PROmoting Mental health In Schools through Education PROMISE

1. PROmoting Mental health In Schools through Education PROMISE Introduction to researchers. Going to be talking about the �PROMISE� project which is going to be happening in the school over the next year� Introduction to researchers. Going to be talking about the �PROMISE� project which is going to be happening in the school over the next year�

3. Effective treatment is available but�.. Few are identified and referred for treatment 33% of those with anxiety and 45% of those with depressive disorders had contact with any health service (primary & secondary) over 3 years (Ford et al 2008) Specialist treatment is scarce UK survey of child focused CBT highlighted that CBT was the dominant approach of only one in five specialist CAMHS clinicians (Stallard & Udwin 2007)

4. ���� Many do not respond to treatment The Cochrane review of CBT for the treatment of anxiety disorders found 56% were diagnosis free at the end of treatment (Soler & Weatherall (2007) Others drop out Systematic review of attrition in depression trials ranged from 0 -71% with a mean of 12.8% (Weisz, McCarty, & Valeri 2006)

5. An alternative approach: Prevention

6. Type of Prevention Programmes Universal Preventive Approaches Delivered to all irrespective of risk status and are designed to build resilience/enhance mental health Selected Preventive Approaches Targets those �at risk� of developing psychological problems by virtue of risk factors. Indicated Preventive Approaches Target those already displaying mild to moderate problems (Mrazek & Haggerty, 1994)

7. A spectrum of mental health interventions

8. PROmoting Mental health In Schools through Education (PROMISE) Collaboration of mental health experts and academics from the Universities of Bath, Bristol, Nottingham, and Peninsula Medical School. Funded by the NHS NIHR Health Technology Assessment Programme for 40 months Approval from School for Health Research Ethics Panel Monitored by an Independent Trial Steering Committee and Data Monitoring and Ethics Group

9. Primary Aim To compare the effectiveness and cost effectiveness of 3 types of PSHE on the mental health of young people aged 13-16. Particularly interested in children at �high risk� of depression

10. 3 Arm RCT

12. Assessment Outline Screening: short mood screening questionnaire 2-4 weeks before the initial (baseline) assessment Baseline assessment Intervention: For the next 9 PSHE lessons the children will receive either usual, enhanced or focused PSHE 6 and 12 month follow-up assessments

13. Assessment measures Demographic summary Feelings � Revised Child Anxiety and Depression Scale Mood � Short Mood and Feelings Questionnaire Thoughts about self � Rosenberg Self Esteem Scale Negative Thoughts � Child Automatic Thoughts Scale School Connectedness Attachment Health Status � EQ-5D Client Receipt of Services Questionnaire Self-harm, alcohol & drug misuse, bullying

14. Pilot study

15. What did we find? Approx 20% classified as �high risk� of depression 10% had seen someone for anxiety or depression 4.5% diagnosed by a Doctor with anxiety/depression 2% prescribed medication 30% (194) had thought of harming themselves 16% (104) on one or more occasions 79% drunk alcohol; 13% smoked cannabis 10% taken other street drugs in past 6 months

16. RAP group are happier

17. and have significantly better self-esteem

18. Working in schools: the challenges! Some you people are not so engaged! Variation in teaching approaches and engagement with the project Various other challenges, inc. staff and student absences due to illness, bad weather, problems getting to school, school closures, school events (e.g. sports days, work experience, project days etc.) While collecting data and delivering interventions to large groups has benefits, if any sessions are missed, this can result in losing a fair bit of data and it can be very difficult to re-schedule due to other demands on the school/students. Some you people are not so engaged! Variation in teaching approaches and engagement with the project Various other challenges, inc. staff and student absences due to illness, bad weather, problems getting to school, school closures, school events (e.g. sports days, work experience, project days etc.) While collecting data and delivering interventions to large groups has benefits, if any sessions are missed, this can result in losing a fair bit of data and it can be very difficult to re-schedule due to other demands on the school/students.

19. Main Trial - September 2009 8 Schools � BaNES, Bristol, Nottingham, Wiltshire 28 year groups, 221 classes, 5746 students Consent for first two schools (1571 students) 38 parents and 84 students opted out 96% completed screening and 91% baseline assessments assessments Clinical Trial Manager, 2 Research Officers, 1 Clinical Trial Manager, 44 Psychology Assistants ���..

20. Thank you� Participating schools Collaborators Paul Stallard (PI), Alan Montgomery, Ricardo Araya, Glyn Lewis, Rob Anderson, Kapil Sayal Local clinical leads Dr Moldavsky, Dr Phil Shoebridge and Dr Wendy Woodhouse Research team Rhiannon Buck, Clinical Trial Manager Karen Spillard, Trial Co-ordinator Abi Millings & John Taylor, Research Assistants Psychology Assistants on pilot; Megan Attwood, Francine Bear, Ellen Cook, Katherine Deans, Emily Doe, Emma Dunford, Sarah Green, Lucy Georgiou, Susannah Padiachy, Hannah Paniale, Tom Richardson, Sophie Velleman TSC & DMEC Funders: NHS NIHR HTA Research Grant + Excess Treatment Costs from Department of Health and local PCTs and Service Support Costs from Research Networks