Child and adolescent psychotherapists have long been involved in the provision of therapy and mental health support within schools. The form such support takes has evolved over the years, and while once such interventions would primarily have been offered to students who struggled to engage with their education or manage the school environment, there is now a much wider remit. The UK government’s 2017 Green Paper, ‘Transforming Children and Young People’s Mental Health’ (Department of Health & Department for Education, 2017), recognised the important role schools can play in addressing mental health concerns and detailed its intention to focus on providing young people with additional therapeutic support through schools and colleges. This expansion of provision within the sector has included the development of Mental Health Support Teams (MHSTs), which are intended to provide early intervention on some mental health and emotional wellbeing issues, help staff within schools provide a ‘whole school approach’ to mental health and wellbeing, and provide a link with local CAMHS teams. Child and adolescent psychotherapists have been involved in the setting up and management of these teams and thus have played a key role in how schools develop their attitude and approach to supporting the mental health of their pupils. Meanwhile, some within the profession continue to be employed directly by schools in ‘school counsellor’ roles. This is particularly prevalent within the independent (private) school sector.
Working as a mental health professional within a school presents opportunities for supporting children on an individual basis through an early intervention approach, but also for working with young people who would struggle to access traditional community mental health services (so-called ‘hard-to-reach’ children). In addition, there is also the potential to effect change in contextual and environmental issues within schools, which may be driving or exacerbating mental health difficulties in individual students, or on a whole-school basis. Those employed within schools can deploy numerous and varied strategies to support the many needs of the organisation, its staff and pupils.
This edition of the Research Digest consists of studies published over the past ten years that assess and explore different facets of mental health support within schools. It has been curated to include studies that examine interventions aimed at a whole class or school (a so-called ‘universal approach’), those that target particular groups of students in need (‘targeted group interventions’), and those covering therapeutic support offered to pupils within schools on an individual basis.
Evident from the studies included is the breadth of creativity in the sector, and the range of supportive interventions that have been developed. While there is currently no research in the field specifically focusing on psychoanalytically derived interventions, findings from some studies may resonate strongly with this Journal’s readership: for example, Knight, Gibson, and Cartright’s (2018) exploration of the therapeutic relationship between students and their school counsellor.
Undoubtedly, child and adolescent psychotherapists have much to offer schools as they develop their pastoral services to meet the growing mental health needs of young people today. As this provision grows, so will the need for good quality research that brings evidence and understanding to this field. We hope that psychoanalytic clinicians within schools will be inspired by some of the research included in this issue to consider small-scale research projects of their own, to highlight the work they are doing.
Regular readers of the Research Digest will note that a glossary has been included in this section of the Journal for the first time. While understanding all the terminology used in the abstracts published below is not necessary to grasp the key findings, we hope this addition will increase the accessibility of this segment.
Universal approach
Classroom-based cognitive behaviour therapy (FRIENDS): a cluster randomised controlled trial to Prevent Anxiety in Children through Education in Schools (PACES)
Paul Stallard, Elena Skryabina, Gordon Taylor, Rhiannon Phillips, Harry Daniels, Rob Anderson and Neil Simpson
The Lancet Psychiatry, Elsevier, 2014, volume 1(3): 185-192, doi: 10.1016/S2215-0366(14)70244-5
Background: Anxiety in children is common, impairs everyday functioning, and increases the risk of severe mental health disorders in adulthood. We investigated the effect of a classroom-based cognitive behaviour therapy prevention programme (FRIENDS) on anxiety symptoms in children.
Methods: Preventing Anxiety in Children though Education in Schools (PACES) is a three-group parallel cluster randomised controlled trial. Interventions were given between September, 2011, and July, 2012, with schools as the unit of allocation and individual participants as the unit of analysis. We enrolled state-funded junior schools in southwest England. We sent information to all eligible schools (state-funded junior schools in southwest England) inviting them to enrol in the study. School year groups were assigned by computer-generated randomisation (1:1:1) to receive either school-led FRIENDS (led by teacher or school staff member), health-led FRIENDS (led by two trained health facilitators), or usual school provision. Children were not masked to treatment allocation. The allocated programme was given to all students (aged 9–10 years) in the school year (ie, universal delivery) as part of the school curriculum as nine, 60 min weekly sessions. Outcomes were collected by self-completed questionnaire administered by researchers masked to allocation. Primary outcome was symptoms of anxiety and low mood at 12 months assessed by the Revised Child Anxiety and Depression Scale (RCADS 30). Analyses were intention to treat and accounted for the clustered nature of the design. The study is registered, number ISRCTN23563048.
