An Evaluation of the FRIENDS for
Life Programme Delivered by
Teachers in Irish Primary Schools
NCSE Research Conference
Wednesday 19th November 2014
Dr. Richard Ruttledge
Educational & Child Psychologist
National Educational Psychological Service
An tSeirbhís Náisiúnta Síceolaíochta Oideachais
Members of Research Team
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Dr. Richard Ruttledge (Psychologist, Monaghan)
Eileen Devitt (Psychologist, Kerry)
Gabrielle Greene (Regional Director, Limerick)
Mary Mullany (Senior Psychologist, Navan)
Elizabeth Charles (Senior Psychologist, Kilkenny)
Joanne Frehill (Psychologist, Dublin)
Maura Moriarty (Research Assistant, Ennis)
Afric McArdle (Research Assistant, Ennis)
Anxiety in Children & Young People
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Anxiety disorders are one of the most common
forms of psychological distress in childhood and
youth (Cartwright-Hatton et al., 2004)
Prevalence of anxiety disorders in children and
adolescents has been reported to be as high as
21% (Kashani & Orvaschel, 1990) with most
studies estimating around 10% (Carr, 2006)
Can have negative consequences on educational
attainment and social functioning (Pine, 1997)
Childhood anxiety problems significantly increase
the risk of developing mental health difficulties in
adulthood (Mattison, 1992)
Resilience in Children & Young People
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Capacity of a person to prevent, minimise or overcome the
damaging effects of adversity (Grotberg, 1997)
Characteristics associated with being a resilient person:
- Using effective coping strategies
(Werner & Smith, 1992)
- Effectively controlling negative feelings
(Eisenberg et al. 2004)
- Nurturing a sense of self-efficacy or mastery
(Cowen et al., 1997)
- Using available social supports
(Jonzon & Lindblad, 2005)
Belonging in School
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The need to belong is central to the acquisition of
knowledge (Maslow, 1962)
Having a sense of belonging to a school community is
likely to have a positive effect on learning, mental health
and happiness
Not belonging may lead to disaffection disengagement
from learning, anxiety and depression (Frederickson &
Baxter, 2009)
Schools where pupils report more feelings of
connectedness to adults in peers were strongly associated
with higher-pupil ratings of resilience (Stewart et al, 2004)
Access to Early Intervention
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Interventions using cognitive-behavioural approaches are
recommended for anxiety (NICE, 2008)
Frequently, childhood anxiety is overlooked as these
children are likely to be shy, cooperative and compliant
(Essau et al., 2012)
Children from disadvantaged communities are less likely
to receive intervention and more likely to discontinue
attendance prematurely (Misfud & Rapee, 2005)
Need to consider how evidence-based interventions can
be made accessible to children and adolescents
presenting with anxiety symptoms
Nobel Laureate Economist Dr. James Heckman (2000)
has posited that early intervention for children and young
people is optimum as later intervention in adulthood is
economically inefficient
Role of Schools
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Growing recognition of the important contribution schools can make to
the psychological and emotional health of children (Stallard, 2010)
Meta-analysis by Durlak et al. (2011) found that school-based,
universal social and emotional learning programmes significantly
improved social functioning, behaviour and academic performance
Vision for Change (DoH&C, 2006) recommends that positive mental
health is promoted across the community
Social, Personal & Health Education (SPHE) curriculum provides
opportunities for children to improve their ability to cope with problems
and emotions, and to develop their interpersonal skills (Buckley, Gavin
& McNicholas, 2009)
Reach Out National Suicide Prevention Strategy (2005-2014)
recommends that promotion of positive mental health should form an
important part of the school curriculum
Better Outcomes, Brighter Futures – National Policy Framework for
Children and Young People (DCYA, 2014) highlights the importance of
prevention and early intervention to develop emotional resiliency, selfregulation, empathy and self-esteem
The FRIENDS Programmes
Developed for children aged 4 years right through to adults. Each
programme is similar in theoretical principles. However, each
programme is age appropriate and has additional techniques for
each stage of development
Fun Friends (4 to 7 years)
Friends for Life (8 to 11 years)
My Friends Youth (12 to 16 years)
Resilience for Life (16+)
FRIENDS for Life
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The programme, developed and licenced by Pathways
Australia, is a cognitive-behavioural early intervention and
prevention programme for childhood anxiety, which can be
delivered universally to children and adolescents (Barrett,
2004)
Very positive evaluations internationally
Endorsed by the World Health Organisation & listed on US
National Registry of Evidence-Based Programs and
Practices (2013)
