Psychology need assistance with homework for psychology2

Can a targeted, group-based CBT intervention reduce depression and anxiety and improve self-concept in primary-age children?

Paul O’Callaghana,1* and Enda Cunninghamb,1

aEducational Psychology Service, Education Authority Southern Region, Dungannon Psychology Office, Circular Road, Dungannon BT71 6BE, UK; bEducational Psychology Service, Education Authority Southern Region, 3 Charlemont Place, The Mall, Armagh, Co. Armagh BT61 9AX, UK

This pilot study examined the impact of a 10 session, group-based, early- intervention cognitive behavioural therapy (CBT) programme (Cool Connec- tions) on anxiety, depression and self-concept in nine 8–11 year old pupils in Northern Ireland. The intervention was facilitated by a teacher, education welfare officer and two classroom assistants, with support from the school’s educational psychologist. A group of pupils identified by teachers as presenting with symptoms of anxiety and depression or low self-esteem and who scored in the mild, moderate or severe range of difficulties on the Beck Youth Inventories took part. Findings indicate statistically significant improvements in both anxiety (t(8) = −3.29, p < 0.017) and depression (t(8) = −3.06, p < 0.017) but not self-concept (t(8) = 2.63, p = 0.030). The article concludes with strengths and limitations of the current study, professional reflections on implementing a multi-agency, group-based, CBT intervention and implications for future research and educational psychology practice.

Keywords: Cool Connections; targeted CBT intervention; group-based; depression; anxiety; self-concept

Introduction

In the United Kingdom (UK) 10% of five to 15 year olds have a diagnosable mental health disorder with 10% of children and young people presenting with less serious psychological problems that would benefit from psychological input (Department of Health, 2004). Yet, despite the high prevalence of mental health difficulties, it has been suggested that the majority of children and young people, particularly those with emotional disorders, remain unidentified and untreated (Stallard, 2011). Extrap- olation studies comparing prevalence of mental health problems with statistics for uptake of mental health services found that in certain parts of the UK, up to 90% of children with significant psychological problems that impact on their academic and social functioning may never access specialised help from Child and Adolescent Mental Health Services (CAMHS) (Williams, 2005).

Given the difficulties encountered by CAMHS in supporting the mental health needs of all children and young people that require their help, it is unsurprising that the government is looking increasingly to educational settings to assist in meeting

*Corresponding author. Email: [email protected] 1formerly the Southern Education and Library Board (SELB).

© 2015 Association of Educational Psychologists

Educational Psychology in Practice, 2015 Vol. 31, No. 3, 314–326, http://dx.doi.org/10.1080/02667363.2015.1060587

this need (Department of Health [DoH], 2004). As familiar, non-stigmatising settings (Jordans et al., 2010), schools are well placed to overcome access barriers to health care faced by children from poor or minority backgrounds (Stein et al., 2003). Addi- tionally, early years settings are uniquely placed to recognise and identify mental health difficulties promptly and intervene early before difficulties increase and become more entrenched (Rait, Monsen, & Squires, 2010).

Research literature

A systematic review of 27 prevention and early intervention programmes for anxiety found that school-based universal, selective and targeted prevention programmes were effective in reducing anxiety symptoms in children and adolescents with effect size ranging from 0.11 to 1.37 (Neil & Christensen, 2009). This review found that most programmes reduced symptoms of non-specific anxieties (67%) and were cogni- tive behavioural therapy (CBT)-based interventions (78%). Although caution must be observed in interpreting findings since this review included both targeted and universal programmes in the same analysis, no difference was found in outcome effectiveness if the programme was led by a teacher, educational psychologist (EP) or a non-teaching mental health worker. This finding was supported by a systematic review of teacher involvement in school-based mental health interventions (Franklin, Kim, Ryan, Kelly, & Montgomery, 2012) which found that of the 49 school-based mental health studies analysed, teachers were actively involved in 40.8% of them and both teachers and school mental health professionals had similar intervention outcomes.

