Identifying and changing cognitive vulnerability in the classroom: preliminary evaluation of CUES-Ed, a school-based universal cognitive behavioural early intervention service for 7-10 year olds.

BACKGROUND: School-based early intervention may alleviate current emotional and behavioural problems, and, by targeting underlying vulnerability, safeguard children's future mental health. Improving on mixed outcomes to date is an international public health priority. CUES-Ed is a classroom-based, clinician-led, universal cognitive behavioural programme for primary school children, designed to promote emotional literacy and regulation. Additionally, CUES-Ed targets cognitive mechanisms implicated in the future development of mental disorder: stigmatising appraisals of emotional expression and of unusual perceptual experiences, and the tendency to jump-to-conclusions (JTC). We report here on fitness for purpose of our in-service assessment of cognitive vulnerability, and change in cognitive vulnerability following CUES-Ed and compared with a naturalistic waitlist. METHODS: From 05/2017-11/2017, 960 children participated (900 CUES-Ed; 60 naturalistic waitlist). Assessments were completed in whole classes; 732 children provided pre-post data on all measures; 227 were missing data through absence or poor completion (n = 1 declined assessment). RESULTS: Relationships between baseline cognitive vulnerability measures and their components were consistent with reliable and valid assessment. Cognitive vulnerability reduced from before to after CUES-Ed and compared with the naturalistic waitlist, for JTC (large effects) and stigmatising appraisals (small-medium effects), for all children (ESs pre-post: 0.2-1.0; between-group: 0.1-1.0) and vulnerable subgroups (ESs pre-post: 0.5-1.7; between-group: 0.2-2.0). CONCLUSIONS: Targeted cognitive vulnerability mechanisms change following CUES-Ed. As stigmatising appraisals and JTC may increase vulnerability to future mental illness, findings suggest a promise in reducing future risk. A formally controlled research study, with longer-term follow-up, is required to test this. Limitations and implications for future evaluation are discussed.

Attachment Anxiety, Rape Myth Acceptance, and Sexual Compliance.

People may consent to sexual activity with a partner when they do not desire it (i.e., sexual compliance), and such behavior is particularly prevalent in women. Despite the negative consequences of unwanted sex, (e.g., guilt and poor health), few studies have considered those factors influencing sexual compliance. Attachment anxiety is characterized by overestimation of relationship threats and sensitivity to romantic rejection and rape myths are beliefs about rape that deny, trivialize, or justify sexual aggression and assault. In the present study both attachment anxiety and rape myth acceptance were hypothesized to influence perceptions of unwanted sex and personal experience of sexual compliance. Heterosexual women (N = 158) completed a series of online standardized self-report measures. Hierarchical multiple regressions were conducted to determine whether attachment anxiety and rape myth acceptance predicted women's perceptions of unwanted sex (perpetrator blame, victim blame, no blame, compliance, confrontation, and ignore) and personal experience of sexual compliance, while controlling for participant age and length of their current romantic relationship. Women high on attachment anxiety were less likely to endorse confrontation of a partner and were more likely to report personal experience of unwanted sex. Those accepting rape myths were more likely to endorse compliance and less likely to blame perpetrators or endorse confrontation of the partner. Future research should consider the consequences of unwanted sex and experiences of sexual compliance in nonheterosexual relationships and those who do not identify as women.

Innovations in Practice: CUES-Ed: an in-service evaluation of a new universal cognitive behavioural early mental health intervention programme for primary school children.

BACKGROUND: Earlier childhood interventions to reduce mental health vulnerability are a global health priority yet poorly implemented. Barriers include negotiating health/education interfaces, and mixed outcomes, particularly for vulnerable children. CUES-Ed aimed to address these barriers, comprising a cognitive behavioural early intervention targeting mental health vulnerability in 7-10 year-olds, with integrated evaluation, delivered through close liaison with stakeholders. Following 2 years of ad hoc delivery, relationship-building, and refining the intervention and evaluation, we report on implementation and in-service outcomes for local schools completing the standardised CUES-Ed programme. METHOD: We evaluated delivery from 01/2017 to 07/2017 across n = 12 schools (n = 23 classes, n = 638 pupils, n = 35 teachers). Eight one-hour weekly sessions (S1-S8) were delivered by mental health professionals with teachers present. Pupil-reported wellbeing/distress and emotional/behavioural difficulties were assessed at S1 and S8; pupil free text feedback/ratings and teacher ratings at S8. Two classes (n = 60) completed outcomes whilst awaiting CUES-Ed, forming a naturalistic waitlist. RESULTS: At S8, pupil-reported outcome data were obtained from 535 and feedback/ratings from 577 pupils, respectively. Thematic analysis of feedback indicated positive subjective impact. Vulnerable children (defined as self-rated borderline/clinical cut-off baselines scores on the wellbeing/distress and emotional/behavioural difficulties measures) improved with medium pre-post effect sizes (d = 0.46-0.65), and small, but consistent, effects compared to waitlist. CONCLUSION: In-service evaluation suggests a feasible model of delivery, good acceptability and potential to improve outcomes for vulnerable children. Controlled evaluation is now indicated.