Introduction
The past two decades have seen a rise in youth mental health problems, with services struggling to balance demand with capacity (McGorry et al. Reference McGorry, Alvarez-Jimenez and Hickie2024). In response, novel interventions and ways of delivering services are being deployed to improve access and efficiency. One approach gaining attention is single-session therapy (SST) (Schleider et al. Reference Schleider, Dobias, Sung and Mullarkey2020; Young and Dryden Reference Young and Dryden2019). SST focuses on a client’s immediate concerns with the use of clear goals and the application of practical strategies over a single consultation without the automatic intention of offering subsequent meetings (Hoyt Reference Hoyt2024; Tolmon, Reference Talmon1990; Young and Dryden Reference Young and Dryden2019). SST is also not triage or screening. SST is an approach rather than a single modality. It can draw on solution-focused, cognitive-behavioural, and person-centred methods, but is unified by the assumption that each session should be structured as a complete piece of therapeutic work (Hoyt et al. Reference Hoyt, Bobele, Slive, Young and Talmon2018; Rycroft and Young Reference Rycroft, Young and Hoyt2021). Evidence for SST in adult services is well established (Dryden Reference Dryden2021, Reference Dryden2023; Hoyt et al. Reference Hoyt, Bobele, Slive, Young and Talmon2018), few studies have looked at application in settings with young people (Schleider et al. Reference Schleider, Dobias, Sung and Mullarkey2020, Reference Schleider, Zapata, Rapoport, Wescott, Ghosh, Kaveladze, Szkody and Ahuvia2025).
Background
This study examines the feasibility and acceptability of SST as a point of entry to a talk therapy service for young people aged between 12 and 25 years at a single Jigsaw site in the south of Ireland. Jigsaw is a national primary care youth mental health service that provides free, evidence informed talk therapy. A three-stage model of SST was introduced to provide more timely care for young people (for more see Joseph and Rajan Reference Joseph and Rajan2024; Talmon Reference Talmon2012; Young Reference Young2023). This model includes pre-session ‘priming’ where clients are invited to reflect on several questions in advance of their SST (e.g. ‘what problem would you like to work on during your session?’), the SST consultation itself with a clinician, and a follow-up phone or video call two weeks later to check-in on the young person’s experience of their session and enquire whether more help is needed. Although further therapy was available after the completion of SST when requested in line with recommended practice with SST (Dryden Reference Dryden2021, Reference Dryden2023), it was anticipated that timely SST would meet the needs of some service users. SST was implemented during a period of increased demand and was initially partially used as a response to long waiting lists. While operating at a primary care level, the service routinely supports young people with varying levels of risk and complexity, with enduring or high-risk cases referred to specialist or crisis services as appropriate.
Methods
This study employed Orsmond and Cohn’s (Reference Orsmond and Cohn2015) feasibility framework, focusing on three domains: recruitment capacity, participant response, and intervention acceptability. Recruitment capacity evaluated the ability to engage service users in SST, while participant response assessed the initial therapeutic impact on service users’ psychological distress. Acceptability was measured by service user satisfaction with the intervention. Clinicians were drawn from a range of registered mental health professions, including clinical, counselling, and educational psychology, mental health nursing, social work, occupational therapy, and counselling and psychotherapy.
Participants and data collection
From January to August 2024, 549 young people accessed a SST session at this site. Data were collected at each meeting with a clinician. Consent was obtained at the first session. In line with policy, this secondary analysis of routine clinical data obtained ethical exemption from the Jigsaw research ethics committee.
Measures
The GAD-7 (Spitzer et al. Reference Spitzer, Kroenke, Williams and Löwe2006) and PHQ-9 (Kroenke et al. Reference Kroenke, Spitzer and Williams2001) measured self-reported anxiety and depression and were collected at the first sessions. The YP-CORE (Evans et al. Reference Evans, Connell, Barkham, Margison, McGrath, Mellor-Clark and Audin2002; α = .76) assessed psychological distress and was collected at each session. Satisfaction was measured at completion the Youth Service Satisfaction Survey (YSSS; Rickwood et al. Reference Rickwood, Mazzer and Telford2015).
Analysis
Descriptive statistics, t-tests, and chi-squared tests assessed recruitment and service user characteristics. A pre–post time series and Welch’s t-test evaluated service wait time reductions post-SST. We analysed changes in YP-CORE distress scores over sessions using a linear mixed-effects model, which compares scores across session numbers and baseline clinical status while allowing for repeated scores from the same young person. Due to a small sample size of young adults (17–25; n = 111) and high missingness at follow-up, we did not include analysis of the CORE-10 in this study. A piecewise regression analysis was conducted to examine trends in waiting times across three phases: pre-pilot, pilot, and full intervention. Satisfaction was compared pre- and post-intervention and against other services within the same network using independent-samples t-tests, and a time series regression examined satisfaction trends over time.