However, these findings were not replicated in a systematic review of 12 ran- domised control trials of school-based prevention and early intervention programmes for depression (Calear & Christensen, 2010). The authors found that teacher-led pro- grammes had fewer significant effects than programmes implemented by mental health practitioners. Nonetheless it is suggested that anxiety programmes in schools are sustainable, can be implemented well by school teachers and other professionals and are effective both as universal and targeted programmes. However, interventions for depression are less robust in producing symptom reductions, are less effective when run as universal programmes and appear to require more specialist training and experience to deliver the same benefits as anxiety-based programmes (Calear & Christensen, 2010).

Although many school-based interventions for anxiety (Neil & Christensen, 2009) and depression (Calear & Christensen, 2010) are based on CBT principles, it is impor- tant to note that CBT is not a uniform, singular treatment programme. Instead it com- prises a family of models encompassing an eclectic group of techniques that combine cognitive and behavioural strategies (Rait et al., 2010). For example, of the 21 CBT- based programmes included in Neil and Christensen’s (2009) systematic review, 13 separate CBT-based programmes were used. Although a variety of CBT-based pro- grammes are available, most contain the following features: psycho-education, somatic management (for example, breathing, relaxation techniques), cognitive restructuring (finding alternative explanations), problem solving (finding new solutions) and exposure and relapse prevention (testing and maintaining new learning) (Pugh, 2010).

In addition to systematic reviews of the effectiveness of CBT in reducing symp- toms of anxiety and depression in young people, studies have also found CBT to be effective in reducing post-traumatic stress symptoms (McMullen, O’Callaghan,

Educational Psychology in Practice 315

Shannon, Black, & Eakin, 2013; O’Callaghan, McMullen, Shannon, Rafferty, & Black, 2013; Tol et al., 2008) and improving self-control of behaviour (Squires, 2001). Yet despite the emerging evidence highlighting the effectiveness of CBT in alleviating symptoms of anxiety and depression in children and adolescents (National Institute for Health Care Excellence [NICE], 2005) most studies are outcome studies, examining “if” CBT interventions work and not process studies, examining “how” or “why” CBT interventions works (Pugh, 2010). Although this article will not be able to address this question completely, it uses both outcome and process variables to describe a model of service delivery that aims to be cost- effective, resource-efficient and maximises psychology time and input in order to reduce the need for statements of special educational needs (SEN) for social, emotional and behavioural difficulties in the future (Squires, 2001).

Method

Participants

Nine pupils (three girls and six boys) took part in the intervention (range: 8–11 years old; ẍ = 9.44; standard deviation [SD] = 1.24). All attended a large (n = 556) co-educational primary school in Northern Ireland. At the time of the intervention 47% of the school were entitled to free school meals, 24% of the school’s pupils had English as an additional language and 18% were identified by the school as requiring additional support in learning.

Procedure

The nine participants were drawn from a group of 14 pupils identified by teachers or parents as presenting with symptoms of anxiety or depression in school. Written consent was sought from all parents concerned in a letter sent by the school outlin- ing the research project and intervention aimed at reducing symptoms of anxiety and depression and promoting psychosocial resilience among school-aged children. Once parental consent was obtained, the school’s EP met with all 14 pupils identified to explain the research and intervention project and seek assent from all to participate in the research and intervention. One pupil chose not to participate after completing the screening questionnaires and was exempted. The intervention ran for 10 sessions (attendance range: 7–10 sessions; ẍ = 9; SD = 1.11) on a Friday afternoon from approximately 1:30 p.m. to 3 p.m. in the school. The final session concluded with a small party and graduation ceremony. Weekly homework was also set and collected before the intervention session on Friday.

Measures

All pupils were screened on the Anxiety, Depression and Self-concept inventories of the Beck Youth Inventories (second edition). The Anxiety Inventory measures fearfulness, worry, and bodily symptoms indicating anxiety while the Depression Inventory measures sadness, negative thoughts and associated bodily symptoms. The Self-concept Inventory measures perceptions of competency and self-worth. Psychometric properties for the Beck Inventories are good: internal consistency coefficients of all inventories exceed the minimum criterion of 0.80 using Cronbach’s coefficient alpha, median test–retest reliability coefficients across

316 P. O’Callaghan and E. Cunningham

inventories exceed the minimum criterion of 0.80, while strong convergent validity was found for all inventories (Bose-Deakins & Floyd, 2004).

