positive outcomes and new opportunities.

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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

    by | Aug 3, 2023 | News

    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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