Paper by Steve Potter (University of Manchester)
“Routine evaluation of the effectiveness of a university counselling service.”
CORE stands for Clinical Outcomes in Routine Evaluation. The basic component of the core system is a scale occupying two sides of A4 containing 34 statements such as “My problems have been impossible to put to one side”. The client scores the statements on a five point scale ranging from “not at all “to “all of the time”. The accumulation of scores offers an indication of distress, functioning, severity and risk of harm. The scores can be easily scanned by the busy counsellor, it is freely available, and it is well validated. It is becoming more and more widely used. Obtaining client scores after counselling is less easy than at routine intake.
A large number of UK counselling services have since 1997 experimented with CORE, many initially trying the system with 100 clients. Some went on to wider use of CORE. Recently CORE PC has become available. The University of Manchester and UMIST Counselling Service has used this software to analyse a one year cohort of student clients. The software permits the user to analyse data interactively receiving immediate reports on individual cases but also service profiles. Service data can be compared with national data for purposes of benchmarking, promoting good practice.
Apart from the client completed form before and after counselling, the counsellor must complete a case profile and of course input the data and explore it, all easier than before with software.
The Manchester data shows a serious need is being met. Some 82% of clients have pre counselling scores above the clinical cut off point for patients being treated by the NHS mental health services. The outcome data shows a 75% reliable improvement at the end of counselling and that improvement is taking place for a wide range of problems. It also shows counsellors rate suicide risk higher than student clients. However regardless of outcome data, the process of continuous detailed audit is capable of identifying strengths and weaknesses in service provision and therefore of promoting improvement.
CORE can be used at different levels. Apart from the benchmarking of service provision already mentioned it can profile the work of an individual counsellor, types of cases or types of problems. CORE PC offers a scatter plot, where dots are cases, so using cut off scores those who deteriorate as well as those who improve can be identified and examined through item by item ranking changes. So individual counsellor, problem type or cluster, or even treatment type can be examined in detail. This is unprecented in a desktop tool and is obviously a powerful aid to case management, clinical supervision, and targeted continuing professional development.
In discussion, Tony McWalter MP pointed out counselling departments can seem divorced from academic processes. Peter Ross (Reading) gave his own department, which includes study advisers, as the opposite example. It was pointed out many students needed not weekly counselling but less frequent sessions and often more generalised support over the entire course.
The discussion after the presentation also highlighted that much of the data from Manchester pointed to the need for psycho-education or self-management skills especially around the topics of coping skills, confidence building, self esteem, etc. No less important was the need to build a research led network of university counselling services developing better quality CORE normative data for purposes of comparison. Without this it is difficult to give an ongoing demonstration of the immediate impact of counselling, especially the impact on retention, but also the long term effects of improvement in self esteem for life long learning and productivity.
Paper presented by Steve Potter (University of Manchester)
Summary by Peter Ross (University of Reading) with discussion notes by Ruth Caleb (Brunel University).24/1/2003.
Paper given by Annie Grant (University of Leicester)
The student psychological health project: Research findings from the University of Leicester.
In 1998 increasing concern about mental health amongst students led Leicester’s Educational Development and Support Centre to undertake a major survey of psychological well being of Leicester students and of their help seeking behaviour. It was hoped the data would inform a HEFCE funded project to enhance and develop existing community provision.
A literature survey revealed few similar surveys but some use was made of a Columbia survey from 1986/88. The Brief Symptom Inventory, a standard self report tool, was used along with the self report questionnaires.
Following a pilot, some 80% of the target population, all 2nd year students and other select groups (n=1620), filled in questionnaires while at lectures with the co-operation of teaching staff. There was also a postal survey of staff on supporting students. After initial analysis, focus groups were held. In 2001 the survey was repeated (n=1118).
A basic summary report is available on the web www.le.ac.uk/edsc/sphp and will therefore not be repeated here.
Having presented her findings Annie Grant went on to discuss how research informed practice, and engaged in debate with an appreciative audience. The Leicester response had been to stress development not remedial support. Targeted staff training and mental health awareness training was seen as important and a mental health awareness group had been established. Awareness grew that a more diverse staff would help, as would improvements in orientation programmes even at school. In first year, improved formative assessment was highlighted, plus strengthening links between academic departments and central services. In short, a whole institutional approach was needed with resources developed across traditional boundaries.
There was much discussion of why many of the 2nd year students in the survey did not use support services initially or at all. Low self esteem and predicting helpers would be judgmental may explain some of this. The needs of ethnic and young male students were noted, both being vulnerable to suicidal thoughts.
Paper presented by Annie Grant (University of Leicester)
Summary by Peter Ross ( University of Reading) and discussion notes by Ruth Caleb (Brunel University). 24/1/2003.
ã HUCS 2003