All pupils who scored in the mild, moderate or extreme level of difficulty on any of the Anxiety, Depression or Self-concept scales were eligible to participate in the intervention. Following this screening, nine pupils met criteria and provided assent to participate.

The intervention

Cool Connections (Seiler, 2008) is a 10-session, group-based, early intervention, CBT programme (Table 1). This manual-based programme uses illustrations, games, theory and fun activities to encourage more positive ways of thinking and dealing with worries and anxieties.

Facilitators

A Year 6 teacher, an education welfare officer and two classroom assistants facilitated the intervention. In vivo supervision was provided by the school’s EP who also met the facilitation team every week before the intervention to recap on the teaching points in the week’s module session and to prepare any resources necessary for that session. A brief treatment post-session review took place every week to ensure treatment fidelity (Pugh, 2010), discuss any modification to the intervention (for example, re-emphasising the contract, contacting teachers to check

Table 1. An outline of the 10 session, group-based Cool Connections CBT programme.

Session Focus

One Introduces the intervention, discusses group rules, normalises stress reactions and provides psycho-education on stress and its effect on people

Two Explains what feelings are, how faces and body language can reveal feelings and the connection between thoughts and feelings

Three Introduces body signals and how body signals are linked to thoughts, feelings and behaviour

Four Introduces thoughts, ways of identifying thoughts and how thoughts influence feelings and actions

Five Summarises the previous four sessions, explores similarities and differences among the group in reacting to similar situations (for example, someone bumping into you) and re-examines the impact of changes in thoughts, feelings, body signals and actions on a person

Six Introduces different ways of thinking (for example, “gloomy” versus ‘Pollyanna’ thinking) and Socratic Questioning as a tool for understanding in more detail an upsetting problem

Seven Explores alternative ways of looking at difficulties, challenges cognitive distortions by encouraging more “scientific” problem solving and explores how soothing or calming thoughts can improve the way you feel

Eight Explains how to implement life goals, encourages help-seeking behaviour and helps participants to define and articulate their difficulties so their difficulties can be resolved

Nine Explores the individualised nature of worry and how certain thoughts, feelings and behaviours can either hinder or help people in resolving their difficulties

Ten Explains how problems can be broken into smaller, more achievable steps, how mental imagery can be used to visualise success in adversity and how modelling yourself on someone else who coped well can help overcome fears

Educational Psychology in Practice 317

on class activities during the scheduled intervention time) and decide which two facilitators would lead the following week’s session.

Results

This study was evaluated both quantitatively and qualitatively. The quantitative analysis used three paired samples t-tests to analyse within group differences between pre- and post-scores. Qualitative analysis involved written feedback from participants to ascertain their views on the programme. The findings are shown and discussed.

Quantitative analysis: within group differences

Using three paired samples t-tests, the analysis shows the Cool Connections group had statistically significant improvements in symptoms of depression and anxiety but not in self-concept from pre-intervention to post-intervention (Figure 1 and Table 2).

Qualitative analysis

Information on Cool Connections was gathered using written feedback question- naires from all nine participants. Participants firstly answered 17 multiple-choice questions on various teaching points in the course (for example, identifying a feel- ing, a body signal or a thought from a set of three options, identifying the Fight or Flight Response, understanding why it is important to experience body signals, etc.) before completing a brief questionnaire asking if they found the Cool Connections course helpful and why, if they would recommend the course to other children in their school and why, the most enjoyable aspects of the programme as well as any useful strategies or learning points gained from the programme. Qualitative data

0

5

10

15

20

25

30

35

40

45

Anxiety Depression Self-Concept

28.89

20.44

34.56

15.11 10.67

44

Pre-Intervention

Post-Intervention

Figure 1. Improvements in symptoms of anxiety, depression and self-concept in the intervention group after the 10-week, Cool Connections cognitive behavioural therapy (CBT) intervention.

318 P. O’Callaghan and E. Cunningham

were analysed using theoretical thematic analysis underpinned by a contextualist epistemology (Braun & Clarke, 2006). Findings from this feedback will now be discussed.

