title: A qualitative process evaluation of classroom-based cognitive behaviour therapy to reduce adolescent depression.
abstract: Small scale trials indicate that classroom-based Cognitive Behaviour Therapy (CBT) for adolescents has good reach and can help prevent depression. However, under more diverse everyday conditions, such programmes tend not to show such positive effects. This study examined the process of implementing a classroom-based CBT depression prevention programme as part of a large (n = 5,030) randomised controlled trial across eight UK secondary schools which was not found to be effective (PROMISE, ISRCTN19083628). The views of young people (n = 42), teachers (n = 12) and facilitators (n = 16) involved in the Resourceful Adolescent Programme (RAP) were obtained via focus groups and interviews which were thematically analysed. The programme was considered to be well structured and contain useful content, particularly for younger pupils. However, challenges associated with implementation were its age appropriateness for all year groups, its perceived lack of flexibility, the consistency of quality of delivery, the competing demands for teacher time and a culture where academic targets were prioritised over personal, social and health education. Whilst schools are convenient locations for introducing such programmes and allow good reach, the culture around improving well-being of young people in schools, increasing engagement with teachers and young people and sustaining such programmes are issues that need addressing.
authors.affiliation: Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK. john.a.taylor@nottingham.ac.uk.
authors.forename: John A
authors.initials: JA
authors.lastname: Taylor
authors.affiliation: Wales School for Primary Care Research, Institute of Primary Care and Public Health, School of Medicine, Cardiff University, 5th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK. PhillipsR19@cardiff.ac.uk.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Phillips
authors.affiliation: Department for Health, University of Bath, 22-23 Eastwood, Bath BA2 7AY, UK. ellencook62@hotmail.com.
authors.forename: Ellen
authors.initials: E
authors.lastname: Cook
authors.affiliation: Department for Health, University of Bath, 22-23 Eastwood, Bath BA2 7AY, UK. lucygeorgiou@hotmail.com.
authors.forename: Lucy
authors.initials: L
authors.lastname: Georgiou
authors.affiliation: Department for Health, University of Bath, 22-23 Eastwood, Bath BA2 7AY, UK. p.stallard@bath.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Stallard
authors.affiliation: Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK. kapil.sayal@nottingham.ac.uk.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sayal
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012572:School Health Services; D012574:Schools; D006113:United Kingdom