Findings: 45 schools were enrolled: 14 (n=497 children) were randomly assigned to school-led FRIENDS, 14 (n=509) to health-led FRIENDS, and 12 (n=442) to usual school provision. 1257 (92%) children completed 12 month assessments (449 in health-led FRIENDS, 436 in school-led FRIENDS, and 372 in usual school provision). We recorded a difference at 12 months in adjusted mean child-reported RCADS scores for health-led versus school-led FRIENDS (19·49 [SD 14·81] vs 22·86 [15·24]; adjusted difference −3·91, 95% CI −6·48 to −1·35; p=0·0004) and health-led FRIENDS versus usual school provision (19·49 [14·81] vs 22·48 [15·74]; −2·66, −5·22 to −0·09; p=0·043). We noted no differences in parent or teacher ratings. Training teachers to deliver mental health programmes was not as effective as delivery by health professionals.
Interpretation: Universally delivered anxiety prevention programmes can be effective when used in schools. However, programme effectiveness varies depending on who delivers them.
School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis
Deborah Caldwell, Sarah Davies, Sarah Hetrick, Jennifer Palmer, Paola Caro, José López-López, David Gunnell, Judi Kidger, James Thomas, Clare French, Emily Stockings, Rona Campbell and Nicky Welton
The Lancet Psychiatry, Elsevier, 2019, volume 6(12): 1011-1020, doi: 10.1016/S2215-0366(19)30403-1
Background: Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.
Methods: We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.
Findings: 1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.
Interpretation: Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.
Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study
Willem Kuyken, Katherine Weare, Obioha C. Ukoumunne, Rachael Vicary, Nicola Motton, Richard Burnett, Chris Cullen, Sarah Hennelly and Felicia Huppert
The British Journal of Psychiatry, Cambridge University Press, 2013, volume 203(2): 126-131, doi: 10.1192/bjp.bp.113.126649
Background: Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness among young people.
Aims: To assess the acceptability and efficacy of a schools-based universal mindfulness intervention to enhance mental health and well-being.
Method: A total of 522 young people aged 12–16 in 12 secondary schools either participated in the Mindfulness in Schools Programme (intervention) or took part in the usual school curriculum (control).
Results: Rates of acceptability were high. Relative to the controls, and after adjusting for baseline imbalances, children who participated in the intervention reported fewer depressive symptoms post-treatment (P = 0.004) and at follow-up (P = 0.005) and lower stress (P = 0.05) and greater well-being (P = 0.05) at follow-up. The degree to which students in the intervention group practised the mindfulness skills was associated with better well-being (P<0.001) and less stress (P = 0.03) at 3-month follow-up.
Conclusions: The findings provide promising evidence of the programme’s acceptability and efficacy.
