The DISCOVER Implementation study

Plain English Summary

Background and study aims
The number of young people with mental health problems has been increasing at an alarming rate. This seems to be particularly true of adolescents. However, young people do not use services mainly because of worry about the risk of stigma. Even if they do try and get help, the capacity of services is a problem and services tend to prioritise those with the most severe problems. There is an urgent need to deal with this problem.
In the recently completed ‘BESST’ trial, researchers measured the effectiveness and costs of a brief accessible stress workshop (for up to 15 students) called DISCOVER. They also interviewed students and staff running the workshops. The workshops were run by a new professional group of NHS clinicians who work in schools called mental health support teams (MHSTs). This trial recruited 900 students from 57 schools in four regions in England. It was a well-designed trial and we tried to make sure that research staff did not know which students had received the
workshop or else that could bias the results.
The workshops led to reduced depressive symptoms after 6 months. With students with high depression scores at the beginning, the researchers found even stronger effectiveness and cost-effectiveness results. Interviews with students and staff also supported these findings. The trial engaged 80% who had not previously sought help and a diverse group of students with 48% from different ethnic groups.
This proposed study aims to answer the question of how best to implement this intervention that has been offered by a specialist DISCOVER service in normal NHS services in a non-trial environment. Some issues arose from the trial results which appear relevant to how we might implement the workshops in the NHS. Firstly, the two clinical and trial follow-up systems for students need to be made more consistent. Secondly, training and support for MHST staff for the DISCOVER workshops could be made more economical for the NHS. Finally, as schools had been recruited by the research team in the trial, the researchers want to see how schools could be recruited in normal NHS services without the involvement of a research team.
In this new study, the researchers want to know how they can deliver the DISCOVER workshops in a way that can be maintained over time, provide good value for money for the NHS in normal services, and also be as effective as in the trial. They want to understand what may help, as well as make it difficult, to roll out these workshops across England. With this information, they can then provide guidance to new sites in England about how the DISCOVER workshops can be run in 6th forms in the future.
In this study, there will be five work streams.
1. First, the researchers will be developing a system of recording clinical and cost outcomes. They will be doing this with the help of young people in the PPI group.
2. The researchers will be running DISCOVER workshops in three sites that were part of the BESST trial (sustaining sites) and three new (scaling up) sites to see if similar outcomes can be achieved in the new non-trial NHS environments and how best we can support these sites to run the workshops.
3. The researchers want to systematically understand the factors that may help the way the workshops can be implemented using the CFIR implementation framework.
4. The researchers will measure the cost-effectiveness of the revised DISCOVER model in the general population of 16-18-year-old students.
5. The researchers will pull together the findings into a DISCOVER workshop implementation guide for sites.

Who can participate?
Students: 16-18 year olds in participating schools in six regions (London, Midlands, North West, North East, Kent and South West) will be invited to self-refer to the DISCOVER workshops
MHST clinicians: six teams of MHST clinicians in those six areas (London, Midlands, NorthWest, North East, Kent and South West) will offer the workshops to the students; they will be asked for their views about implementing the intervention
University HEI staff: three teams of university staff (Exeter, Northumbria, London) will be trained to offer training to the clinicians to deliver the workshops. They will be asked for their views about implementing the training

What does the study involve?
Students:
1. It will involve deciding to refer themselves to a DISCOVER stress workshop if they would like to attend
2. Deciding to give consent to take part in study
3. Completing assessment forms on a digital device called POD at the start
4. Meeting with a member of staff to plan goals
5. Attending the day-long workshop
6. Responding to a text after the workshop to see how they have got on
7. Completing assessments at the 3-month follow-up and the 6-month follow-up
MHST Clinicians:
They are trained to offer DISCOVER workshops to 16-18 year olds in their areas. They will be asked for their views about offering the workshops.
University HEI staff:
They will be trained to offer the training (train the trainers’ programme) so that they can deliver the training to the clinicians. They will be asked for their views about the training.

What are the possible benefits and risks of participating?
Students: The benefits are that the student could benefit from attending the workshop, finding they are not alone, finding the methods useful and feel better at 3 and 6 months. The risks may involve not liking the methods taught, not feeling comfortable in the group of up to 15, not finding the methods useful.
MHST Clinicians: The benefits are they will feel empowered to offer the workshops. The risks are that they may feel discouraged by all the work involved in running the workshops
University HEI staff: Benefits: They will feel empowered as this is one of the few evidence-based interventions for 16-18-year-olds. Risks: they will feel confused and discouraged by the train the trainers programme and when they train the MHSTs.

Where is the study run from?
King’s College London (UK)

When is the study starting and how long is it expected to run for?
April 2024 to March 2028

Who is funding the study?
NIHR Health and Social Care Delivery Research (HSDR) (UK)

Who is the main contact?
1. Dr June Brown, june.brown@kcl.ac.uk
2. Dr Jenny Shand, j.shand@ucl.ac.uk

Contact information

Dr June Brown
Public, Scientific, Principal Investigator

Psychology Department (PO77)
Institute of Psychiatry, Psychology and Neuroscience
De Crespigny Park
London
SE5 8AF
United Kingdom

ORCID ID	0000-0002-0479-8166
Phone	+44 (0)7875015282
Email	June.brown@kcl.ac.uk

Dr Jenny Shand
Scientific, Principal Investigator

Department of Clinical, Educational and Health Psychology
UCL
1-19 Torrington Place
London
WC1E 7HB
United Kingdom

Phone	+44 (0)7855400495
Email	j.shand@ucl.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centres

Sponsor information

King's College London
University/education

Level 8, Melbourne House
44-46 Aldwych
London
WC2B 4LL
England
United Kingdom

Phone	+44 (0)2078487247
Email	bashir.al-hashimi@kcl.ac.uk
Website	http://www.kcl.ac.uk/index.aspx
"ROR"	https://ror.org/0220mzb33

Funders

Funder type

Government

Results and Publications

Editorial Notes

21/02/2025: Study's existence confirmed by the NIHR.