Results
Evaluating recruitment and sample characteristics
The mean age was 15 (SD = 2.86). Nearly two fifths were male (37.15%, n = 235). The majority were referred by parents (80%), followed by self-referral (10%) and GP (10%). Of the 549 service users who entered SST during the study period, 209 (38.07%) requested further care and were offered additional therapy sessions. Based on GAD-7 scores (n = 530), 90 individuals (17.0%) were classified as experiencing minimal anxiety (scores 0–4), 148 (27.9%) with mild anxiety (scores 5–9), 154 (29.1%) with moderate anxiety (scores 10–14), and 135 (25.5%) with severe anxiety (scores ≥ 15). The mean PHQ-9 score was 12.5 (n = 530; SD = 15.8). The distribution of participants across depression severity categories (PHQ-9) was as follows: 26.98% (n = 143) were categorised as having mild depression, 30.57% (n = 162) were in the moderate range, 20.38% (n = 108) were classified as moderately severe, 16.98% (n = 90) were in the none-minimal range, and 2.83% (n = 15) were in the severe category. Nearly five per cent (n = 23, 4.33%) scored at high risk for suicide or self-harm.
Half of all clinical sessions were classified as SST (50.2%, n = 549 contacts). This was followed by intervention session (n = 232, 21.2%). Contact with parent/guardian represented a fifth of all contacts (n = 220 referrals, 20.1%). The follow-up session was offered to young people who did not transition into standard care, and this made up 15.2% of contacts (n = 166 contacts).
The mean waiting time of 26.1 weeks (SD = 4.23) represents the interval between first referral/administrative contact and the SST consultation session. No formal screening or assessment occurred prior to the SST consultation. The regression model indicated a non-significant increase in waiting times during the pre-pilot phase (b = 0.05, p = .190). During the pilot phase there was a significant decrease in waiting times (b = −0.09, p < .001), with average wait times dropping to 10.2 weeks (SD = 8.29). In the full-intervention phase, the model showed a further significant decrease in waiting times (b = −0.13, p < .001), stabilising at an average of 4.6 weeks (SD = 0.61). Overall, the model accounted for approximately 60% of the variance in waiting times (R 2 = 0.60, F(3, 33) = 16.79, p < 0.001). Figure 1 shows local site waiting times alongside national figures, with the decline coinciding with SST implementation.
Analysis of waiting times following pilot and full-team implementation.
Figure 1. Long description
A line graph showing average waiting times in weeks for Cork and national locations over a period from January 2023 to June 2024. The horizontal axis represents the months from January 2023 to June 2024. The vertical axis represents the average waiting time in weeks. The graph includes two data lines: one for Cork waiting time in blue and one for national waiting time in red. The blue line for Cork shows a significant decrease in waiting times after the Cork pilot start in June 2023 and the full intervention start in October 2023. The red line for national waiting time remains relatively stable with slight fluctuations throughout the period. The shaded areas around the lines represent the confidence intervals for the data.
Preliminary evaluation of service user responses to SST at point of access
A total of 418 service users completed the YP-CORE. Most young people attended only their SST consultation (41.63%). About one in five completed both the SST and the follow-up session (22.49%). Attendance then declined with each additional session: 12.44% attended one extra session after the follow-up, 8.13% attended two, 7.18% attended three, 4.55% attended four, and 3.59% attended five or more sessions. There was an overall effect of session number, with scores differing across sessions and being lower at subsequent sessions compared with session 1 (F(7, 488.65) = 14.66, p < 0.001). When baseline clinical status was included, there were significant effects of session number (F(7, 513.17) = 10.12, p < 0.001), clinical status (F(1, 721.37) = 63.23, p < 0.001), and a session-by-status interaction (F(6, 517.54) = 6.45, p < 0.001). Distress decreased from session 1 to session 2 in the clinical group (M = 16.09, SE = 0.51; Δ = −6.08, p < 0.001; d = 1.36), while the change in the non-clinical group was smaller and not statistically significant (M = 8.40, SE = 0.76; Δ = −1.06, p = 0.18; d = 0.24). In an exploratory comparison of change from session 1 to session 2, both young people who completed SST plus follow-up only and those who went on to additional sessions showed significant improvement (2-session: Δ = −4.0, p < 0.001, d = 0.88; 3+ sessions: Δ = −4.5, p < 0.001, d = 0.99), with no difference in the size of early change between groups (interaction p = 0.60).
Evaluation of intervention acceptability
The mean satisfaction score for the sample was 61.29 (SD = 6.29, n = 67). A two-sample t-test showed no significant difference in satisfaction between males and females, t (61) = 0.11, p = 0.9. The t-tests comparing satisfaction scores between the SST pilot service and 13 other services delivering a standard model of care over the same time period found no statistically significant differences across any of the four subscales of the YSSS. For instance, ‘centre satisfaction’ had a mean of 4.45 in the SST pilot service and 4.41 across other services (t (74.23) = 0.70, p = 0.49), while ‘staff satisfaction’ showed similar stability with means of 4.60 (SST pilot) and 4.62 (wider service), (t (73.1) = −0.37, p = 0.71).