Is It Possible to “Find Space for Mental Health” in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program
Luísa Campos, Pedro Dias, Ana Duarte, Elisa Veiga, Cláudia Camila Dias and Filipa Palha
International Journal of Environmental Research and Public Health, Academic Open Access Publishing, 2018, volume 15(7): 1426, doi: 10.3390/ijerph15071426
Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion of mental health literacy (MHL) in young people (“Finding Space for Mental Health”). A sample of 543 students (22 classes), aged between 12 and 14 years old, participated in the study. Each class of students was randomly assigned to the control group (CG; n = 284; 11 classes) or the experimental group (EG; n = 259; 11 classes). MHL was assessed using the Mental Health Literacy questionnaire (MHLq), which is comprised of three dimensions—Knowledge/Stereotypes, First Aid Skills and Help Seeking, and Self-Help Strategies. The scores on these dimensions can also be combined to give an overall or total score. Participants from the EG attended the MHL promotion program (two sessions, 90 min each) delivered at one-week intervals. Sessions followed an interactive methodology, using group dynamics, music, and videos adapted to the target group. All participants responded to the MHLq at three points in time: pre-intervention assessment (one week prior to the intervention), post-intervention assessment (one week after the intervention) and follow-up assessment (six months after the intervention). The intervention effectiveness and the differential impact of sociodemographic variables on the effectiveness of the program were studied using a Generalized Estimation Equation (GEE). Results revealed that participants from the EG demonstrated, on average, significantly higher improvement in MHL from pre-intervention to follow-up when compared to participants from the CG. Different sociodemographic variables affected the effectiveness of the program on distinct dimensions of the MHLq. Overall, “Finding Space for Mental Health” showed efficacy as a short-term promotion program for improving MHL in schools.
Targeted group interventions
Practitioner Review: Effectiveness of indicated school-based interventions for adolescent depression and anxiety – a meta-analytic review
Brioney Gee, Shirley Reynolds, Ben Carroll, Faith Orchard, Tim Clarke, David Martin, Jon Wilson and Laura Pass
The Journal of Child Psychology and Psychiatry, Wiley, 2020, volume 61(7): 739-756, doi: 10.1111/jcpp.13209
Background: Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10–19 with elevated symptoms of depression and/or anxiety.
Methods: Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety.
Results: Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = .34, 95% CI −0.48, −0.21) and a medium effect on reducing anxiety symptoms (SMD = −.49, 95% CI −0.79, −0.19) immediately postintervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤ 12) or long-term (>12-month) follow-up. Reductions in anxiety symptoms were not maintained at any follow-up.
Conclusions: Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately postintervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence base. Further high-quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety.
‘Let’s Talk Autism’ –a school-based project for students to explore and share their experiences of being autistic
Kathryn Stevenson, Katie Cornell and Vivian Hinchcliffe
Support for Learning, Wiley, 2016, volume 31(3): 208-234, doi: 10.1111/1467-9604.12130
Understanding what autism means on a personal level can be an important process for young people on the autistic spectrum, and being able to reflect on this and discuss with autistic peers can be particularly helpful. However, opportunities may be restricted by reluctance to talk about diagnosis and because of difficulties in communication inherent in autism. This article describes a therapeutic media project within an ASD school that attempted to support young people to reflect together about what autism meant for them and create resources to share with others. The process is described and main themes of discussions analysed using thematic analysis. Main themes emerged of making sense of diagnosis, experiences of difference and transition to adulthood. Various strategies to manage diagnosis and negotiate identity also emerged. Issues around informed consent and confidentiality and the therapeutic value of such groups are discussed.
Individual therapeutic support
Evaluating the outcomes of a school based Theraplay project for looked after children
Yvonne Francis, Kim Bennion and Sarah Humrich
Educational Psychology in Practice, Taylor and Francis, 2017, volume 33(3): 308-322, doi: 10.1080/02667363.2017.1324405
Research shows that Looked After Children (LAC) may experience emotional instability which can reduce their capacity to engage with education. This study evaluates an attachment based therapeutic Theraplay intervention designed to bridge the gap between the emotional well-being of LAC and their engagement in education. Twenty LAC between the ages of five to 11 from nine schools participated in the project over eight months. The mixed method study used a repeated measures design. Strengths and difficulties questionnaires were used pre- and post-intervention; semi-structured interviews with teaching staff were conducted and children’s views were gathered. Quantitative results show a reduction in the children’s total strengths and difficulties stress scores post-intervention. Qualitative feedback shows noticeable changes in the children’s relationship skills, confidence and engagement with education. The complexities of supporting LAC in education and implications for educational psychology practice are explored
Therapeutic change processes in school-based counselling: the perspectives of students and counsellors in Hong Kong
Mark Gregory Harrison
British Journal of Guidance and Counselling, 2020, published online only, doi: 1080/03069885.2020.1729340
School-based counselling is an effective intervention for psychological distress in adolescents, but little is known about the processes leading to a therapeutic change in a Chinese sociocultural context. Twenty-five Chinese senior secondary school students and eight school counsellors in Hong Kong were interviewed, and the data were analysed thematically within a critical realist paradigm. Three change processes were developed: new ways of thinking, developing better relationships and experiencing positive emotions. The study’s findings were broadly consistent with previous research into school-based counselling in Western contexts but not consistent with previous studies carried out with adult Chinese clients. Counselling in schools has the potential to deliver significant benefits to adolescents in Hong Kong.