Participants’ feedback

The average number of questions answered correctly on the multiple-choice assessment was 12/17 questions (69%) with participants finding it easier to identify examples of feelings than examples of body signals.

All nine participants found the Cool Connections course helpful. Reasons given included help in identifying, acknowledging and expressing emotions in more pro- ductive ways, “helped with expressing feelings and dealing with anger” (eight chil- dren), help with thoughts “helped me how to control thoughts” (two children), understanding body signals better, “control my body signals” (two children), developing friendships “helped me get to know people” (two children), learning calming techniques “helped me learn calming techniques” (one child), reducing stress, “Cool Connections helped me with stress and anger” (one child) helping with confidence, “Cool Connections helped my confidence” (one child) and feeling happy, “Cool Connections makes me feel happy” (one child).

All nine participants would recommend the Cool Connections intervention to other children in their school. They would recommend it because they believed it helped them to understand, accept, and settle their feelings, “Cool Connections really helped me with controlling my feelings” (three children), acknowledge their worries and fears, “I would recommend Cool Connections because people have worries and don’t get help” (three children), acknowledge feelings of anger and/or stress, “helped so much with anger and stress” (two children), build up confidence, “helps build up confidence” (one child) and like school more, “I’d recommend Cool Connections to other children so they wouldn’t end up not liking school” (one child). Participants cited the games and activities (seven children) and opportunities to make new friends (five children) to be the most enjoyable aspect of the intervention.

Discussion

This research project provides preliminary quantitative and qualitative evidence that a targeted, group-based, CBT intervention, facilitated by a teacher, education welfare

Table 2. Means, standard deviations (SDs), t-value, p-value and effect size (Cohen’s d) for the intervention group from pre- to post-intervention screening.

Measure

Pre-intervention (n = 9)

Post-intervention (n = 9)

Mean (SD) Mean (SD) t-Valuea p-Valueb Effect sizec

Anxiety symptoms 28.89 (13.75) 15.11 (7.04) −3.29 < 0.017 d = 1.09 Depression symptoms 20.44 (13.03) 10.67 (9.08) −3.06 < 0.017 d = 1.02 Self-concept 34.56 (6.25) 44.00 (10.23) 2.63 = 0.030 d = 0.88

aBased on paired samples t-test [95% confidence interval (CI)] comparison with pre-intervention scores. bBonferroni adjustment of significance levels was applied for multiple comparisons (Bonferroni-corrected significance level: 0.05/3 = 0.017). cEffect size of pre- to post-intervention gains, calculated by dividing the mean difference of the pre- to the post-intervention scores by the standard deviation (SD) of the difference.

Educational Psychology in Practice 319

officer and two classroom assistants is effective in reducing reported symptoms of anxiety and depression in 8–11 year olds. In line with previous research (O’Callaghan, McMullen, Shannon, & Rafferty, 2015) that used a group-based CBT in a school-setting, statistically significant improvements in self-concept were not recorded. This may be because improving self-esteem requires more targeted in situ activities that allow the young person to experience success in an area that con- tributed to a poorer self-concept in the past, for example, school work, friendships, or sporting success. It may also suggest that self-concept is more deep-seated than mood symptoms and thus less open to change in the wake of an intervention than symptoms of depression or anxiety.

All nine participants reported that they enjoyed the intervention, found it helpful and would recommend it to others. Reasons quoted included insights gained from the intervention in managing thoughts and feelings (for example, “Cool Connections helped me forget about my worries and would help younger children stop worry- ing”), growth in confidence (“Cool Connections has helped me grow in confidence and be less shy”), making new friends, (“the most enjoyable thing about Cool Connections was making new friends”), providing a discussion forum not normally available to discuss feelings (“I love the Cool Connections club, it helps me with stuff I can’t tell anyone else”) and help in thinking about more appropriate actions in response to feelings (“Cool Connections helped to get out the feelings that you fight about deep inside yourself”).

