Keynote speech by Mick Cooper at the European Association for Counselling conference in St Petersburg Sept 26th - 28th 2013 "The effectiveness of school-based counselling with young people"

1. The effectiveness of
school-based counselling
with young people
Mick Cooper, Professor of Counselling
EAC, Pushkin 2013
Thanks to: Jo Pybis, Katherine McArthur, Karen
Cromarty, Andy Hill, Nancy Rowland, Jamie Murdoch, Nick
Turner, Ruth Levesley, Peter Pearce, Sarah Osman, Ros
Sewell
Contact: mick.cooper@strath.ac.uk

2. Aims of talk
1. Review evidence from UK on
school-based counselling and
its effectiveness
2. Explore pathways by which
school-based counselling
might bring change about

3. The emergence of schoolbased counselling for young
people in the UK
1960
1970
1980
1990
2000
2010
Source: Baginsky, 2004; BACP 2012

4. Widely disseminated
• Today, school-based
counselling is one of the most
common mental health and
wellbeing provisions for young
people in the UK
Source: BACP 2012; Hill, 2011; estimated figures

5. Dissemination of school-based counselling
in UK secondary schools
Scotland: 64-80% (approx.)
NI: All schools since 2007
England: 61-85% (approx.)
Wales: All schools since 2008
Source: BACP 2012; estimated data for England and Scotland

6. International prevalence
• 39 countries around globe mandate
school-based counselling (inc. Czech
Republic, Slovakia and Romania)
• 24 countries: well-established but not
compulsory (inc. Georgia, England)
• „Overall, school counselling is developing
relatively quickly into an integral part of
the education system in many parts of
the world‟ (Harris, 2013)

7. Service delivery in UK
• Delivered by qualified counsellors
• Primarily
humanistic/integrative, orientation:
relational, supportive, „nondirective‟ practice
• Generally one-to-one, confidential
• Orientation to mental wellbeing
• Mainly for young people: 11-18
Source: Cooper, 2009; Hill, 2011

8. Referral routes
School staff
Self
Parents/carers
Source: Cooper, 2009; Hill, 2011, estimates from approximately 20,000 young people

9. Reported waiting
times: relatively brief
50%
35%
1 week
15%
1 month
Source: BACP, 2012; Hill, 2011; approximate data, as reported by school staff and local authority leads

10. Psychological difficulties at
assessment (SDQ) (counselling)
„Normal‟
„Abnormal‟
„Borderline‟
Source: Cooper, 2009, from 611 young people

11. Presenting/developing issues
35
Percentage
30
25
20
15
10
5
0
Source: Cooper, 2009; Hill, 2011; approximate data from over 20,000 cases

12. BME under-represented
Percentage
2
1.5
1
0.5
0
Counselling clients
All Wales
Source: Hill, 2011; data from 11,043 cases

13. Effectiveness
Effectiveness

14. Pre-/postevaluation

15. YP-CORE:
Principal
outcome
measure for
school-based
counselling
in UK



Higher total
scores =
More distress

16. Change from pre- to postcounselling
Counselling consistently associated with significant
reductions in psychological distress from beginning to end
Meta-analyses, ES=
0.81 – 1.09 from
pre- to postOutcome measure score (higher scores mean more distress)
Welsh Strategy evaluation
25
20
15
10
5
Pre-counselling
Post-counselling
Source: Hill, 2011;
Cooper, 2009; data from

17. In “real” terms…
Over the last week…
„My problems have felt too much for me‟
After
counselling
av. = 1.05
Before
counselling
av. = 1.87
0
1
2
3
4
Not at all
Only
occasionally
Sometimes
Often
Most or
all of the
time

18. Randomised
controlled
trials
(RCTs)

19. The randomised controlled trial
„baseline‟
‟endpoint‟
Counselling
Random
allocation
Not counselling
(e.g., wait-list)

20. Global data
• School-based therapeutic interventions
significantly reduce psychological
distress (107 studies, mean „effect
size‟ = 0.45 = medium effect)
• But evidence comes mainly from US
studies, CBT/psycho-educational, often
group-based
• Is counselling, as delivered by UK
counsellors, effective?

