Distress Brief Intervention - under 18s elements: evaluation

Executive summary

The Distress Brief Intervention (DBI) programme aims to support individuals in distress who seek help from frontline services in Scotland. Launched in 2017, the DBI programme involves collaboration between the Scottish Government, frontline services including the NHS and Police Scotland, third sector organisations, and the University of Glasgow. DBI provides two levels of support:

• Level 1 involves an immediate compassionate response from trained staff such as police and healthcare providers. If assessed by Level 1 staff as appropriate for DBI Level 2 they will be offered a referral for Level 2 support.
• Level 2 offers around 14 days of compassionate, community-based, person-centred support from third sector organisations working in the mental health and wellbeing field. The support can involve distress management planning and guidance about how the person might be able to tackle the background issues which are causing their distress, as well as signposting to other sources of support which are relevant to the issues causing the distress.

Through collaboration between the Scottish Government, DBI central team and the University of Glasgow, the DBI programme has been expanded to those aged under 18 in a number of ways, all of which are included in the scope of this evaluation:

• In 2019, DBI was expanded to include individuals aged 16 and over who were referred via existing routes into DBI for people over 18 (referred to as the adult pathway), including frontline services such as the police, Scottish Ambulance Service, primary care, and accident and emergency departments.
• Since 2021, a controlled ‘test of change’ has been trialling DBI delivery to young people in S3 and above (ages 13–18) via a new referral pathway involving schools and CAMHS. As of August 2025, the pilot is active in 24 schools across Lanarkshire, Aberdeen City, Highlands, and West Dunbartonshire. Education, CAMHS, and DBI work together in a tripartite model, allowing mutual referrals between schools, DBI, and CAMHS.
• In addition, Glasgow City and East Dunbartonshire Compassionate Distress Response Service (CDRS) became the DBI equivalent service for these areas in May 2023. CDRS expanded its distress support model to include 14–15 year olds, building on its existing support for 16–25 year olds (East Dunbartonshire) and 16 and over (Glasgow City). Referrals come from a range of services including CAMHS, schools, social work, and third sector organisations. Unlike DBI, CDRS offers an immediate response (within 24 hours during the day or 1 hour out of hours), followed by up to one month of support.

Aims of the evaluation

The purpose of this evaluation was to produce evidence-based recommendations for the continued development of the DBI Under 18s programme, to inform associated policy and practice decision making by providing a clear and robust account of:

• whether DBI can be an effective intervention for use with young adults aged under 18, and whether this varies among subgroups of young people, particularly those aged under 16 compared with 16- and 17-year-olds?
• what changes in the design and implementation of the DBI, if any, are needed compared with its use in adults?
• what mechanisms of delivery and contextual factors contribute to its successful implementation and impact?

Methodology

The evaluation team used a mixed-methods approach, combining qualitative research with quantitative data review and stakeholder consultation. After an initial scoping phase — including workshops and development of a Theory of Change for under-18s — fieldwork was carried out with young people and with professionals involved in delivering or shaping DBI.

One-to-one interviews were conducted in-person, by telephone, or via WhatsApp text messages, according to the young person’s preference, with 20 young people aged 13 to 18 who received support from DBI. Interviews and focus groups were also conducted with 32 individuals involved in the design and delivery of DBI and/or the test of change, including Level 1 referrers from schools and CAMHS, Level 2 practitioners and strategic stakeholders and a parent.

Aggregate data tables for the data routinely collected by DBI Level 2 services were supplied by Public Health Scotland for all under 18-year-olds referred to DBI between 31st May 2019 to 30th September 2024 (n=2219).

Key findings

• Overall, young people’s distress levels had decreased by the end of Level 2 support and young people felt able to manage their current and future distress.
• The promise of immediate support was valued by young people and referrers. Being able to refer young people to a service which provides immediate support with no waiting list was extremely helpful for school-based Level 1 referrers.
• Young people appreciated flexibility in scheduling and modes of support, though consistency varied. Most young people expressed a preference for in-person support, although this was not always offered.
• A positive relationship with DBI practitioners was crucial for engagement, providing a safe space to talk and feel validated.
• Young people valued the coping strategies provided, though some found generic advice less helpful or the use of worksheets to get in the way of talking about the things which were important to them.
• Young people would have preferred longer support durations, feeling the 14-day limit left issues unresolved. Practitioners found the model to be working well but often extended support beyond the standard 14 days due to the longer time taken to build rapport with young people compared with adults and suggested that longer durations of support should be formalised.
• School staff described how DBI had, to an extent, reduced their workload. By having DBI support, staff felt reassured that the young person was supported when their own time is limited.

Development and delivery of the under 18s elements of DBI

Key facilitators for implementation included strong support at a policy level from the Scottish Government, a need to alleviate pressure on CAMHS, and DBI’s reputation as a reliable service. Challenges included securing school buy-in and engaging with parents/carers. The DBI service offered by the test of change was seen as complementary and additional, rather than an alternative, to existing services, and provided immediate support that schools and CAMHS could not always offer.

Over two-thirds of the 2,219 referrals made between 31st May 2019 to 30th September 2024 to DBI for under 18s were for girls and young women. Staff noted that girls and young women often show more overt distress and seek support more proactively than boys and young men. Education was the most common referral source for under 18s overall and the primary reasons for accessing DBI included stress/anxiety and depressed/low mood, with suicidal thoughts reported by a third and self-harm reported by a quarter of under 18s referred.

