Impact case study database

1. Informing policy

Research undertaken by Cooper has shaped the development and implementation of school-based counselling in England. His research demonstrating the positive effects of school-based counselling ( R1), led to Cooper’s appointment as a National Advisor for Counselling for the Children and Young People’s Improving Access to Psychological Therapies Programme (CYP IAPT) at the Department of Health (DH)/NHS England until 2016 ( IMP1, IMP2). In this role, he spearheaded the development of national guidance, tools and training on the implementation of school-based counselling in England and brought an evidence-based perspective to the working of the Programme. In 2014-2015, Cooper chaired the ‘Integrating CYP Services Task and Finish Group’ for CYP IAPT. Here, he led the development of innovative practices for integration and service user involvement for child mental health services in England, including a new ‘passport’ for young people to use when transitioning between mental health services. This has since been adopted and adapted by Children and Young People’s services at NHS England ( IMP2). Also in 2014-2015, Cooper Co-Chaired the ‘Access and Prevention Task and Finish Group’ for the Children and Young People’s Mental Health Taskforce (NHS England/DH), producing the 2015 Future in Mind report ( IMP3). This report, informed by Cooper’s evidence-based perspective, led to the investment of £235 million per annum to increase children and young people’s access to mental health services ( IMP2). A 2018 Children and Young People’s Mental Health Green Paper Transforming children and young people's mental health provision further outlined steps to improve mental health support in schools and colleges, including the aim for every school and college to have a designated lead in mental health by 2025 and the establishment of 123 school-based Mental Health Support Teams in England ( IMP2).

Cooper’s research demonstrating that school-based counselling can reduce psychological distress in children and young people ( R1) contributed to the decision, by NHS England and Health Education England, to commission an Evidence-Based Counselling Curriculum for training NHS professionals ( IMP1). Cooper co-led the development of the curriculum in 2015-2016. Cooper’s research also supported, and informed, the development of the Department for Education’s 2016 advice Counselling in Schools: A Blueprint for the Future ( IMP4). This guidance, which draws on Cooper’s research findings around the effectiveness of school-based counselling ( R1, R2), has become a ‘go-to’ document for schools, colleges and counselling services ( IMP5). As the Children, Young People and Families Lead at the British Association for Counselling and Psychotherapy (BACP) affirms, this guidance has ‘established school-based counselling as a legitimate activity and key intervention to support young people’s mental health’ and this has in turn ‘enabled commissioners and providers to refer to an evidence-based framework, clearly setting out standards and expectations that help to embed counselling as a separate, yet integrated provision in educational settings across the nation’ ( IMP5).

In 2020, Cooper conducted research with the BACP Policy and Public Affairs Department to establish that, following the implementation of COVID-19 restrictions, the number of children and young people receiving school counselling halved ( IMP5). These findings, drawing on Cooper’s earlier research ( R1, R2), have contributed to BACP’s campaign for further government investment in school counselling. The campaign resulted in over 3,000 letters being sent to MPs calling for government funding for school counselling and led to an Early Day Motion being tabled before the House of Commons by the Labour MP for Hemsworth in September. In response, 34 parliamentary questions were tabled during the period up until December; and in October 2020, Baroness Massey referenced the briefing incorporating Cooper’s research during a House of Lords debate on Children and Young People’s Mental Health ( IMP5).

1. Influencing practitioners

Cooper’s research has been fundamental to the development of national guidance around the practice of school-based counselling in England. Evidence of its benefits ( R1) were ‘instrumental in the commissioning of the “MindEd Counselling” e-learning programme for counsellors working with children, young people, and young adults’, attests the former Chair of the BACP ( IMP1). This free resource, launched in 2014, draws on Cooper’s research demonstrating the effectiveness of humanistic counselling in schools ( IMP2). MindEd Counselling has been accessed by 71,405 registered users between April 2017 and July 2020 across five continents (Europe, Africa, Asia, North America, South America), with a total of 71,914 session launches, 32,210 session completions, and 27,837 hours of learning completed ( IMP1). This evidenced-based training resource has led to direct benefits for practitioners, including ‘increased confidence and better awareness in issues linked to children and young people’s mental health as well as introducing creative problem-solving techniques to look at some of the challenging situations that are presented within counselling’ ( IMP5).

Cooper’s research demonstrating the positive outcomes of the humanistic counselling avatar-based intervention, ProReal ( R4), has also supported its growth and dissemination for young people. ProReal’s Chief Executive credits Cooper’s research as ‘instrumental to our move into the Education sector’ from 2016, as it provided an evidence-based assessment of the use of the technology in UK secondary schools and demonstrated that it was ‘acceptable and even attractive to clients and was particularly helpful for young males’ ( IMP6). The research has directly supported ProReal’s growth, with the service now offered as an adjunct to treatment provided by the Oxford Health NHS Foundation Trust CAMHS team and Off the Record, a youth counselling charity in Bristol. In January 2020, ProReal set up ‘MiHUB’, a project that aims to support young people’s wellbeing through virtual reality, in partnership with Wiltshire Council and Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group. Cooper’s research played a key role in the establishment of this project as it ‘enabled us to illustrate to our project partners that the ProReal tool is effective and supported by evidence’ ( IMP6).