A thematic analysis of young people’s experience of counselling in five secondary schools in the UK
Rosemarie Lynass, Olga Pykhtina and Mick Cooper
Counselling and Psychotherapy Research, Wiley, 2012, volume 12(1): 53-62, doi: 10.1080/14733145.2011.580853
Aim: To investigate young people’s views on the effects of school-based counselling, and what they found helpful and unhelpful. Method: Eleven semi-structured interviews were conducted and thematically analysed. Findings: Participants expressed predominantly positive views of school-based counselling with changes in three main domains: emotional, interpersonal and behavioural. Participants viewed these changes as having had an important effect on their lives. The most commonly cited helpful aspects of counselling were related to talking or getting things out, and counsellor qualities. Conclusions: School-based counselling is viewed positively by those who have experienced it, and appears to be an appropriate and valuable intervention for young people.
“It’s like a refuge”: Young people’s relationships with school counsellors
Karis Knight, Kerry Gibson and Claire Cartwright
Counselling and Psychotherapy Research, Wiley, 2018, volume 18(4): 377-386, doi: 10.1002/capr.12186
Aim: The counselling relationship is important for engaging young people, but more understanding about how young people experience this in the context of school counselling is necessary. This study explored young people’s understanding of the counselling relationship in two New Zealand schools.
Method: Twenty-two participants between the ages of 16 and 18 took part in unstructured narrative interviews on their experience of school counselling. The data were analysed to identify themes related specifically to participants’ experience of the counselling relationship.
Findings: Five themes highlighting positive aspects of the relationship with the school counsellor were identified; young people’s experiences of a genuine connection with a counsellor, the experience of being listened to, availability and accessibility of the counsellor on site at school, the counsellor’s belief in the young person and the counsellor’s potential to be an advocate for the young person in the school context. Negative experiences of the counselling relationship were described in the absence of these features.
Conclusions and implications for practice: The “School counsellor” has the potential to be experienced as a “refuge” for young people in the context of a hierarchical and evaluative school environment, within which they can feel accepted, understood and safe. Accessibility and the counsellor’s ability to serve as an advocate in the school context means school counselling can be an important primary care intervention for young people in distress.
‘At risk of harm’? An exploratory survey of school counsellors in the UK, their perceptions of confidentiality, information sharing and risk management
Peter Jenkins and Joanne Palmer
British Journal of Guidance and Counselling, Taylor and Francis, 2012, volume 40(5): 545-559, doi: https://doi.org/10.1080/03069885.2012.718732
The primary objective of this study was to explore perceptions of UK school counsellors of confidentiality and information sharing in therapeutic work with children and young people, using qualitative methods. The research design employed a two-stage process, using questionnaires and follow-up interviews, with a small, non-random sample of school counsellors. Paper-based questionnaires were used initially to identify themes and sub-themes from respondents (n=13), and were followed up with face-to-face, semi-structured interviews, with a convenience sub-sample (n=6). Counsellors reported a lack of awareness of information-sharing policies, largely assuming a legal duty to report child abuse. Maintaining confidentiality was seen as valuable, in order to protect the therapeutic alliance, despite disclosures of risky behaviour by some young clients.
