Effectiveness of Groups 4 Health in young people with depression: The Connecting Adolescents to Reduce Relapse trial (CARR).

The Groups 4 Health Program: Groups 4 Health (G4H) is a theory-driven, evidence-based, manualized psycho-therapeutic intervention that targets social isolation. G4H is designed to give young people the knowledge and skills needed to build and maintain their social world. G4H was developed using the latest science in social and clinical psychology, which suggests that group-based relationships are especially important for well-being. The intervention comprises 5 x 1.5 hour face-to-face group facilitated sessions, run weekly in the first month with the final module 5 delivered 1 month later. Modules 1-4 have associated homework after each session which takes about 30 minutes. Facilitators are Clinical and Health Psychology postgraduate students who receive training and weekly supervision to deliver the program. Module content is summarised below. Module 1: Schooling. Raises awareness of the beneficial effects that social group memberships have for health. It highlights the costs of ignoring the social dimensions of health and points out that failure to use all the social resources at our disposal generally leads to sub-optimal health outcomes. The module also makes the point that it is within people’s power to counter these effects by learning how best to develop, maintain and harness group-based resources. Module 2: Scoping. Focuses on the range of group-based resources that people have, or ideally should have at their disposal, to optimize health. This module engages participants in the process of social identity mapping (Cruwys, Steffens, Haslam, et al., 2015). This tool was developed to explore respondents’ social identities, in order to assess their current social functioning and develop a sense of how they would ideally like to function in the future, identifying current group memberships and any gaps in group networks. Module 3: Sourcing. Targets development of skills needed to identify and strengthen existing valued social identities with a view to optimizing and sustaining these in the longer term. It also raises awareness of solutions to barriers to making the most of existing groups. Module 4: Scaffolding. Uses the G4H group as a model for establishing and embedding new social group connections whilst at the same time exploring strategies to identify which connections to develop and enact through a social plan of action. The goal is to trial these social plans between this and the final module, which takes place at least one month later. Module 5: Sustaining: Is a booster session held one month later that aims to troubleshoot any difficulties that have arisen in the course of implementing these social plans. It also revisits social identity maps, created in Module 2, to see how they have developed in the course of the program. The social foundations that have been identified and developed in the preceding four modules are also reviewed with a view to encouraging their long-term maintenance. In addition to the facilitator manual, the program is supported by a client workbook. This contains a summarized version of the facilitator’s manual highlighting the main activities and learning points for each session, with sufficient space to complete activities (both within the sessions and as homework) and document any relevant notes and plans to achieve particular goals. Treatment fidelity is assessed by weekly supervision from a registered psychologist, and a brief questionnaire completed by facilitators at the end of each session delivered. This requires facilitators to tick off session activities covered, rate alliance and rapport between participants and with facilitator, indicate the length of session, and rate session satisfaction and ease of delivery.