The comment on making new friends was made by a Year 5 boy who was iso- lated in his year group and had identified peer friendships as a key target prior to beginning the intervention. Although improving peer friendships was not an explicit aim of the intervention it was an unexpected side benefit of the group-based aspect of this intervention. The provision of a forum for discussion and normalisation of anxiety was another unanticipated benefit of the intervention. This came as a sur- prise to the research team who had wrongly assumed that opportunities already existed in school settings (for example, Personal Development and Mutual Understanding) to allow such topics to be raised.

The multiple-choice questionnaire revealed that children had learned a considerable amount from the sessions. After the sessions most participants were able to identify thoughts, feelings and actions, recognise body signals, understand that feelings can change over time and are neither good nor bad.

This intervention was delivered by a heterogeneous multi-disciplinary interven- tion team involving a teacher, two classroom assistants and an education welfare officer, reflecting the increasing range of role partners that EPs now work with (Fallon, Woods, & Rooney, 2010). Weekly facilitator consultation sessions were supported by the school’s EP, who devised the research project and measured the pre- and post-intervention outcomes. As a manual-based intervention, this programme is replicable and now that school staff have experience delivering the sessions, the intervention can be scaled up to be offered to a wider population within the school if necessary.

There were many learning points during this project that practitioners may like to consider prior to implementing a similar intervention in the future.

When working with children who are anxious, more time is required to complete tasks than normal. Although the manual allocates 90 minutes for each module, it was found that some modules required at least two hours. Thus, an additional ses- sion was sometimes added during the week to complete session material, allow more

320 P. O’Callaghan and E. Cunningham

time for participants to share experiences and normalise responses and prevent rushing already anxious pupils during session tasks.

When dealing with a large facilitation team, detailed pre-session preparation and clear demarcation of session topics to be covered by each facilitator is vital to guarantee good time management and ensure that all the learning points of a session are covered. If a planning session was curtailed, the subsequent session sometimes over-ran, lacked coherence and appropriate pace and learning points were not clearly drawn out. This resulted in a more extensive revision of prior learning points being required at the start of the next session.

It was also discovered that more information needed to be given to participants regarding the aims, purpose and format of the intervention. For example, in the first session it was noted that not all participants had understood why they were selected for the intervention or what the intervention was actually about. A detailed informa- tion session for both parents and participants would help reduce this information gap.

Anxious children may also have anxious parents and so additional parent information sessions may be required to explain the aims of homework tasks set. For example, one homework task required participants to observe friends and family and note down any body signals of anger, upset or joy that they observed. One child refused to do this task, citing that he did not want to “spy” on his parents. This con- cern about “spying on parents” was also raised by the boy’s parent in the follow-up telephone-call to explain the aim of the homework task. A subsequent homework task entitled “Eavesdropping” was withheld due to concerns that the task might be misinterpreted in a similar fashion.

Every CBT session had prescribed homework and in the course of this interven- tion eight homework tasks were set. However, homework compliance varied greatly. While an average of 3.89 out of eight homework tasks were handed in for the nine participants, the range was very large: 0–8 tasks. The optional nature of homework tasks for a CBT intervention is at odds with the expectation of homework comple- tion in a school setting and incongruous to school staff used to insisting on 100% homework compliance. To boost homework completion rates while at the same allowing for personal choice in completing the task, a small prize was offered for all pupils who completed a set number of homework tasks.

Another dichotomy emerged between behavioural expectations in a classroom setting and a group-based therapy session held in a school. Some older participants displayed better attention and rule compliance when the teacher was present in the room. When participants became restless, giddy or spoke over each other the beha- vioural contract that they had signed on the first day was placed on prominent dis- play in the room and the participants were reminded of the need to observe the rules that they themselves had composed.

There were also some brief learning points for the facilitation team. For example, Friday afternoon is never the best day to run an intervention as pupils often have art, music or sport then and would rather not miss these subjects. This is especially true for an intervention involving different year groups and classes and creates an administrative problem in liaising with so many teachers to check that pupils are not missing out on any special class activity. It is also best if the venue remains the same for the whole intervention as changing the venue can upset anxious students and disrupt the start time of the planned session. Siblings are probably best assigned to different intervention groups as it was noted that older siblings can inhibit the

Educational Psychology in Practice 321

expression and freedom of younger brothers or sisters. Drama, ice-breaker games and puppet play is popular with children and is a vital part of any intervention but reading aloud must be done judiciously as anxious students can find reading aloud very daunting and this can add to their already elevated stress levels. This challenge can be overcome by explaining that no-one has to read and that participants that volunteer to read will be asked to do so.

