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FRIENDS for Life (health-led)

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Evidence rating: 3+
Cost rating: 1

FRIENDS for Life is part of a suite of FRIENDS programmes (including Fun FRIENDS and FRIENDS for Youth), which aim to improve resilience (or coping) skills in children and reduce anxiety and improve mental health and wellbeing.

The programme is based on cognitive behavioural therapy and positive psychology.

FRIENDS for life is a school-based, universal intervention, which is comprised of 10–12 weekly sessions of one hour each. It is delivered in a group format by teachers to children between the ages of seven and 13. The intervention uses a play-based and experiential learning approach to provide cognitive behavioural skills in a developmentally appropriate manner.

During each session children are taught skills, aimed at helping them to increase their coping skills through stories, games, videos and activities.

EIF Programme Assessment

Evidence rating: 3+
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome. This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
Cost rating: 1
A rating of 1 indicates that a programme has a low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of less than €125. This figure is based on an analysis of UK costs and a conversion rate of 1.19.

What does the plus mean?

The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.

Child outcomes

This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Supporting children's mental health and wellbeing

Reduced social anxiety

based on study 1

  • Statement: 0.41-point improvement on the Revised Child Anxiety and Depression Scale
  • Score: 5
  • Timeframe: A year later
  • Long term: 1

Reduced generalised anxiety

based on study 1

  • Statement: 0.77-point improvement on the Revised Child Anxiety and Depression Scale
  • Score: 8
  • Timeframe: A year later
  • Long term: 1

Reduced child anxiety and depression

based on study 1

  • Statement: 2.66-point improvement on the Revised Child Anxiety and Depression Scale
  • Score: 7
  • Timeframe: A year later
  • Long term: 1

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Who is it for?

The best available evidence for this programme relates to the following age-groups:

Primary school Preadolescents

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Group

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Primary school
  • Secondary school
  • Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Universal

Where has it been implemented?

  • Brazil
  • Canada
  • Finland
  • Hong Kong
  • Japan
  • Mexico
  • Netherlands
  • Portugal
  • Scotland
  • Singapore
  • South Africa
  • Sweden
  • Taiwan
  • United Kingdom
  • Ireland

Ireland provision

This programme has been implemented in Ireland.

Ireland evaluation

This programme’s best evidence does not include evaluation conducted in Ireland.

About the programme

What happens during the delivery?

How is it delivered?

  • FRIENDS for life is delivered in 10 sessions of one hour duration each by one practitioner, to a whole class of children.

What happens during the intervention?

  • During each session children are taught skills, aimed at helping them to increase their coping skills, through stories, games, videos and activities. Skills focus on the following:
    • Learning/behaviour – which involves helping children and adolescents to develop six-step problem-solving plans, using coping step plans, and identify role models and support networks.
    • Psychological – involves teaching children and adolescents to be aware of their body clues, to use relaxation techniques and to self-regulate. It also involves group sessions for parents, which are scheduled at regular intervals throughout the duration of the programme.
    • Cognitive – involves helping children and adolescents to use positive self-talk, challenge negative self-talk, evaluate themselves realistically and reward themselves.

The sessions involve a mixture of group work, role plays, workbook exercises, games, and interactive activities. Some tasks are completed at home with the participant’s family in order to practise new skills learned.

  • The sessions cover the following topics:
    • Session one: Introduction to FRIENDS for life; understanding and accepting difference
    • Session two: Introduction to feelings
    • Session three: Introduction to body clues and relaxation
    • Session four: Self-talk: helpful (green) and unhelpful (red) thoughts
    • Session five: Changing unhelpful (red) into helpful (green) thoughts
    • Session six: Introduction to coping step plans
    • Session seven: Learning for our role models and building support teams
    • Session eight: Using a problem-solving plan
    • Session nine: Using the FRIENDS for Life skills to help ourselves and others
    • Session 10: Review, generalising skills and planning for the future

What are the implementation requirements?

Who can deliver it?

  • The practitioner who delivers health-led friends is a psychologist or other allied health professional with NFQ-7/8/9 level qualifications. 
  • The practitioner who delivers school-led friends is a teacher with NFQ-7/8/9 level qualifications


What are the training requirements?

  • The practitioners have two days of programme training of programme training. Booster training of practitioners is recommended.

How are the practitioners supervised?

  • Regular supervision of practitioners is provided by an accredited FRIENDS trainer. This takes the form of bi-weekly supervision groups to review session aims and content and address any problems with implementation.


What are the systems for maintaining fidelity?

  • Training manual
  • Other printed materials
  • Other online materials
  • Video or DVD training
  • Face-to-face training
  • Fidelity monitoring

Is there a licensing requirement?

There is no licence required to run this programme.


How does it work? (Theory of Change)

How does it work?

  • Coping skills increase a child's resilience and protects children from developing anxiety.
  • The programme aims to teach coping skills such as understanding and managing emotions to assist children in responding to uncomfortable emotions in appropriate and helpful ways.
  •  In short term, children have better awareness of their emotions and helpful emotion management techniques that enable them to better cope with stressful or uncomfortable situations.
  • In the longer term, children will be less likely to develop anxiety disorders.

Intended outcomes

  • Active and healthy, physical and mental wellbeing

Contact details

Casey Dick
Friends Resilience
licensing@friendsresilience.org
https://friendsresilience.org/


About the evidence

The most rigorous evidence for FRIENDS for Life (health-led) comes from a RCT, which was conducted in the UK. This is a rigorously conducted (level 3) study, which has identified a statistically significant positive impact on a number of child outcomes. A programme receives the same rating as its most robust study, and so FRIENDS for Life (health-led) receives a level 3 rating overall. 

Study 1

Citation:Stallard et al (2014)
Design:RCT
Country:United Kingdom
Sample:1,442 children aged 9-10 years
Timing:12 months
Child outcomes:
  • Reduced social anxiety
  • Reduced generalised anxiety
  • Reduced child anxiety and depression
Other outcomes:
    Study rating:3

    Stallard, P., Skryabina, E., Taylor, G., Phillips, R., Daniels, H., Anderson, R., & Simpson, N. (2014). Classroom-based cognitive behaviour therapy (FRIENDS): a cluster randomised controlled trial to Prevent Anxiety in Children through Education in Schools (PACES). The Lancet Psychiatry, 1(3), 185–192.

    Available at
    http://thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70244-5/abstract

    Study design and sample

    This study was carried out in the UK. The sample was comprised of state-funded junior schools in Bath, UK, with all children aged nine to ten in participating schools being eligible unless they were not attending school. The study design was a three-group cluster RCT. Allocation of schools took place once all schools were recruited and balance between trial arms on a range of key characteristics was achieved. 45 schools were enrolled: 14 (n = 497 children) were randomly assigned to school-led FRIENDS, 14 (n = 509) to health-led FRIENDS, and 12 (n = 442) to usual school provision

    Measures

    The primary outcome measure was the Revised Child Anxiety and Depression Scale (RCADS). Children also completed the Rosenberg Self-Esteem Scale, the Penn State Worry Questionnaire for Children, and measures of the degree to which children have bullied others or have been the victim of bullying, satisfaction with six aspects of everyday life and overall life satisfaction (subjective well-being). Parents completed the Revised Child Anxiety and Depression Scale (RCADS-30-P). Class teachers completed the impact rating of the Strengths and Difficulties Questionnaire (SDQ) for all children in their class.

    Findings

    The authors reported a significant difference in adjusted mean RCADS at 12 months for health-led FRIENDS compared with school-led FRIENDS and usual school provision. Analysis of other secondary outcomes and parent and teacher completed measures identified no differences between treatment groups at 12 months.

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