Feasibility pilot of ASPIRE in two secondary schools in Liverpool
Research type
Research Study
Full title
Adolescent Self-harm Psychotherapy to Improve Relational Expertise (ASPIRE) A pilot study to test the feasibility, acceptability and safety of a brief, self-harm specific psychotherapeutic intervention to support Children and Young People (CYP) in Liverpool with self-harm behaviours.
IRAS ID
329439
Contact name
Elizabeth Perkins
Contact email
Duration of Study in the UK
1 years, 3 months, 28 days
Research summary
Self-harm is defined as self-poisoning or self-injury, regardless of purpose. 7% of girls and 4% of boys aged 11- 16 and 20% of girls and 10% of boys aged 17-19 engage in self-harm. CYP who self-harm are more likely to suffer physical/mental ill-heath and are fifty times more likely to die by suicide than the general population. Emergency Department (ED) attendances for self-harm are estimated to cost £129 million annually. CYP who live in more deprived communities, such as Liverpool, are more likely to self-harm.
Few interventions exist that specifically address self-harm. Current interventions are often provided by clinical psychologists/psychiatrists and span 12-weeks to 1-year. There are significant waiting lists for these interventions, meaning that CYP can wait a long time to access support.
Adolescent Self-Harm Psychotherapy to Improve Relational Expertise’ (ASPIRE) is a manualised, 5 session plus follow-up, self-harm specific intervention provided by trained therapists within 2- weeks of referral. The ASPIRE therapy has been successfully piloted in an Emergency Department, General Practices and University Counselling Services in Liverpool, with people aged 16 or older.
This project will embed ASPIRE into existing mental health services in two secondary schools in Liverpool, within the ‘Whole School Approach’ framework. ASPIRE will be delivered by trained Young Persons Advisory Service (YPAS) Wellbeing Practitioners (WPs). YPAS currently provide mental health services in Liverpool schools. Up to 15 eligible pupils will choose to receive ASPIRE in school or in YPAS premises near to school. Access to ASPIRE will be via self-referral or referral by a parent/carer/school staff. We will ask CYP to complete outcome measures before, during and following the intervention and seek their views about doing so in terms of safety, distress and burden. YPAS WPs will complete in-session measures. CYP/parents/carers/school staff views about their participation in ASPIRE will also be sought.
Results Summary
BACKGROUND Self-harm relates to self-poisoning or self-injury with or without intent to die. Some young people self-harm to manage difficult thoughts and feelings. The number of young people who self-harm is increasing year on year in England and around the world. It can be difficult for young people who self-harm to ask for help. When they do, they often don’t get help as quickly as they need it.The Whole School Approach links schools and mental health support providers together to support the emotional and mental wellbeing of pupils, parents/carers, and school staff. Children and Wellbeing Practitioners (CWPs) work in school settings and either provide ‘low intensity’ interventions to pupils, such as ‘Anxiety,’ and ‘Low Mood,’ or arrange for ‘high intensity’ interventions such as ‘talking therapies’. Talking therapies are where a therapist and young person work together to help them understand the reasons why they self-harm and learn new skills to manage difficult feelings, instead of self-harming.
WHAT IS THE PROBLEM
Talking therapies are usually delivered by specialist therapists within Child and Adolescent Mental Health Services (CAMHS), making them expensive. Waiting lists to access talking therapies can be more than a year long.ASPIRE
ASPIRE is a brief self-harm specific ‘talking therapy’ provided by trained CWPs, within two weeks of pupils asking for help. ASPIRE is delivered across five, weekly 1-hour sessions plus one follow-up session a month after the last therapy session. The ASPIRE therapy has been provided in hospital, community health care, and university counselling services with adults aged sixteen or older. These people reported having a greater understanding of their self-harm behaviours and better ways to cope with difficult thoughts and feelings. Many of these people reported that their self-harm thoughts and behaviours started in adolescence.AIM OF STUDY
Our research group were keen to know if it was possible to train CWPs to provide ASPIRE to secondary school pupils and if these pupils would take part in the ASPIRE therapy and be willing and able to fill in research questionnaires. Pupils were able to take part in ASPIRE if they reported self-harm thoughts or behaviours in the previous six months and were willing and able to provide their consent to take part. Their parents also had to give their consent.THE RESULTS
Fifteen pupils from two secondary schools in Liverpool took part in this study and were willing to fill in research questionnaires.
Most pupils who took part reported fewer self-harm thoughts and behaviours after taking part in ASPIRE and felt less likely to act of their self-harm thoughts in the future. These pupils also reported better mental health and wellbeing and used more positive ways to cope with difficult thoughts and feelings after ASPIRE, compared to before taking part in ASPIRE. All the pupils who took part in ASPIRE reported a good connection with their therapist from the start of ASPIRE, which lasted across the five therapy sessions and the follow up session.The research team also interviewed pupils who took part in ASPIRE, their parents/carers and other important people who were involved in ASPIRE, such as school staff and CWPs.
These pupils felt that ASPIRE was different to other support that they had before, that it was quick to access and it was focused on self-harm. They felt that they worked together with the CWP to understand their thoughts, behaviours and emotions that led to their self-harm. They also felt that ASPIRE helped them to understand and manage their emotions better and use other ways to cope, which has been positive for the young people and their relationships with others.
Their parents, school staff and CWPs gave the same feedback.
CWPs found the ASPIRE training acceptable. ASPIRE was considered safe for secondary school pupils.IMPACT OF ASPIRE
This study has proved that ASPIRE can be provided by trained CWPs within two weeks of secondary school pupils seeking help. ASPIRE can provide immediate support, helping young people to use more positive ways to cope with difficult thoughts and feelings, instead of self-harming. This may reduce the need for more intensive support by specialist practitioners.NEXT STEPS
We are planning a larger study, involving more secondary schools and pupils across the Northwest of England to see if we get the same positive results.PUBLIC INVOLVEMENT
The study was supported by two Young Person’s Advisory Groups (YPAGs) who helped to design the information used to raise awareness of ASPIRE to pupils and the animation (ASPIRE - Liverpool CAMHS) reporting the results from this study.FUNDING
This research study was funded via the The Wellcome-University of Liverpool Institutional Translational Partnership (ITPA) Translational Research Access Programme (TRAP).
This work was financially supported by the Wellcome Trust. Grant Number: 219574/Z/19/Z.REC name
North West - Greater Manchester South Research Ethics Committee
REC reference
23/NW/0274
Date of REC Opinion
22 Sep 2023
REC opinion
Favourable Opinion