DBI support for under 18s lasted slightly longer and involved more sessions compared with DBI for adults. For around half of under 18s who took up support, this lasted 14 days or less, though the average intervention length was 16.2 days. Support sessions were mostly carried out over the telephone. Self-help resources were the most common form of follow-on support to which young people were signposted.

Outcomes for children and young people, Level 1 and Level 2

Over 80% of young people referred took up support from DBI. Young people appreciated flexibility in scheduling and modes of support, though consistency varied. Most young people expressed a preference for in-person support although this was not always offered. A positive relationship with DBI practitioners was crucial for engagement, providing a safe space to talk and feel validated.

Young people received compassionate support at both Level 1 and Level 2. Almost all of under 18s referrals had a Level 2 contact attempt within 24 hours, which is consistent with the DBI model. Nearly all young people interviewed reported being successfully contacted by a Level 2 DBI worker within 48 hours of referral, describing initial contacts as positive and focused on their issues and how DBI works.

On average, young people’s distress levels had decreased by the end of Level 2 support. Young people valued the coping strategies provided, though some found generic advice less helpful. Young people would have preferred longer support durations, feeling the 14-day limit left issues unresolved.

Access to other ongoing support for young people beyond DBI Level 2 support, such as counselling or CAMHS, was challenging due to long waiting lists and limited resources. Many young people reported being signposted to school counselling, though some were reluctant to use it due to previous experiences/peer experiences.

Reflections from Level 1 referrers and Level 2 practitioners

School staff received DBI Level 1 training, boosting confidence in making referrals and strengthening links with Level 2 providers. While staff valued DBI’s quick response and alignment with school values, challenges included staff turnover, limited training opportunities, and time pressures. DBI was seen as reducing workload and improving relationships with pupils and parents.

DBI Level 2 staff reported increased confidence and skills from training, especially those newer to working with young people. They emphasised the need for regular training and accessible support options, including in-person sessions in schools. Most young people were contacted within 24 hours, indicating sufficient staffing. Coordination with schools was key, though limited room availability posed challenges.

Level 2 practitioners often extended support beyond the standard 14 days due to the longer time taken to build rapport with young people compared with adults and suggested that longer durations of support should be formalised. Tools and coping strategies, including a Distress Management Plan (D-MaP), were tailored to individual needs, with some practitioners using verbal approaches instead of written forms.

Suggested improvements and considerations for future development

Evaluation participants suggested several improvements to the DBI CAMHS/schools pathway, including more flexible referral options (e.g. phone, email, text), longer support (up to 4–6 weeks), and a follow-up check-in after 2–3 months. School staff requested more consistent feedback and greater integration, such as DBI practitioners being based in schools. Young people preferred face-to-face support, less paperwork, and informal contact between sessions.

There was broad support for further roll out of DBI via the tripartite model of schools and CAMHS referral pathways. Ensuring that fidelity is maintained to the DBI model of immediate, brief and time limited one-to-one support was seen as central to any further expansion. Evaluation participants suggested expanding referral pathways, such as through GPs and NHS24, and ensuring longer-term funding and evaluation. Involving young people in the future development of DBI development was deemed crucial.

Conclusions

The findings of this evaluation provide evidence of promising practice, and indications that DBI can be an effective intervention for use with young people. The extension of DBI to 16- and 17-year-olds as part of the national adult service has been well implemented and is now embedded in the service.

There is evidence that young people feel less distressed by the end of DBI Level 2 support and that person-centred approaches enable them to develop coping strategies. Some shared clear examples of positive impact. No major differences in distress levels were found across age groups, but girls were referred at twice the rate of boys, suggesting DBI may be more accessible for, or seen as more suitable for girls.

DBI was seen as particularly effective in terms of providing immediate support to young people. It is less clear whether DBI is effective in reducing pressure on other services such as CAMHS and the evaluation findings indicate that young people are frequently being referred to DBI while on the waiting list for other services. The information shared at referral by Level 1 referrers and the data collected by Level 2 services as part of the routine dataset should include a field to record whether a young person is on the waiting list for another service.

While there are indications of promising outcomes for young people who access DBI and clear examples of good practice, this evaluation is not of the scope to state definitively that wider roll-out across Scotland would be effective.

The core DBI principles — compassionate support, contact within 24 hours, and short-term, community-based help — remain central in the test of change. Compared to adults, young people tend to engage slightly longer, prefer face-to-face support, and may find paperwork a barrier to open discussion. Suggested improvements include extending support beyond 14 days, balancing paperwork with person-centred dialogue, and strengthening follow-on support and signposting.

A number of delivery mechanisms and contextual factors contributed to the successful implementation of the under 18s elements of DBI. Strong leadership by DBI Central, governance, and pre-existing networks facilitated successful implementation overall. Key facilitators for the implementation of the test of change included strong policy drivers, a need to alleviate pressure on CAMHS, and DBI’s reputation as a reliable service. Training for both Level 1 referrers and Level 2 staff had been successful in increasing skills and confidence - and was well-received.

While the evaluation highlighted promising practices and positive short-term outcomes, it faced limitations such as lack of medium or long-term follow-up, lack of a control group for comparison and potential bias from opt-in recruitment. Any potential wider rollout of DBI via the schools and CAMHS tripartite approach would require further robust evaluation and understanding of DBI’s place within the broader mental health support and children’s services landscape.