Limitations of the study

However, despite the apparent positive outcomes mentioned earlier, the research pro- ject and intervention was not without its limitations. Firstly, it was a pilot project involving only nine pupils with no control group or follow-up results so consider- able caution must be observed in generalising findings from this small sample, since some of the variability in pre- and post-intervention scores could have been linked to spontaneous remission. Although spontaneous remission of depression and anxi- ety symptoms in waiting list control groups has been found in previous studies (McMullen et al., 2013; O’Callaghan et al., 2013; O’Callaghan et al., 2015), these reductions have been significantly less than the reduction in depression and anxiety among male and female participants in the group-based CBT intervention.

Secondly, while anecdotal evidence is present from teaching staff regarding per- ceived improvements in the mental health of participants, the study relied exclu- sively on self-report measures and would have benefitted from the triangulation of outcomes afforded by multi-rater responses (for example, parents, class teacher, year head, etc.) There was also a wide variation in pre-intervention symptoms of anxiety and depression among participants with some participants reporting severely ele- vated symptoms of depression and anxiety and others reporting no significant levels but lower than average self-concept. The four member team of facilitators was heterogeneous with different training backgrounds (for example, social work, teach- ing, classroom assistance). Some facilitators were known to the pupils while others were not. Although the large number of facilitators was beneficial in sessions when two or more participants became emotionally distressed or in sessions that required individualised support to complete written tasks, it also introduced the confounding variable of different styles and levels of competency in teaching and facilitating intervention sessions.

Future research

Based on the qualitative and quantitative findings of the current study, the school is keen to scale up the intervention and is considering screening all children in Key Stage II and running intervention groups facilitated by the school staff who delivered this current pilot study. This scaled up intervention might provide further evidence of the effectiveness of the intervention, with a larger sample size and a non-intervention group to control for spontaneous remission.

It was also proposed by the school that some participants from the pilot study could act as facilitator assistants to help run the next block of interventions. The school is also interested in delivering this intervention to Key Stage I pupils and adapting the programme to account for children at the pre-operational stage of cognitive development, for example, greater use of narrative to concretise abstract

322 P. O’Callaghan and E. Cunningham

concepts, externalising introspection through storytelling, reasoning by analogy and metaphor, greater use of drama, etc. (Freeman et al., 2007).

Future dismantling studies are also required to explore the key “ingredients” (Rait et al., 2010) that account for the intervention’s effectiveness. It was interesting to note that participants cited the games played and the opportunity to make friends as the most enjoyable aspect of the intervention. This begs the question as to whether the provision of a supportive, non-judgemental setting which normalises anxiety, provides a forum to discuss worries and helps foster peer interactions is sufficient to record symptom reduction, independent of any specific cognitive or behavioural techniques learned? This is a key point because if it is the supportive, fun-based group-aspect of the intervention that is the crucial factor in reducing symptoms of anxiety and depression, then group-based creative-expressive interven- tions (for example, Circle Time) can be provided in all schools without the need for a specific programme to be implemented.

Although research is limited in exploring this question, meta-analyses have failed to find CBT to be superior to non-CBT interventions for young people with depres- sion (Weisz, McCarty, & Valeri, 2006) or anxiety (Neil & Christensen, 2009). These meta-analytical findings are supported by two studies that compared trauma-based CBT interventions with non-trauma based creative-expressive interventions involving sport, art, dance, music and drama. These studies found that both CBT and non-CBT based interventions were equally successful in reducing symptoms of anxiety and depression among war-affected participants (Catani et al., 2009; O’Callaghan et al., 2015).

Future studies would also benefit from parental reporting of symptoms of anxi- ety, depression and well-being before and after the intervention occurs as well as parent training in managing anxiety and stress. The role of maternal anxiety in mediating the treatment outcomes of anxious children has been highlighted by Bernstein, Layne, Egan, and Tennison (2005) as a fruitful area of future research.