21. „School-based humanistic
counselling‟
• Developed as distillation of
UK practice
• Based on humanistic
competences:
relational, supportive
approach, Rogerian
foundations
• Four pilot RCTs comparing
against waitlist

22. School-based humanistic
counselling
Reduced psychological distress
• Combined data
from three RCTs
with 53 clients in
counselling, and
57 in waiting list
Large effect • Up to 10 weeks
ES = 0.78
of SBHC
• Audited for
‘adherence’ to
humanistic
competences

23. Qualitative data
from service
users

24. Service user perspectives
“It really does help you to concentrate better in class cos all your
problems are like, sorted, so the teachers probably think it's good.”
“I was sad when I went in there cos I lost my grandmother….. She
says it goes– she says it goes on in my life, she says she knows how
hard it is ...The more and more I do learn from her, the more and
more I get happier.”
“Yeah it's changed my behaviour a lot.. I can walk away from
situations instead of swing punches. Before, if I was fighting and one
of my friends would grab me I'd hit „em but now if they grab me I'll
get off.”
“I have recommended it to my friend, I said it really, really helps, you
can talk about anything doesn't have to be a really big problem, just
any problem you have -- bullying, relationships, friendships, anything - and she always tries to understand everything you say and even if
she doesn't understand you can tell her off and just say, „No you got
it wrong,‟ and she listens to everything you're saying, and what I'm
describing -- it really helps.”

25. Do teachers
think counselling
is helpful for
clients?

26. Helpfulness: Teachers‟ ratings
(N = 125 pastoral care teachers)
„Extremely
unhelpful‟
„Neither helpful
or unhelpful‟
„Extremely
helpful‟

27. Teachers‟ open-ended responses
• In general, very positive about the
helpfulness of counselling:
„I was sceptical to begin with…but it‟s been
great, excellent, superb‟
„This is an excellent service which has been of
huge benefit to pupils on a short/long term
basis‟
„Excellent resource which pupils find very
valuable‟

28. Educational
impact

29. Global data
• School therapeutic interventions
significantly improve academic work
(83 studies, overall effect size = 0.38)
–
–
–
–
Class behaviour (teacher-rated): ES = 0.26
Academic achievement: ES = 0.36
Environmentally-related: ES = 0.26
Self-reported academic outcomes: ES = 0.59

30. Educational impact: UK data
• Self- and teacher-rated impact on: Motivation
to attend / Ability to concentrate / Motivation
to study / Willingness to participate in class
• Clients:
– Improved: 60-70%
– Same: 25-35%
– Worse: 5-10%
• Teachers
– Improved: 75-90%
– Same: 5-20%
– Worse: 2-3%

31. Long term
outcomes

32. Follow-up data: YP-CORE
25
counselling
20
15
10
6 months
endpoint
midpoint
startpoint
5
n = 17

33. Case controlled data: YP-CORE
25
counselling
20
15
10
6 months
endpoint
midpoint
startpoint
6 weeks pre
12 weeks pre
5
n = 11 (n = 5 at 6 months)

34. How might school-based counselling
help to bring about individual change?

35. Helpful aspects:
young people
1.
2.
3.
4.
Opportunity to talk and being listened to
Getting things off one‟s chest
Confidentiality
Counsellors‟ personal qualities
(e.g., accepting)
5. Independence of counsellor
6. Directive therapeutic interventions
(e.g., relaxation exercises)

36. Helpful aspects:
school staff
1.
2.
3.
4.
5.
6.
Accessibility of service
Independence
Confidentiality
Specialist training
Available for extended time periods
Non-stigmatising

38. Summary
1. School-based counselling is major area
of development internationally
2. Increasing evidence that significantly
reduces young people‟s levels of
psychological distress, and their ability
to engage with education
3. Gives young people an opportunity to
talk through problems and feel better
about selves

39. Summary
• School-based counselling is a widely
disseminated intervention, but
rigorous evidence of effectiveness is
limited
• Emerging body of evidence suggests
that it does bring about significant
reductions in psychological distress
• Matches many clients‟ experiences of
counselling and cohort data