The impact of school-based counselling on young people’s capacity to study and learn
Pooja Rupani, Nuala Haughey and Mick Cooper
British Journal of Guidance and Counselling, Taylor and Francis, 2012, volume 40(5): 499-514, doi: 10.1080/03069885.2012.718733
This article explores how school-based counselling might impact young people’s capacity to study and learn. Previous research has indicated that counselling in schools has an indirect positive impact on academic achievement. A mixed methods approach, using a semi-structured qualitative interview and a brief rating scale, was employed with 21 young people who have been recipients of school-based counselling in the UK. The findings from the interviews were analysed thematically. All participants felt counselling had in some way benefited their studying and learning. Counselling was perceived by clients as positively impacting upon their academic achievement by improving their concentration, motivation to study and attend school, behaviour in class and relationships with teachers. The findings replicate evidence from previous research that school-based counselling indirectly benefits young people’s capacity to study and learn.
Secondary school students’ views of inhibiting factors in seeking counselling
Stephanie Chan and Philip Quinn
British Journal of Guidance and Counselling, Taylor and Francis, 2012, volume 40(5): 527-543, doi: 10.1080/03069885.2012.719603
This study examines secondary school students’ perceptions of inhibiting factors in seeking counselling. Responses to a questionnaire completed by 1346 secondary school students were analysed using quantitative and qualitative methods. Exploratory factor analysis highlighted that within 21 pre-defined inhibiting factors, items loaded strongly on one component, ‘diffident’, suggesting that this is a main inhibiting factor. A second component, ‘self-reliant’, also emerged as a main inhibiting factor. Significant differences were found across gender, with female participants rating the pre-defined inhibitory factors higher than males on items relating to diffidence and self-reliance. The main inhibiting factors, ‘diffidence’ and ‘self-reliance’, warrant development into measures for future investigations into students’ views of school-based counselling.
Therapeutic outcomes in the Welsh Government’s school-based counselling strategy: An evaluation
Mick Cooper, Joanne Pybis, Andy Hill, Sylvia Jones and Karen Cromarty
Counselling and Psychotherapy Research, Taylor and Francis, 2013, volume 13(2): 86-97, doi: 10.1080/14733145.2012.713372
Aims: The purpose of this study was to evaluate the outcomes of school-based counselling, as delivered in the Welsh Government’s School-based Counselling Strategy, for reducing psychological distress in young people aged 11–18. Method: The study used a quantitative cohort design, comparing levels of distress on either the Young Person’s CORE (YP-CORE) or the Strengths and Difficulties Questionnaire (SDQ) from baseline to endpoint. Data were available on 3613 episodes of counselling, across 42 datasets. Meta-analytical procedures were used to identify the mean effect size and predictors of outcomes. Results: Within each dataset, counselling was associated with significant reductions in psychological distress, with a mean effect size (d) of 0.93(95% CI = 0.89–0.97) using a fixed effects model and 1.09 (95% CI = 0.97–1.22) using a random effects model. Datasets using the YP-CORE had larger effect sizes than those using the SDQ, and datasets with more complete response rates had lower outcomes than those with poorer response rates. Conclusion: The results confirm that school-based counselling, as delivered in the UK, is associated with significant reductions in psychological distress, comparable to adult counselling and psychotherapy services.
Impact Evaluation of a School-based Counselling Intervention in Northern Ireland: Is it Effective for Pupils Who Have Been Bullied?
Aisling McElearney, Gary Adamson, Mark Shevlin and Brendan Bunting
Child Care in Practice, Taylor and Francis, 2013, volume 19(1): 4-22, doi: 10.1080/13575279.2012.732557
Bullying remains a significant issue in the lives of many children and young people at school and can have serious negative implications for emotional health and well-being in the short and longer term. This paper reports on an impact evaluation of the effectiveness of a school counselling intervention in promoting positive change in the peer relationships of pupils who have been bullied. Longitudinal data were collected from 202 pupils (mean age = 12.5, standard deviation = 2.3) using the self-rated Strengths and Difficulties Questionnaire (SDQ). In total, 27.2% of referrals (55 pupils) to the intervention related to being bullied. Latent growth curve modelling confirmed that pupils who had been bullied scored significantly higher initial status scores (1.40, p <0.01) on the Peer problems subscale of the SDQ and experienced a significantly more rapid rate of decrease on this subscale (−0.25, p <0.01) with each successive session of school counselling compared with those pupils who had accessed the intervention for another reason. Results indicate that school counselling is an effective intervention in supporting pupils who have been bullied and should be a key component of an effective whole school approach aimed at addressing bullying. The implications for research and practice development are considered.