Implications for practice

This research intervention involved all five core functions of an EP: consultation with the school to identify suitable participants and plan an intervention, assessment of need, intervening to reduce symptoms of anxiety and depression, research evalua- tion to ascertain the effectiveness and efficacy of the programme and training sup- port to school staff to deliver the intervention (Scottish Executive Education Department [SEED], 2002). Furthermore, it allowed for the continued development of a research interest into a specialism (Fallon et al., 2010). This research interest in group-based mental health and psychosocial interventions originally developed dur- ing an Educational Psychology doctoral training programme that the lead author undertook (McMullen et al., 2013; O’Callaghan et al., 2015; O’Callaghan et al., 2014; O’Callaghan et al., 2013; O’Callaghan, Storey, & Rafferty, 2012). Personal experience of running group-based interventions helped overcome one of the great- est challenges that EPs face in adapting to their developing role within children’s services; anxiety regarding profession confidence and competency to deliver some- thing new (Fallon et al., 2010). The empirical evaluation of an intervention also ful- fils the need that EPs express for a more rigorous, scientific approach to their work (Burnham, 2013).

Educational Psychology in Practice 323

Lastly, the effective marketing of an Educational Psychology Service’s ability to provide therapeutic service delivery to the school (Pugh, 2010) as part of the school’s time allocation offers a feasible alternative to a practice focused primarily on single-agency, reactive assessments. Group-based, multi-agency, systemic, early prevention interventions such as this one can support almost double the number of children that would normally have received help had the school chosen to use their time allocation for individual assessments instead.

Conclusion

In summary, this pilot study has provided preliminary evidence for the effectiveness and efficacy of a group-based, CBT intervention delivered by school staff in reduc- ing symptoms of anxiety and depression among primary school children. Further research, however, is required to examine if this intervention is successful with a randomised sample or with younger children and also to determine the key compo- nents that account for the majority of the variation in intervention outcomes. Implications for practice include the opportunity to further develop the five core functions of educational psychology practice, the chance to develop a research interest into a specialism, the opportunity to develop networks and strengthen inter- agency/professional relationships (Rait et al., 2010) and the more efficient use of a school’s time allocation to assess and intervene with more children, train more staff and provide an evidence-based model for future school consultation.

Acknowledgements This research is indebted to the four facilitators who delivered this intervention. Special thanks must also go to the school principal and special educational needs coordinator (SENCo) who greatly supported this project and to the boys and girls who participated in the study. Without their invaluable contributions this research project and intervention would not have been possible.

Conflicts of interest and disclosure The authors are unaware of any conflict of interest, any biomedical, direct or indirect finan- cial or personal relationships, interests, and affiliations whether or not directly related to the subject of the article that have occurred over the last two years, or that are expected in the foreseeable future that need to be declared. Furthermore, as this research occurred as part of work as a main-grade educational psychologist employed by a Local Area Authority, there were no grants or funding, employment, affiliations, patents (in preparation, filed, or granted), inventions, honoraria, consultancies, royalties, stock options/ownership, or expert testimony involving the authors of this article.

References Bernstein, G. A., Layne, A. E., Egan, E. A., & Tennison, D. M. (2005). School-based

interventions for anxious children. Journal of the American Academy of Child & Adolescent Psychiatry, 44(11), 1118–1127.

Bose-Deakins, J. E., & Floyd, R. G. (2004). A review of the Beck youth inventories of emotional and social impairment. Journal of School Psychology, 42(4), 333–340.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

324 P. O’Callaghan and E. Cunningham

Burnham, S. (2013). Realists or pragmatists? “Reliable evidence” and the role of the educational psychologist. Educational Psychology in Practice, 29(1), 19–35.

Calear, A. L., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention programs for depression. Journal of Adolescence, 33(3), 429–438.

Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and Tsunami: a comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka. BMC Psychiatry, 9(1), 22.

Department of Health (DoH). (2004). National service framework for children, young people and maternity services core standards – Every Child Matters. In The mental health and psychological well-being of children and young people (3779, pp. 3–48). London: Department of Health and Department for Education and Skills.

