Stage 1
A brief universal in-school ACT programme, InTER-ACT, was developed by Victoria and Chloe and delivered by them within a secondary school in England. An acceptability and feasibility trial was conducted to evaluate how practical it was to deliver the programme and whether young people considered it acceptable and useful. Data from focus groups with students and interviews with school staff and workshop facilitators was analysed using content analysis to identify key themes. See Harris (2019) for further details.
Stage 2
Feedback from the students who attended InTER-ACT, their teachers and the programme facilitators led to significant amendments to the programme content, including the addition of bespoke illustrations to help visually convey key concepts.
To broaden the reach of the intervention, Chloe and Victoria developed a two-day training programme to enable school counsellors and teachers to deliver InTER-ACT themselves.
A four-stage research trial has been undertaken to evaluate the revised programme, involving a:
- Randomised controlled trial (RCT) comparing mental health and wellbeing outcomes of pupils who attended InTER-ACT with a control group across 6 UK schools.
- Fidelity study which involved coding and analysing audio recordings from staff delivering the programme to evaluate the extent to which they were able to implement the programme in a way that was faithful to the InTER-ACT protocol and ACT ethos.
- Qualitative process study with the school counsellors and teachers who took part in the InTER-ACT trial, to understand more about their experiences of implementing this intervention.
- Trial of InTER-ACT as a targeted intevention for young people seeking support for their mental health (i.e. rather than as a universal intervention provision). We collaborated with the children’s charity, Let’s Talk Well (previously TIC+) and InTER-ACT was delivered online for the first time. A doctoral student at Cardiff University assessed the feasibility and acceptability of this delivery format on young people and staff.
Findings
The acceptability and feasibility trial showed that overall the students found the programme engaging and relevant. There were some areas, however, that students described finding less easy to follow, which led to significant revisions to the programme content. This initial trial also helped to guide some revisions to the evaluations measures we used to assess the programme, along with how we present the information about our research to young people, so it is clear for them to understand.
The RCT ended up being conducted right over the pandemic, which introduced multiple confounding variables to the study. However, there was some indication of reductions in perceived stress for the intervention group. We were really impressed with how staff were so committed to the programme and continued to implement it, despite multiple pressures related to COVID.
The fidelity study showed that staff delivered the programme with high levels of fidelity to the protocol and were able to interact with pupils and respond to questions in a way generally consistent with the ACT ethos/framework. There were some areas where it appeared ACT was applied with slightly less consistency, and this led to some helpful revisions to our training as a result.
The qualitative process study provided invaluable insight into the experiences of staff undertaking InTER-ACT facilitator training and then facilitating the programme with young people in schools. A key theme to emerge was the benefits of self-practice as this enabled facilitators to talk authentically about the ACT skills, which increased student ‘buy-in’. Facilitators described believing in the approach, which they felt had ‘good fit’ and ‘made sense’ to students. Another interesting finding was a perception from facilitators about the need to be willing to show vulnerability in order to learn something unfamiliar, especially when taking part in experiential exercises.
The evaluation of InTER-ACT delivered as a targeted intervention for young people (age 9-25years) seeking support for their mental health used a mixed method approach. Analysis was carried out on: i) transcribed interviews with young people who attended the workshops, InTER-ACT facilitators and service leads ii) detailed engagement data direct from the online workshops and iii) a feedback survey completed by young people. InTER-ACT was found to be broadly acceptable, appropriate and feasible, with young people valuing the online format for its ease of access and the anonymity it afforded (cameras were all kept off) and there was high engagement with interactive features. Facilitators found the anonymity of the young people challenging for building rapport and perceiving understanding.
Finally, we were keen to share our experience of designing, implementing and evaluating a new intervention and were pleased to have a research paper describing this process published in Pastoral Care in Education, which has been widely read.
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