Effectiveness and cost-effectiveness Trial of Humanistic cOunselling in Schools: Individual RCT (ETHOS)

有一个当前的危机，在精神卫生保健的年轻人，和英国政府正试图找到解决它的方法。目前，大约十分之一的年轻人在英国的经验与他们的情绪或他们的行为的重大问题。学校可能是解决这个问题的一个特别好的地方，因为几乎所有的年轻人都去学校。事实上，有证据表明，年轻人参加学校服务的可能性是非学校服务的十倍。某些心理治疗，如认知行为疗法（CBT），可以帮助年轻人解决特定的心理健康障碍，如广泛性焦虑。然而，许多年轻人经历的那种心理问题并不适合这种诊断类别。相反，它们是对特定生活问题的反应，如家庭困难、丧亲之痛和欺凌。虽然这些困难可能并不严重，但尽早解决它们可能非常重要，有助于确保它们不会在以后的生活中发展成更慢性的问题。在英国，帮助年轻人解决这些问题的最常见方法之一是以学校为基础的咨询。“这可以采取多种形式，但与CBT相比，主要侧重于为年轻人提供一个空间，让他们谈论他们的问题，把事情放在心上，并在支持，保密和理解的关系中为自己解决问题。初步证据表明，咨询在年轻人及其教师中非常受欢迎，而且有一些科学证据-包括通过教育与科学研究委员会资助的博士研究-表明，标准化形式的校本咨询（校本人本主义咨询）减少了心理困扰，提高了自尊。然而，为了正确地为政府决策提供信息，需要更好的证据来检验它是否真的有帮助。为了提供这方面的证据，我们将在18所英文中学进行一项研究。我们会为部分有心理问题的青少年（13至16岁）提供长达10星期的校本人本辅导，而其他青少年则会接受学校的日常牧灵关怀。关于谁得到什么的决定将是随机的，因为这给了我们最好的机会来确定治疗是否真的有效。在六个星期、三个月和六个月后，我们会看看接受辅导的青少年是否比没有接受辅导的青少年少受心理困扰。我们亦会研究提供辅导服务的效益是否与所需费用相称。这一点很重要，因为可能有更好的方式来花钱改善学校的福利。此外，我们将研究咨询是否有助于年轻人提高他们的适应力，自尊和对教育的参与;以及他们-他们的老师和父母/照顾者-认为咨询有帮助和没有帮助。这项研究很重要，因为学校咨询可能能够为改善英国年轻人的心理健康做出重大贡献。项目团队在进行此类研究方面拥有丰富的经验，目前的设计已经过测试并显示有效。试验的费用包括项目小组的工作以及曼彻斯特大学专家试验单位的参与沿着。项目组成员还密切参与了最近有关儿童精神健康的政策措施，其中青少年的安全是一个主要问题。我们不会包括任何有伤害自己或他人风险的年轻人，但会将他们转介给专家支持。我们会在研究中评估青少年，并在我们关注他们时，为他们安排适当的支援。我们还将确保参与者的匿名性和保密性达到最高水平。

There is a current crisis in mental health care for young people, and the UK government is trying to find ways of addressing it. Currently, approximately one in ten young people in the UK experience significant problems with their emotions or their behaviour. Schools may be a particularly good place to tackle this problem because they are somewhere that nearly all young people go to. Indeed, evidence suggests that young people are as much as ten times more likely to attend a school-based service than a non-school-based one. Certain psychological treatments, such as cognitive behavioural therapy (CBT), can help young people address specific mental health disorders like generalised anxiety. However, the kind of psychological problems that many young people experience do not fit into such diagnostic categories. Rather, they are responses to particular life problems, such as family difficulties, bereavements and bullying. Although these difficulties may not be at a severe level, addressing them early on may be very important in helping to ensure that they do not develop into more chronic problems in later life. In the UK, one of the most common ways to try and help young people through these problems is school-based 'counselling.' This can take a variety of forms but, in contrast to CBT, focuses mainly on providing young people with a space to talk through their problems, get things off their chest, and work things out for themselves in a supportive, confidential and understanding relationship. Initial evidence suggests that counselling is very popular with young people and their teachers, and there is some scientific evidence -- including PhD work funded through the ESRC -- that a standardised form of school-based counselling (school-based humanistic counselling) reduces psychological distress and improvements in self-esteem. However, to properly inform government decision-making, better evidence is needed to test whether it really is of help. To provide this evidence, we will conduct a study in 18 English secondary schools. We will provide some young people (aged 13-16) who are experiencing psychological difficulties with up to 10 weeks of school-based humanistic counselling while others will receive their school's usual pastoral care. Decisions about who gets what will be made on a random basis, as this gives us the best chance of working out if the therapy really works. After six weeks, three and six months, we will look at whether those young people who received the counselling are experiencing less psychological distress than those who did not. We will also look at whether the benefits of providing the counselling service justify the costs. This is important as there might be better ways of spending the money to improve well being in schools. In addition, we will look at whether the counselling helps young people improve their resilience, self-esteem and engagement with education; and what they -- and their teachers and parents/carers -- think is helpful and unhelpful about counselling. This research is important because school counselling may be able to make a major contribution to improving the psychological wellbeing of young people in the UK. The project team have extensive experience of conducting studies like this, and the current design has been tested and shown to work. The costs of the trial cover the work of the project team along with involvement from a specialist trials unit at Manchester University. Members of the project team have also been closely involved in recent policy initiatives regarding children's mental health.The safety of young people is a major concern. We will not include any young person who is at risk of harm to self or other, but refer them to specialist support. We will assess young people in the study and arrange for appropriate support for them if we become concerned about them. We will also ensure the highest levels of anonymity and confidentiality for participants.