NCSE report by Cooper & Jacobs (2011) stated that the
“programme has been shown to be effective in improving the
emotional coping skills of children and young
people…combines the best qualities of a therapeutic
programme with a general life skills intervention that
can be incorporated into the regular curriculum for all
students” (p.106)
FRIENDS for Life
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Helps children to cope with feelings of fear, worry and
sadness by building emotional resilience and self-esteem
Teaches children cognitive, behavioural and emotional
skills in a simple, well structured format
Promotes self-expression, problem solving and the
building of positive relationships with peers and adults fits well with normal SPHE curriculum
Aims to reduce the incidence of psychological disorders,
emotional distress and impairment in social functioning
Founded on two teaching philosophies: the Peer Learning
Model and Experiential Learning
Involves 10 sessions with children and 2 psychoeducational sessions for parents
Uses a variety of approaches: group work, role plays,
written exercises, games, and interactive activities
FRIENDS for Life
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The word ‘FRIENDS’ is an acronym that helps children
remember coping steps, as follows:
F - Feelings
R - Remember to Relax. Have quiet time
I - I can do it! I can try my best!
E - Explore Solutions and Coping Step Plans
N - Now reward yourself! You’ve done your best!
D - Don’t forget to practice
S - Smile! Stay calm and talk to your support networks!
Why should NEPS Psychologists train teachers to
deliver FRIENDS for Life?
 Teachers have a unique perspective on understanding the
particular school context (Shute, 2012)
 Teachers are more effective than outsiders at providing
social-emotional education in schools (Durlak et al., 2011)
 “Educational Psychologists are the (mental health)
professionals most thoroughly embedded in the educational
system” (MacKay, 2006, p.16)
 NEPS consultative model of service provides an appropriate
framework to support teachers in implementing the FRIENDS
for Life programme
 Neil & Christenson (2009) suggested that further research is
needed to establish what levels of training, support and
supervision are needed to increase teacher confidence in
delivering of social and emotional learning programmes
Objective of the Study
Further develop the evidence base for teacher
delivery of the FRIENDS for Life programme as
part of the SPHE curriculum, after receiving
training from Pathways accredited Psychologists
from NEPS
Study Design & Methodology
27 Primary Schools
(709 Pupils)
13 Schools in
Intervention Group
(333 Pupils)
January – April
2013
Receive
FRIENDS for
Life
Programme
 Mean age: 10.83 years
 Mostly 5th Class
 Some 4th & 6th Class
where Multi-Grade
Setting
14 Schools in
Control Group
(376 Pupils)
January – April
2013
SPHE
Curriculum as
Normal
April - June
2013
Receive
FRIENDS for
Life
Programme
Data
Collection
Time 1
January 2013
Time 2
April 2013
Time 3
June 2013
Study Design & Methodology
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Parents/Guardians, teachers and children completed
questionnaires a number of times in order to evaluate
the effectiveness of the programme
Teachers attended two days training delivered by
NEPS psychologists leading to certification as
FRIENDS for Life Group Facilitators (November 2012
or March 2013)
NEPS psychologists co-facilitated two parent
workshops with school staff. (One at the beginning and
one in the middle of the programme)
NEPS psychologists were available to teachers
throughout the study when needed
Results
Anxiety
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Measure: Spence Children’s Anxiety Scales (Child & Parent Version)
Females reported significantly higher levels of Total Anxiety than males
At Time 1 17% (n = 106) rated themselves in the elevated range on the
Total Anxiety Scale; At Time 3 6% (n = 39) rated themselves in the
elevated range
Hypothesis that the intervention group would have lower levels of Total
Anxiety at Time 2 than the control group was supported by ratings on
SCAS-Parent (p = .04); however, despite reductions, scores on the
SCAS-Child did not reach statistical significance (p = .06)
Reductions in Total Anxiety were maintained and continued to drop at 3
month follow-up for intervention group
Significant effect found on Total Anxiety for children attending designated
disadvantaged schools (DEIS) (p = .02) and EBD Special Schools (p =
.04)
Significant reductions in child ratings of social phobia (p = .01) and
physical injury fears (p = .00)
Significant reductions in parent ratings for separation anxiety (p = .00)
and social phobia (p = .00)
Analysis of Written Concerns from the
Spence Childhood Anxiety Scale
Common concerns:
SCAS-C
Self
Animals &
Physical
injury
Social
Societal
Family
Friendships/
Social
Inadequacy
Criminal
activity
Familial Loss
Results
Anxiety
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Decrease in anxiety symptoms was supported by the reduction
over time in the number of children answering the open-ended
question on the SCAS-Child “Is there anything else you are afraid
of?”
