# Support for young people who are distressed by hearing voices: protocol for an uncontrolled feasibility evaluation of a psychological intervention package delivered within secondary schools (the ECHOES study)

## TL;DR

This study evaluates a new psychological intervention package for young people who hear distressing voices, aiming to improve accessibility and effectiveness within schools.

## Contribution

The study introduces a novel intervention package combining 1:1 coping strategies and parent workshops, specifically adapted for delivery in secondary schools.

## Key findings

- The intervention package will be adapted and tested for acceptability and feasibility in school settings.
- Quantitative and qualitative data will inform the optimal structure and delivery of the intervention.
- The study will guide the design of a future randomized controlled trial if findings are promising.

## Abstract

Hearing voices is a common experience for young people and can cause significant distress. There are no evidence-based psychological interventions for distressing voices in young people, although a focus on coping strategies has been suggested as a useful approach. We have developed and evaluated a brief 1:1 coping intervention for young people who hear distressing voices. This intervention has been successfully piloted within Child and Adolescent Mental Health Services (CAMHS), together with a psychoeducational workshop for parents. The 1:1 intervention and the workshop will be combined into an intervention package and offered within schools to maximise accessibility.

This study will be an uncontrolled feasibility evaluation addressing the following questions: is the intervention package acceptable to young people, those who support them, and staff and practitioners within secondary schools? What is the optimum content, structure, and duration for the intervention package? Is delivery of the intervention package feasible for the practitioners and what are their requirements for training and supervision? What tools can be used to evaluate the impact of the intervention package?

The study will be guided by the MRC Framework for the development of complex interventions and consist of an iterative process over four phases: phase 1—adaptation of the intervention package with young people, parents, and school staff; phase 2—delivery of the intervention package through Mental Health Support Teams to students, supporters who have been nominated by the students and school staff; phase 3—analysis of quantitative and qualitative data collected from participants and practitioners; phase 4—further adaptation of the intervention package with young people, parents and school staff.

If the findings from the study suggest that a future trial is warranted, a feasibility Randomised Controlled Trial will be designed to establish the parameters for a definitive trial.

Current Controlled Trials ISRCTN registration number: 16395888. Registered on 11 January 2024. 10.1186/ISRCTN16395888.

The online version contains supplementary material available at 10.1186/s40814-025-01611-x.