A Qualitative Process Evaluation of Classroom-Based Cognitive Behaviour Therapy to Reduce Adolescent Depression
Abstract
:1. Introduction
2. Method
2.1. Research Design
2.2. Context
2.3. Participant Recruitment
Focus Group/ Interview Type | Gender | School Code | Initials of Member of Team Who Coded Transcript |
---|---|---|---|
Young people (Year 8) | 6 male | 103 | JT/EC/LG |
Young people (Year 8) | 6 female | 103 | JT |
Young people (Year 8) | 6 male/5 female | 106 | EC |
Young people (Year 9) | 1 male/4 female | 102 | LG |
Young people (Year 9) | 4 male/2 female | 105 | JT |
Young people (Year 10) | 2 male/4 female | 105 | JT |
Young people (Year 11) | 2 female | 102 | LG |
Teacher | 1 male | 101 | JT |
Teacher | 1 female | 102 | JT/EC/LG |
Teacher | 2 female | 103 | JT |
Teacher | 1 male/4 female | 105 | JT |
Teacher | 1 female | 106 | LG |
Teacher | 1 male | 107 | LG |
Teacher | 1 male | 108 | EC |
Facilitator | 1 male/7 female | South West | EC |
Facilitator | 3 female | South West | JT/EC/LG |
Facilitator | 5 female | East Midlands | JT |
2.4. Flexible Topic Guides
2.5. Procedure
2.6. Ethical Considerations
2.7. Analysis
3. Results and Discussion
Main Theme | Sub-themes | Key Points |
---|---|---|
Structure and content of the classroom-based CBT | Types of teaching | Hands-on activities preferred. |
Useful aspects of the programme | Useful aspects of the programme were highlighted, e.g., sessions on resolving conflict, recognising body signals, and problem solving. | |
Number of sessions | Shorter faster-paced programme would have been preferred. | |
Delivery | Quality of delivery | Variable. Experience, confidence, reliance on scripts, and teacher engagement were important. |
Classroom management | Teachers and facilitators found this challenging and were unsure of their roles. | |
Rapport with young people | Success in achieving this was variable, particularly where classes did not have the same facilitators throughout the programme. | |
Flexibility and differentiation | Age | The classroom-based CBT used (RAP) seemed to be more appropriate for Year 8 than older year groups. |
Involvement of teachers | Teachers wanted more flexibility and involvement in development of the classroom-based CBT. | |
Sustainability | Resources | Cost and time involved meant classroom-based CBT would not be sustainable in current form |
Future use of the programme | Teachers generally felt they could deliver the programme alone with the right training, although they would be most likely to adapt it and select some parts only. | |
Implementation in the school context | Value of PSHE | PSHE was perceived to be undervalued and under-resourced. |
Busy school environment | Insufficient lead in time, communication within schools, lack of time for contact between teachers and facilitators, were problematic. |
3.1. Structure and Content
I preferred doing the hands-on stuff... the discussions, sometimes I think they kind of just went off a bit because some people lost concentration. (Year 11 female)
Being more interactive and getting the children involved a lot more. (Teacher)
You’ve got a really good little connect activity actually here, this ‘two sides’ of things... and they love that. (Teacher)I thought the body signals one was handy... I think that’s something that works across the age range. (Teacher)
You could see the light going on for so many of them… it was almost like it was news to them… that we don’t have to think like this. I saw it happening with a lot of them that they embraced it… you could see it working. (Teacher)
For the amount of work that was got through, I think it could’ve been condensed to four or five weeks. (Teacher)
Many of the lessons, we’d go in, learn about one thing, come out and the next lesson we’d go back in and we’d learn about exactly the same thing for about half an hour, and then we’d move on to a different thing. (Year 9 male)
3.2. Delivery of Programme
Some of the people who delivered were quite comfortable and I felt quite successful in what they did. Whereas I got the impression from some of my colleagues that some of the people who came to teach it struggled really, and found it hard to deliver the materials in the way they needed to be delivered. (Teacher)