In contrast to international research, where fears of physical
danger is thought to decrease with age (Westenberg et al., 2004)
it was found that “fear of physical injury” was a highly rated
concern for participants
Stallard (2002) posits that given the skills based nature of
cognitive behavioural based interventions, substantial practice
and reinforcement is required to ensure maximum effectiveness
Children need time to practice the skills learned, therefore the
current study may not have captured the true impact of the
programme (e.g. with long-term follow-up at 12-24 months)
In Summary: Evidence to accept Hypothesis
Results
Self-Concept
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Measure: Beck Self-Concept Inventory for Youth & Social Validity
Measure
Self-Concept is an important resilience factor influencing children’s
ability to cope with life challenges (Liddle & Macmillan, 2010)
The intervention group reported significantly greater improvements
in self-concept than the control group (p = .00)
Gains were maintained, and continued to improve, at three month
follow-up
Previous research has also reported improvements and
maintenance, at long-term follow-up, of self-concept gains following
participation in the FRIENDS for Life programme (Stallard et al.,
2008; Liddle & Macmillan, 2010; Crosbie et al., 2011)
Data from the SVM indicated that children reported they “feel good”,
parents reported that their children appeared “more confident”, and
teachers noted that the programme “opened up self-esteem
within the children”
Results
Self-Concept
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Measure: Beck Self-Concept Inventory for Youth
Results
Coping
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Measure: Coping Efficacy Scale & Social Validity Measure
People with higher levels of coping self-efficacy beliefs tend to
approach challenging situations in an active and persistent way,
whereas those with lower levels tend to direct greater energy to
managing increasing emotional distress (Bandura, 1997)
Significant reductions on the Coping Efficacy Scale (p = .00)
indicating that the intervention group had improved capacity to cope
with stress and challenging situations
Gains were maintained at three month follow-up
Participants reported that they learned skills about coping when
feeling worried e.g. Coping Step Plans
Participants reported on current situations where they were using
the skills learned in the programme to cope better with anger
management, friendships and sports
Results
School Connectedness
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Measure: School Connectedness Scale & Social Validity Measure
The intervention group’s sense of happiness, belonging, safety and
closeness to others in school was significantly higher than the
control group at Time 2 (p = .00)
Gains were maintained at three month follow-up
Children reported “liking school better” and their teachers noted a
more “positive outlook” in school and that the “FRIENDS for Life
language is used naturally throughout the day”
Parents described how the skills learned during the programme led
to an improved sense of family connectedness
Home activities are a core part of the programme to help
consolidate new skills and to share experiences. In addition,
psycho-educational sessions for parents serve to reinforce the
importance of family connectedness and secure attachments
Results
Teacher Implementation of the FRIENDS for Life
programme
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Measure: Social Validity Measure
Hypothesis that teachers are effective programme leaders was
supported by quantitative data showing positive outcomes for children
Qualitative data from children and parents was overwhelmingly positive
in attesting to teacher’s capacity to deliver the programme
Value of having teacher-led social and emotional interventions has
been advocated in the literature as being equally (Barrett & Turner,
2001) or indeed more effective than outside professionals (Durlak et
al., 2011)
In the current study the teachers were delivering the FRIENDS for Life
programme for the first time. Therefore, it could be hypothesised that
the impact of the programme on participants would be greater as
teachers become more practiced at delivering it
Through universal delivery by teachers the programme is nonstigmatising and therefore more acceptable to parents as opposed to
being targeted at specific groups of children (Rait et al., 2010)
Pupil voice…
“Before the FRIENDS programme I felt sad, dull, guilty and I was really
worried. I liked all of the activities and I had fun with my friends. Now I
feel good about myself”
“It’s helpful and
helps you cope
with stress”
“I thought it was great,
fun and a great way to
conquer your fears.”