A time series analysis was conducted to evaluate changes in satisfaction across the four subscales of the YSSS (centre, staff, outcome, general) and total satisfaction. For ‘centre satisfaction’, there were no significant effects of time before the introduction of SST, b = −0.001, p = 0.85, or after, b = 0.031, p = 0.30. Similarly, ‘staff satisfaction’ showed no significant changes before (b = −0.008, p = .19) or after SST (b = 0.005, p = 0.84). ‘Outcomes satisfaction’ also did not exhibit significant change before (b = −0.010, p = .21) or after SST (b = 0.029, p = 0.38) changes. The results for ‘general satisfaction’ mirrored this trend, with no significant effects before (b = −0.014, p = 0.15) or after SST (b = 0.038, p = 0.32) . Finally, ‘total satisfaction’ showed no significant change over time, with non-significant effects both before (b = −0.009, p = 0.12) and after SST (b = 0.026, p = 0.28). These findings are illustrated in Figure 2, which shows that mean satisfaction scores across all subscales and total satisfaction remained consistently high and broadly stable before and after the introduction of SST.
Satisfaction pre- and post-implementation of single-session therapy.
Discussion
This study found that implementing SST as a first point of care in a youth mental health service may be feasible and acceptable. Recruitment and engagement were strong, consistent with evidence that SST can improve access (Dryden Reference Dryden2021; Hoyt et al. Reference Hoyt, Bobele, Slive, Young and Talmon2018). Waiting times dropped sharply following implementation, echoing findings that brief interventions can help services manage demand and improve responsiveness (Schleider et al. Reference Schleider, Zapata, Rapoport, Wescott, Ghosh, Kaveladze, Szkody and Ahuvia2025). Distress scores decreased significantly across sessions, with the largest improvement between the SST consultation and follow-up, showing a large effect of session number. The mean reduction exceeded the threshold for reliable clinical change (Evans et al. Reference Evans, Connell, Barkham, Margison, McGrath, Mellor-Clark and Audin2002), suggesting a meaningful impact for many participants. This pattern aligns with previous research demonstrating that single-session interventions can produce rapid early gains (Schleider and Weisz Reference Schleider and Weisz2017; Talmon Reference Talmon2012). Satisfaction remained high and comparable to other services in this national network delivering standard care supporting the acceptability of the SST model and highlighting its suitability for youth settings.
These findings contribute to the growing evidence that structured, clinician-led single-session approaches can improve access and deliver meaningful short-term benefits within primary care youth mental health settings (Hoyt et al. Reference Hoyt, Bobele, Slive, Young and Talmon2018; Schleider et al. Reference Schleider, Zapata, Rapoport, Wescott, Ghosh, Kaveladze, Szkody and Ahuvia2025). Although this study did not evaluate effectiveness, the findings suggest that SST can support early, proportionate intervention consistent with current youth mental health policy priorities (McGorry et al. Reference McGorry, Alvarez-Jimenez and Hickie2024). Future controlled research should examine the durability of change, explore staff and implementation factors, and assess cost-effectiveness to inform scalable and sustainable adoption.
This study has several limitations. It was conducted at a single site and lacked a control group. Although best practice in SST emphasises timely access, service pressures during rollout meant many young people waited several months between referral and their session, reducing immediacy and potentially affecting outcomes. Future research should evaluate SST when delivered at first contact to better assess its early-intervention potential. Missing data among older participants limited analysis to those aged 12–16. Staff acceptability and effectiveness and the therapeutic components underpinning SST should also be examined in future studies to guide broader implementation.
Conclusion
This study suggests that introducing SST as a point of entry into an existing primary care youth mental health network may be a feasible and acceptable approach that shows promise for clinical outcomes and reducing waiting times in high volume settings. Further high-quality controlled research is needed to assess the effectiveness of SST in youth mental health settings alongside investigation of how to successfully implement and sustain SST in mental health practice networks.
Author contributions
JM contributed the conceptual design of the study, statistical analysis, interpretation and write up. JL, AK, SC, JS contributed to the design and implementation of the intervention. All authors contributed to the write up of the manuscript.
Funding statement
The work of Jigsaw’s research department is part funded by the Health Service Executive (Ire).
Competing interests
All authors were employed by Jigsaw at the time of writing.
Ethical standards
This study involved secondary analysis of routinely collected clinical data. All participants provided consent for routine clinical data to be used for research and evaluation purposes as part of their initial service consent. Ethical exemption was granted by the Jigsaw Research Ethics Committee in accordance with institutional policies and procedures.
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