Fallon, K., Woods, K., & Rooney, S. (2010). A discussion of the developing role of educational psychologists within Children’s Services. Educational Psychology in Practice, 26(1), 1–23.

Franklin, C. S., Kim, J. S., Ryan, T. N., Kelly, M. S., & Montgomery, K. L. (2012). Teacher involvement in school mental health interventions: A systematic review. Children and Youth Services Review, 34, 973–982.

Freeman, J. B., Choate-Summers, M. L., Moore, P. S., Garcia, A. M., Sapyta, J. J., Leonard, H. L., & Franklin, M. E. (2007). Cognitive behavioral treatment for young children with obsessive-compulsive disorder. Biological Psychiatry, 61(3), 337–343.

Jordans, M. J., Tol, W. A., Komproe, I. H., Lasuba, A. C., Ntamutumba, P., Susanty, D., et al. (2010). Comprehensive psychosocial support for children in areas of armed conflict. International Journal of Mental Health Systems, 4(15), 1–12.

McMullen, J., O’Callaghan, P., Shannon, C., Black, A., & Eakin, J. (2013). Group trauma- focused cognitive-behavioural therapy with former child soldiers and other war-affected boys in the DR Congo: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 54(11), 1231–1241.

National Institute for Health and Care Excellence (NICE) (2005). Depression in children and young people. London: NICE.

Neil, A. L., & Christensen, H. (2009). Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clinical Psychology Review, 29(3), 208–215.

O’Callaghan, P., Branham, L., Shannon, C., Betancourt, T., Dempster, M., & McMullen, J. (2014). A pilot study of a family focused, psychosocial intervention with war-exposed youth at risk of attack and abduction in north-eastern Democratic Republic of Congo. Journal of Child Abuse and Neglect, 38(7), 1197–1207. doi:10.1016/j.chiabu.2014. 02.004.

O’Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited, war-affected, Congolese girls. Journal of the American Academy of Child and Adolescent Psychiatry, 52(4), 359–369.

O’Callaghan, P., McMullen, J., Shannon, C., & Rafferty, H. (2015). A randomized trial of a trauma-focused and non trauma-focused intervention with war-affected Congolese youth. Intervention Journal of Mental Health and Psychosocial Support in Conflict Affected Areas, 13(1), 28–44.

O’Callaghan, P., Storey, L., & Rafferty, H. (2012). Narrative analysis of former child sol- diers’ traumatic experiences. Journal of Educational & Child Psychology, 29(2), 87–97.

Pugh, J. (2010). Cognitive behaviour therapy in schools: The role of educational psychology in the dissemination of empirically supported interventions. Educational Psychology in Practice, 26(4), 391.

Rait, S., Monsen, J. J., & Squires, G. (2010). Cognitive behaviour therapies and their implications for applied educational psychology practice. Educational Psychology in Practice, 26(2), 105–122.

Scottish Executive Education Department (SEED) (2002). Review of provision of educational psychology services in Scotland. Edinburgh: SEED.

Seiler, L. (2008). Cool Connections with cognitive behavioural therapy: Encouraging self-esteem, resilience and well-being in children and young people using CBT approaches. London: Jessica Kingsley Publishers.

Educational Psychology in Practice 325

Squires, G. (2001). Using cognitive behavioural psychology with groups of pupils to improve self-control of behaviour. Educational Psychology in Practice, 17(4), 317–335.

Stallard, P. (2011). Promoting children’s well-being. In D. Skuse, H. Bruce, L. Dowdney, & D. Mrazek (Eds.), Child psychology and psychiatry – frameworks for practice (pp. 72–77). Chichester: Wiley.

Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA, 290(5), 603–611.

Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J., Macy, R. D., & De Jong, J. T. (2008). School-based mental health intervention for children affected by political violence in Indonesia: A cluster randomized trial. JAMA, 300(6), 655–662.

Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132(1), 132.

Williams, R. (2005). Service contacts among the children participating in the British Child and Adolescent Mental Health surveys: A commentary – implications for service design. Child and Adolescent Mental Health, 10(1), 12–15.

326 P. O’Callaghan and E. Cunningham

Copyright of Educational Psychology in Practice is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.