“I would like to do this FFL programme again because the
things I learnt were terrific. I loved FFL it made me feel really
happy. I always had a lovely comment going home about FFL. I
loved doing the family activities and games”.
Teacher voice…
“It provides excellent coping strategies
for dealing with difficult situations”
“I think those in my class who are ‘worriers’
benefitted a lot from the course. All children
enjoyed it and learnt something useful from it”
“I found the FRIENDS programme very useful and worthwhile. The pupils in
my class benefitted greatly and were very open to giving their opinions
and feelings when they were finished. I believe it was particularly helped
the girls that were timid, reserved and shy before the beginning of the
programme. I feel they interact more with the class now and in class
discussions” .
Parent voice…
“He is no longer scared of being alone in the
house and can sleep in his room by himself”
“A brilliant programme and needs to be brought into
schools for all classes, I feel that this programme is as
important, if not more important than any other
subjects taught”
“Each day we discuss the day at mealtime as
a family unit. Myself as a parent I also
benefit from changing negative to positive
thoughts”
Study Limitations
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Skills based and cognitive-behavioural nature of the FRIENDS for Life
programme indicates that longer-term outcomes are particularly
important for assessing the true effect of the intervention
In the present study there was less time for changes to take effect and
impact on daily life; the reported results may therefore underestimate
the true impact of the programme (In-Albon & Schneider, 2007)
International research has found larger effects for the programme
when children are followed up at 6 and 12 months (Essau et al., 2012)
Anecdotal evidence suggests that teachers stuck rigidly to the
children’s workbook, which was not always culturally or age
appropriate
In addition, teachers were confined to a very tight timeline within which
to deliver the programme
It is likely that teachers would be more effective at delivering the
programme after repeated delivery, as they would become more
familiar with programme content and structure
Future Directions
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Durlak et al. (2011) found that that social and emotional
learning programmes yielded an average gain on
achievement test scores of 11 percentile points
An area of future investigation would be to ascertain if
children’s attainment scores rose after completing the
FRIENDS for Life programme
Further longitudinal research could assess programme
impact over a longer period of time and allow
examination of associated helpful effects in relation to
the issue of transition from primary to post-primary
school
Future Directions
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Jennings and Greenberg (2009) highlight the
importance of teachers’ social and emotional
competence and well-being in the development of
supportive teacher-pupil relationships, effective
classroom management, and successful social and
emotional learning programme implementation
Future research could consider the effect of completing
the Adult Resilience programme on teacher delivery of
the FRIENDS for Life programme with children
Given that the programme was developed in Australia,
some of the activities were culturally unsuitable and
need to be modified to suit an Irish context
Study Implications
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Teachers are in a unique position to intervene early with
preventive social and emotional learning programmes
Through providing such resilience building programmes
universally and using real life examples where anxieties
can be acknowledged and explored, these interventions
can help to normalise feelings of worry and can reduce
the stigma that is related with such difficulties
Current study complements previous research which
has shown that the FRIENDS for Life programme can
be successfully delivered by staff who are not mental
health professionals such as teachers and school
nurses (Barret & Turner, 2001; Stallard et al., 2007)
Study Implications
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Effective delivery is predicated by a number of factors
including leader commitment and confidence in talking
about issues relating to mental health (Stallard, 2010)
Ongoing support and consultation to support the
implementation of the programme in schools is an
important aspect of the intervention protocol, to ensure
the syllabus is delivered with fidelity
Psychologists from the National Educational
Psychological Service (NEPS) are in a unique position
to offer such support and they have the requisite skills to
support the implementation of programmes like
FRIENDS for Life in schools (Fagan & Wise, 2007)
Finally, a word of
thanks to all of the
children, parents,
teachers and schools
who participated in the
study