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Key overview details
- Universal
- Targeted
- Promoting Emotional Wellbeing
- Anxiety / Worry / Stress
- Emotion Regulation / Emotional literacy
- Self Esteem / Resilience
- Primary school: 6 to 12 years
- Show only programmes known to have been implemented in Scotland
FRIENDS for Life
Summary
FRIENDS for Life is a cognitive-behavioural programme designed to build resilience and promote socio-emotional development in children aged 8-11 years. This universally delivered or targeted programme also teaches techniques to reduce anxiety, thereby preventing the development of mental health problems, and socio-emotional impairment. The 12-session manualised programme can be universally delivered in schools and health settings or as a targeted intervention. There is flexibility in mode of delivery, but the structure and sequence of the sessions must be maintained. Activities conducted during the sessions include group discussions, interactive activities, and individual exercises. To bring structure to the sessions and help participants remember the topics, the acronym FRIENDS is used:
- Feelings
- Remember to relax
- I can try my best
- Encourage
- Nurture
- Don’t forget to be brave
- Stay happy
FRIENDS for Life programme has been delivered in Scotland and across the UK.
Website: https://www.friendsresilience.org/
Core Components
FRIENDS for Life is a cognitive-behavioural, early intervention and prevention programme designed to build resilience, and promote socio-emotional development in children aged 8-11 years. This universally delivered programme also teaches techniques to reduce anxiety, thereby preventing the development of mental health problems, and socio-emotional impairment.
To bring structure to the sessions and help participants remember the topics, the acronym FRIENDS is used: Feelings; Remember to relax; I can try my best; Encourage; Nurture; Don’t forget to be brave; Stay happy. Session topics includes talking about feelings, recognising body clues and relaxation, identifying and changing unhelpful (Red) thoughts into helpful (Green) thoughts, identifying role models and a support team, making plans for the future, and giving back to the community. Activities conducted include group discussions, interactive activities, and individual exercises.
The FRIENDS for Life manualised programme can be delivered in individualised and group format; in schools and health settings; by educators and health professionals. Programme delivery method is dependent on the setting in which the programme is delivered, and can be modified to suit the needs of the children in the group. In schools, the programme is integrated in the school curriculum. It is recommended that the programme is delivered daily, in small 15 minutes segments for 6-12 months. Alternative formats include:
- 12 consecutive structured sessions (10 programme sessions and 2 booster sessions), each session delivered weekly over 1-1.5 hours
- 2-2.5-hour sessions over 5 weeks
- 30-60 minutes sessions delivered twice weekly across two school terms.
As part of the programme, parents are highly encouraged to attend two 2 hours psychoeducation and behavioural management evening sessions.
In the health setting, FRIENDS for Life is delivered as a universal or targeted intervention, to small groups of 8-10 children. They receive twelve consecutive structured sessions (10 programme sessions and 2 booster sessions), each session delivered weekly over 1-1.5 hours. Alternatively, it can be delivered over 5 consecutive days in 2.5 hour sessions. Family involvement in each session (10-15 minutes at the end of each group session) is recommended.
Targeted children (identified as having clinical anxiety) can also receive FRIENDS for Life in an individualised format. In this form, the mode of delivery is dependent on the specific needs of the child. A whole family approach to delivering the individual programme is also highly recommended. Families (parents and siblings) are encouraged to be present in the final 30 minutes of each individual session. Whether delivered as a universal or targeted intervention, in group format or to individual participants, programme delivery must follow the structure and sequence specified in the programme manual. In addition, parents are highly encouraged to participate in the FRIENDS adult resilience programme.
Fidelity
Programme fidelity is ensured by implementation of the following measures:
- Practitioner training prior to programme delivery
- Programme delivery using sequence and structure specified in the programme manual
Modifiable Components
FRIENDS for Life can be delivered in schools, health settings, or community centre. The mode of delivery of the FRIENDS programmes may be varied to suit the needs of the participants, as long as the structure and sequence of the sessions are maintained. For every activity, practitioners can add content and examples relevant to the cultural context of participants in the group. Lastly, the facilitator manual allows for replacement of suggested activities with similar activities to suit the needs and strengths of children in the group.
FRIENDS for Life programme has been delivered in several countries including Australia, Brazil, Canada, Denmark, Germany, Ireland, Japan, Mexico, New Zealand, Norway, Pakistan, Portugal, Singapore, Taiwan, Netherlands, UK, USA and UAE. The programme is available in several languages including English, German, Dutch and Spanish.
FRIENDS for Life is one of the suite of FRIENDS programmes (Fun FRIENDS, FRIENDS for Life, My FRIENDS Youth, and Adult Resilience) offered by FRIENDS Resilience. Implementation support in the UK for all FRIENDS programmes is provided as standard by FRIENDS resilience staff in Australia.