Self-report tools for monitoring outcomes in adolescent counselling and psychotherapy are limited, and existing tools are often lengthy, based on diagnostic criteria, and/or oriented to US respondents. Cooper’s contribution to the development of the Young Person’s Clinical Outcomes in Routine Evaluation (YP-CORE) measure – and the research demonstrating that this tool provides a psychometrically robust assessment of psychological distress in young people ( R5) – has also helped facilitate the widespread uptake of this brief, standardised outcome measure by practitioners. Since 2014, the YP-CORE has been used with over 100,000 young people in the UK and internationally. It has been adopted across Wales to evaluate school-based counselling services ( IMP5). The YP-CORE has shaped the way counselling services have been commissioned across the UK and has become the most-widely used measure for evaluating such services. As such, it has provided essential evidence of the benefits of school-based counselling; and has supported the commissioning, funding and delivery of these services ( IMP5).

Cooper’s Inventory of Psychotherapy Preferences (C-NIP), a new therapy preference tool developed from his research ( R6), has provided practitioners with a means of systematically assessing their clients’ preferences and tailoring their therapeutic work accordingly. The C-NIP has been adopted by therapists working in a range of clinical settings in the UK and US. A psychotherapist at the Bethlem Royal Hospital, UK states, ‘By engaging with the C-NIP, I have observed a more rapid establishment of a therapeutic alliance between client and therapist [and] the possibility of avoiding some dispiriting ruptures through a heads-up of potential pitfalls earlier in the work’ ( IMP7). Since August 2020, the C-NIP tool has also been adopted by Marvin—a US-based mental health support company—with 100 clients across four major hospitals in California and Massachusetts. As their Co-Founder and CEO attests: ‘The C-NIP has been extremely impactful: both in terms [of] helping us to match each client with a provider, and helping each provider to understand their client’s therapeutic preferences’ ( IMP8). These practitioner improvements have in turn led to clinical and reputational benefits for Marvin: ‘our client retention has increased and client satisfaction has significantly increased since using the C-NIP’ and ‘use of the C-NIP has also improved our standing with our hospital partners and increased our ability to build long-term contractual relationships’ ( IMP8). The C-NIP has a dedicated website through which the tool can be completed by clients and an interpretation of responses is provided. It has been translated into eight languages, with an estimated 3,000 clients having used the measure since its inception in 2015.

Cooper’s research demonstrates that humanistic counselling for young people offered in the community and voluntary sector is effective in reducing psychological distress ( R3), and it has shaped the ability of the third sector to support young people. Youth Access—the UK’s lead organisation providing young people’s information, advice, and counselling services (YIACS)— used Cooper’s research to enact policy change and successfully bid for vital funds. The Chief Executive states that Cooper’s evaluation was ‘instrumental in securing a commitment in the NHS Long Term Plan to develop age-appropriate mental health models for young adults and to recognise the vital role that voluntary and community sector services play in bridging crucial gaps in provision for at-risk young adults’ ( IMP9). Youth Access also used the research to directly support several successful major funding bids, including a grant of £1.4m from the National Lottery Community Fund to develop access to YIACS across the UK and a grant of £1m from the Department of Culture, Media, and Sport to improve access to mental health support for young women, and BAME women in particular ( IMP9).

1. Improvement of therapeutic interventions for clients

Cooper’s research regarding the effectiveness of an avatar-based tool for supporting humanistic counselling has led to direct patient benefits. Approximately 4,000 children and young people have now used the ProReal tool ( IMP6). The tool may be particularly useful for counselling clients who have trouble expressing themselves verbally. For example, one school counsellor attests that ‘with ProReal she [one pupil] could show her anger and be her anger… After using ProReal she was much calmer, it was her being allowed to express herself.’ A Senior Mental Health Professional with the NHS Trust reported the usefulness of the tool in assessment, and for patients. ProReal’s Chief Executive attributes these successful patient outcomes to Cooper’s research ( IMP6).

Cooper’s impacts on policy and practitioners have had deep and pervasive consequences for young people’s access to, and benefit from, humanistic counselling interventions in schools. School-based counselling is now delivered in all publicly funded secondary schools in Wales and Northern Ireland (approximately 380 schools) and in around 70% of schools in England and Scotland. The former Advisor for School-Based Counselling within the Department of Education (DE) in Northern Ireland (NI), states: ‘The DE were greatly influenced in their decision-making by the positive outcomes your research identified’ ( IMP10). Cooper’s body of research demonstrating school-based counselling reduces young people's psychological distress ( R1, R2) was subsequently used by the DE to successfully bid for continued funding from the NI Government, leading to increased access to counselling interventions for children and young people in NI: ‘Substantiated by your research findings, during the 15 years the service has been available, an estimated 15,000 students across 230 post primary school settings, including 25 Educated other than at School settings, have now benefited from the school based counselling interventions.’ ( IMP10). As the Children, Young People and Families Lead at the BACP attests, Cooper’s research ‘and its impact on policy and practitioners have had a significant influence on young people’s ability to access humanistic counselling interventions in schools’ ( IMP5). She adds that, as a consequence of Cooper’s research, between 2014 and 2021 ‘approximately 800,000 young people will have received school-based counselling across the UK’ and concludes, ‘Based on predicted recovery rates, approximately 360,000 of these young people will have moved from clinical to non-clinical levels of psychological distress (though 80,000 will also have moved from non-clinical levels to clinical levels). As such, your research has directly contributed to the alleviation of psychological distress in thousands of young people in the UK’ ( IMP5).