It definitely got easier the more you did the sessions because you just obviously knew them more by heart and didn’t have to rely on the script so much and you can just take the lead. (Facilitator)
That made such a crucial difference with the teacher’s attitude, just… make or break… whether it went… how the class reacted to it. (Facilitator)
I sometimes felt it was hard to know whether to, when to intervene and say “OK come on we’ve asked for quiet now, let’s quieten down”. I didn’t want to take over. (Teacher)
It made it a bit awkward because we got to know the people and all of a sudden they were swapped. (Year 8 male)
3.3. Flexibility and Differentiation
…the Lower School I think really enjoyed it. (Teacher)
I think it would have been much more successful if it had, for instance, been done with the Year 8 group, which is where I would have situated those particular materials. (Teacher)I think with Year 7 this (classroom-based CBT) would have been fantastic and it’s very similar to the Year 7 scheme of work we already use. (Teacher)
All the sessions were the same... for Year 9 and 10 they were identical. It wasn’t age appropriate, I don’t think. (Teacher)I think the idea of Key Stages is really important… we’re going in and aiming it at Year 8 who are 13 to Year 11 who are 16. (Facilitator)
There must be some flexibility built into it... your own guys were strangled by some of the rules that were so rigid. (Teacher)If we’d have been consulted, you could have actually done loads with it. (Teacher)
3.4. Sustainability of Programme
We don’t, unfortunately, think we can give it nine sessions, just because of the constraints of what else we have to put into the curriculum, sadly... but we’ve put five in I think. (Teacher)I think the programme’s excellent, but there just isn’t that kind of money in a budget really to cover things like that. (Teacher)
I think it’s the sort of programme that teachers would take and adapt. (Teacher)
I don’t think there’s anything about the way it’s been structured or put together, the subject matter, that makes it difficult for a teacher to pick up and go with. But again, I think it’s down to that person. (Teacher)
3.5. School Context
3.5.1. Value of PSHE
That’s the sad thing about our PSHE, unfortunately we don’t have a designated team... it is squeezed on the timetable, it’s not given the proper priority it should be. (Teacher)It’s always one of the least funded departments, PSHE. (Teacher)
The fact that the RAP sessions were in PSHE, a lesson that isn’t taken particularly seriously, I think that really affected how people came into the class. (Facilitator)
3.5.2. School Environment
Because it’s that initial bit... we didn’t get the bonding side of it, we didn’t get the team building side of it... we did not have that luxury. (Teacher)
We needed the equipment there and it was really frustrating to turn up and the school go, “Oh, I didn’t know you needed a laptop”. (Facilitator)
I think the length of time that you’re here is quite challenging for us… it’s just trying to fit that in with our curriculum, it’s really hard. (Teacher)
I think it’s difficult bringing mental health programmes into a school environment and it’s a massive job to integrate that kind of clinical into everyday school. (Facilitator)
4. General Discussion
Study Strengths and Limitations
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Taylor, J.A.; Phillips, R.; Cook, E.; Georgiou, L.; Stallard, P.; Sayal, K. A Qualitative Process Evaluation of Classroom-Based Cognitive Behaviour Therapy to Reduce Adolescent Depression. Int. J. Environ. Res. Public Health 2014, 11, 5951-5969. https://doi.org/10.3390/ijerph110605951
Taylor JA, Phillips R, Cook E, Georgiou L, Stallard P, Sayal K. A Qualitative Process Evaluation of Classroom-Based Cognitive Behaviour Therapy to Reduce Adolescent Depression. International Journal of Environmental Research and Public Health. 2014; 11(6):5951-5969. https://doi.org/10.3390/ijerph110605951
Chicago/Turabian StyleTaylor, John A., Rhiannon Phillips, Ellen Cook, Lucy Georgiou, Paul Stallard, and Kapil Sayal. 2014. "A Qualitative Process Evaluation of Classroom-Based Cognitive Behaviour Therapy to Reduce Adolescent Depression" International Journal of Environmental Research and Public Health 11, no. 6: 5951-5969. https://doi.org/10.3390/ijerph110605951