Support for Organisation / Practice
Implementation Support
Prior to training in a FRIENDS programme, the implementing organisation must become a licenced partner. Subsequently, FRIENDS resilience staff deliver training (online or face-to-face) to practitioners affiliated with the licensed partners. To support programme delivery, practitioners get access to FRIENDS Resilience Hub website. On the hub, practitioners receive; 1) information, for licence registration; 2) learning, including programme resources and facilitator accreditation; and 3) skills for skills delivery. FRIENDS resilience staff also provide organisations with support for programme data collection, storage, analysis and evaluation. FRIENDS resilience staff continue to provide weekly support to all practitioners (via GoToMeeting, Skype or phone) to promote staff development and long term programme sustainability.
Licence Requirements
A licence is required to deliver this programme. Licence agreements can be with individual schools, school clusters, health boards, local authorities or countries. Organisations can purchase small local licences, medium sized licences, or universal licences depending on the size of the organisation. Licences cover delivery of all four FRIENDS programmes, are valid for three years, and can be renewed.
Start-up Costs
Start-up costs include a licencing fee. This fee varies depending on the implementation plan chosen, the organisation’s size, and organisation’s overall reach. Licences cover practitioner training (online or face-to-face), accreditation, access to online resources (including electronic copies of practitioner manuals and children activity books), and community package (including resilience booklets for all ages and informational videos). Additional costs are incurred for printed participant workbooks, and practitioner manuals (costs vary with quantities purchased). Electronic copies of manuals and activity books are received as complementary when hard copies of these resources are purchased. Train-the-trainer training is available, and is included in the licence fee.
Building Staff Competency
Qualifications Required
Two facilitators (i.e. primary facilitator and co-therapist) deliver the FRIENDS for Life programme to groups of participants. Both practitioners are required to have received the FRIENDS training before delivering the FRIENDS programmes. In health settings, FRIENDS for Life is delivered by registered allied health professionals including occupational therapists, speech therapists, psychologists, social workers, and counsellors. In schools, the programme is delivered by educational professionals including teachers, teaching assistants, principals, school psychologists, and guidance counsellors.
Training Requirements
Practitioner participation in the Adult Resilience programme is mandatory and should be received as a prerequisite to receiving the FRIENDS for Life training. Practitioner training prior to programme facilitation is required and is delivered in two stages; 1) Content training, a 4-6 hour online training that is compulsory for all practitioners. This training covers the sequence and structure of the programme, and foundation training (which includes programme theoretical and research background); 2) Process training, a 2-hour interactive web training that is complimentary to content training, and is a necessary component of the overall training. The training covers modes of delivery; use the electronic resources in an experiential manner; involving the community in meaningful ways; and measures to ensure long term programme sustainability. Content and process trainings can also be delivered face-to-face, with length of trainings dependent on arrangements made with implementing organisation.
Practitioners can only deliver the FRIENDS programme on which they have been trained. Completed training gives practitioners the certification to deliver FRIENDS in education or health service organisations. Practitioner certification is valid for three years and can be renewed after a 2-hour refresher unit.
A train-the-trainer training is available. This 10- 12 hour online training covers FRIENDS content training, process training, all four FRIENDS programme training, psychoeducation and behavioural management. Trainers provide training and support to organisation(s) covered under the organisation’s licence agreement.
Supervision Requirements
There are no supervision requirements. Trainers provide continued implementation support.
Theory of Change
FRIENDS for Life programme addresses the attachment, physiological, cognitive, and learning processes that interact in the development, experience and sustenance of anxiety. Therefore the programme teaches skills and techniques that are associated with the above processes, and have been applied in the prevention and treatment of anxiety disorders.
Primary school: 6 to 12 years - Rating: 5
Research Design & Number of Studies
The best evidence for FRIENDS for Life in children aged 6-12 years comes from three externally conducted cluster randomized controlled studies (RCTs). The first study included 709 children aged 9-13 years recruited from 27 primary schools in Ireland (Ruttledge et al, 2016). The schools were located in rural and urban areas, and included both single and mixed sex schools. Schools assigned socioeconomic disadvantaged (DEIS) status, as well as special schools for children with significant emotional and behavioural difficulties were also included. The second study included 1,362 children aged 9-10 years recruited from 45 state funded junior schools in Southwest England (Stallard et al, 2014). The third study included 638 children recruited from 14 schools in Germany (Essau et al, 2010). The students in this third study were aged 9-12 years and were mostly of German origin.
