Eleanor Sweeney - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: school
Cognitive-Model
Youth
Shame
adolescents
parents
prevention
teen dating violence
benchmarking
IPV
psychological support
PTSD
neonatal unit

Systematic literature review: Are school-based interventions to prevent teen dating violence theory-driven, and are they effective? A systematic literature review
Background: Adolescents are at risk of experiencing dating violence (DV); this has significant personal and economic consequences. Prevention efforts need to start before adulthood, and school provides a unique platform for this. This review examined what school-based teen DV (TDV) interventions focus on, whether they are theory-driven and their effectiveness. Method: A literature search was conducted across OVID (including Embase, PsychInfo, MedLine), Scopus and CINAHL for peer-reviewed papers published, published in English, from 2015 (inclusive) onwards. Titles and abstracts were screened, then potentially eligible articles were reviewed in full. Inclusion criteria were that interventions were school-based, had an explicit aim to reduce DV, had a pre and post quantitative measurement of DV and that participants were aged between 10-20 (inclusive). At each stage, an independent researcher assessed a proportion of papers to ensure agreement. A quality assessment was conducted for each included study. Findings: Twenty eligible studies of good-excellent quality were included. Studies most commonly focused on recognising DV, and healthy relationship behaviours. 60% of interventions were theory-driven, with social cognitive theory most commonly underpinning interventions. 70% of interventions significantly improved one or more DV outcome measure. The majority of effect sizes were small. Conclusions: Despite small effect sizes, given the opportunity to reach a large number of individuals, and the potential positive personal and economic implications, delivering school-based TDV interventions may be worthwhile. Further research is needed to establish the reliability of interventions, and the mechanisms by which they impact TDV to refine and enhance their efficacy.

Service improvement project: Understanding the psychological needs of parents of whose babies have received care on a Neonatal Care Unit, and exploring the barriers to meeting these
Objectives: Parents of infants admitted to a Neonatal Unit (NNU) can experience elevated distress, which can have negative impacts on both parent and baby wellbeing. However parents often report receiving insufficient psychological support. This project aimed to identify strengths and areas of need regarding the provision of parental psychological support in the current NNU service. Methods: A benchmarking exercise was conducted, whereby available UK guidelines regarding NNU parental psychological support were identified; these were then rated against current provision. Following this, 33 parents of babies who received care on the NNU completed a self-report online survey. This investigated the accessibility, barriers and effectiveness of the current support, and what psychological support they felt was needed. Survey data were analysed using descriptive statistics and content analysis. Results: The benchmarking exercise found strength in the expertise and breadth of the parental psychological support available whilst their babies were on the unit. It identified gaps in support regarding transition to home, peer-support and parent-informed support. It highlighted a need for further staff resource in order to meet guidelines. The parental survey emphasised that those who received support were generally satisfied with this, particularly benefiting from the opportunity to talk with staff. The survey identified a need to increase the awareness of support, opportunities for discussions, and for staff to initiate support. It also identified a barrier of stigma. Discussion: Areas of strength and need with regards to parental psychological support are discussed and recommendations are given to guide future service development.

Theory-driven research project: Does the Cognitive-Model predict PTSD symptom severity, and how is this related to shame, in youth who have experienced Intimate Partner Violence?
Background: Intimate Partner Violence (IPV) is prevalent in youth, and can lead to Post-Traumatic Stress Disorder (PTSD). Ehlers and Clark’s (2000) Cognitive-Model, which proposes negative appraisals, disjointed memories and unhelpful coping strategies maintain PTSD, commonly informs PTSD treatment. Shame is linked to PTSD symptoms, and the Cognitive-Model. Objectives i) To assess if the Cognitive-Model predicts PTSD symptoms in Youth IPV (Y-IPV) survivors. ii) To examine if trauma-related shame predicts PTSD symptoms. iii) To assess if trauma-related shame moderates the relationship between the Cognitive-Model variables and future PTSD symptoms. Method: 85 Y-IPV survivors aged 18-25 completed questionnaires measuring the Cognitive-Model variables, trauma-related shame and possible covariates, approximately six months apart. Results: Safety behaviours, responses to intrusions and negative appraisals predicted PTSD symptoms; however, when controlling for covariates, only safety behaviours predicted future PTSD symptoms. Trauma-related shame predicted PTSD symptoms; however, when controlling for covariates, it no longer predicted future PTSD symptoms. Trauma-related shame did not moderate the relationship between the Cognitive-Model variables and future PTSD symptoms, when controlling for covariates. Discussion: The results provide partial support for the Cognitive-Model, and its prediction of PTSD symptoms, indicating safety behaviours as a unique predictor in Y-IPV survivors. Implications, limitations and future research are discussed.