Glossary
Acceptability - the extent to which those receiving or delivering an intervention consider it appropriate
Adjusted mean - a mean result that has been corrected to remove the influence of data imbalances, such as outliers
Bayesian framework - based on a theory in the field of statistics that deals with probability. A Bayesian framework handles uncertainty and provides mathematical tools, allowing us to incorporate prior beliefs and new data, to update our subjective beliefs
Change processes - the processes by which change occurs
Control group - participants who do not receive an intervention and so can be used as a comparison in an experimental study
Convenience sub-sample - a sample from the group that are ‘convenient’ to the researcher, usually by being easy to contact or reach
Critical realism - a philosophical approach that distinguishes between the ‘real’ world and the ‘observable’ world. Research that adopts this style focusses on understanding rather than merely describing
Dependent variable - the variable being tested or measured
Downstream intervention - where the focus is on supporting change in an individual
Effectiveness - how well an intervention performs under real world conditions, including how feasible it is
Effect size - a number that shows the strength of a relationship between two variables
Efficacy - the effectiveness of an intervention under controlled research conditions
Experimental group - the group that is exposed to the variable or intervention under study
Factor analysis - a statistical method used to uncover the latent structure of a set of variables, reducing a large number of variables to a smaller number of factors
Fixed effects model - a statistical model in which the values of independent variables are assumed to be fixed, and so only the dependent variables change in response to the independent variables
Funnel plot - a scatterplot which displays treatment effect against a measure of study precision, and is used to check for the existence of publication bias
Generalised Estimation Equation - a statistical approach applied in clinical trials that use longitudinal data
Independent variables - the variables the researcher will change or manipulate
Latent growth curve modelling - a statistical technique used to estimate growth trajectories
Longitudinal data - data collected from the same participants over time
Masked - the steps taken within a study to ensure that those involved are unaware of the treatment or intervention that each participant receives. Also referred to as ‘blinding’
Meta-analysis - the examination of data from a number of different but similar studies, in order to determine trends and test for overall statistical significance
Mixed method study - where qualitative and quantitative data collection and analysis are combined within one study
Network meta-analysis - where multiple treatments are compared directly within randomised controlled trails and indirectly across trails, based on a shared outcome measure or comparator
Parallel cluster randomised controlled trial - where groups of individuals are randomised to different conditions or interventions
Primary outcome - the outcome the investigator considers the most important
Qualitative data - data that is descriptive and relates to a phenomenon that can be observed but not measured
Quantitative data - data that is in a numerical form
Quasi-randomised trials - where participants are allocated to different interventions within a trial, in a way that is not truly random, such as by date of birth
Random effects meta-analysis - the statistical synthesis of studies that examine similar research questions when it is assumed that the underlying effects across studies differ, yet are related
Random effects model - a statistical model in which some of the parameters exhibit random variation
Randomisation - the process by which participants are assigned by chance to treatment groups
Random sequence generation - a method used to randomly allocate participants to groups
Repeated measures design - a study design whereby each participant is exposed to each condition of the independent variable
Semi-structured interviews - a qualitative data collection strategy where the researcher asks set, open ended questions
Standardised mean differences - a summary statistic used in a meta-analysis, when the same outcome is reported across studies but using different outcome measures
Study precision - how close the measurements are to each other
Subgroup analysis - a type of analysis done by breaking down study samples into subsets of participants, based on a shared characteristic (e.g. gender), with the goal of exploring differences in how people respond to an intervention
Systematic review - the application of a clear and reproduceable methodology to identify and appraise all relevant literature in a chosen area
Thematic analysis - a method for analysing qualitative data that involves identifying and analysing repeated patterns
Treatment effect - the causal effect of the treatment or intervention
Unstructured narrative interviews - a qualitative data collection strategy, where the researcher has a list of topics for the participant to talk about, allowing them to tell their own story