Outcomes Achieved
Compared to the control group who did not receive the intervention, the following outcomes were observed:
Child Outcomes
- Significantly increased self-concept, coping efficacy and school connectedness at post-intervention (Ruttledge et al, 2016)
- Significantly reduced generalised anxiety at 12 months (Stallard et al, 2014)
- Significantly reduced total anxiety and depression scores at 6 months (Essau et al, 2012), and at 12 months (Stallard et al, 2014; Essau et al, 2012)
- Significantly improved school performance at 6 and 12 months, and significantly reduced total perfectionism score at 12 months (Essau et al, 2012)
- Significantly reduced cognitive avoidance at 6 and 12 months (Essau et al, 2012)
Parent Outcomes
None
Key References
Ruttledge, R., Devitt, E., Greene, G., Mullany, M., Charles, E., Frehill, J., & Moriarty, M. (2016). A randomised controlled trial of the FRIENDS for Life emotional resilience programme delivered by teachers in Irish primary schools. Educational & Child Psychology, 33(2), 69–89
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
Essau, C.A., Conradt, J., Sasagawa, S. & ollendick, T.H. (2012). Prevention of anxiety symptoms in children: Results from a universal school-based trial. Behavior Therapy, 43(2), 450–464
Values
FRIENDS for Life is early intervention and prevention programme, designed to build resilience, promote socio-emotional skills, and reduce anxiety in children aged 8-11 years. This cognitive behavioural intervention is for both universal and targeted delivery and can be delivered in schools and health settings. All FRIENDS programmes take an approach that aims to promote mutual respect, self-care and interconnectedness
- Does this approach align with the key values of your organisation?
Priorities
FRIENDS for Life is an emotional resilience programme that teaches techniques to manage anxiety, and skills for socio-emotional and personal development. The 12-sessions manualised programme can be delivered in schools and health settings. It is recommended that the programme is delivered daily, in small 15 minutes segments for 6-12 months. Parents are highly encouraged to attend two 2 hours psychoeducation and behavioural management evening sessions. In health settings, the 12 sessions can be delivered weekly over 1-1.5 hours, or over 5 consecutive days in 2-2.5 hour sessions. Family involvement at the health setting sessions is encouraged.
- Is building resilience, promoting socio-emotional skills, and reducing anxiety in children aged 8-11 years a priority for your organisation?
- In what setting is your organisation looking to deliver this programme? Would a home visiting programme, or telehealth programme suit better?
- Is your organisation looking to deliver an intervention that consists of a parent component?
- What mode of programme delivery would be adopted?
Existing Initiatives
- Does your organisation have existing emotional resilience programmes that teach children techniques to manage anxiety?
- Are there components addressed by FRIENDS for Life programme that are not met by existing programmes?
- Are the existing initiatives effective? Do they fit your current and anticipated future requirements?
- Can existing initiatives be delivered to children aged 8-11 years?
- Do existing initiatives have the delivery flexibility to suit participants’ needs?
Workforce
Two trained facilitators are required to deliver the programme. Facilitator training prior to programme delivery is required and can be completed online in 6-8 hours. In health settings, FRIENDS for Life is delivered by registered allied health professionals including occupational therapists, speech therapists, psychologists, social workers, and counsellors. In schools, FRIENDS for Life is delivered by educational professionals including teachers, teaching assistants, principals, school psychologists, and guidance counsellors. Train the trainer training is available, and can be completed online in about 10-12 hours.
- Do you have practitioners with required qualifications and skills, who are able to deliver this programme within the chosen setting?
- Can your organisation support the time commitment required for practitioner /trainer training and delivery?
Technology Support
Practitioner training can be received online on the FRIENDS hub website under a License. This website also provides access to programme resources and digital materials to support programme delivery.
- Does your organisation have the technology to allow access to the hub website (e.g. computer/ tablet, internet access)?
Administrative Support
FRIENDS for Life programme is delivered in schools and health settings. Parents are highly encouraged to participate in the FRIENDS adult resilience programme. Parents are also encouraged to attend the evening sessions when the programme is delivered in schools; and attend the end of the sessions when the programme is delivered in health settings.
- Does your organisation have administrative capacity and systems for programme delivery in the setting of choice?
- If delivered in schools, is there capacity to integrate this programme in the school curriculum?
- Can your organisation support parent evening sessions?
- If delivered in the health settings, is there a venue where programme sessions can be held?
- Can family involvement in these sessions be supported?
- Does your organisation have the capacity to support the delivery of the adult resilience programme to parents?
Financial Support
Start-up costs include licence fee. This fee varies depending on the implementation plan chosen, the organisation’s size, and organisation’s overall reach. Other costs include hard copies of programme materials, which vary depending on quantities purchased.
Comparable Population
FRIENDS for Life is an early intervention and prevention programme for children aged 8-11 years. Evidence of effectiveness comes from studies conducted in students aged 9-13 years. The students were recruited from mixed and single sex schools in Ireland, Germany and England.
- Is this comparable to the population your organisation would like to serve?
Desired Outcome
FRIENDS for Life is designed to build resilience, promote socio-emotional skills, and reduce anxiety in children aged 8-11 years. Programme delivery is associated with significant improvements across several outcomes including anxiety, depression, cognitive avoidance, self-concept, coping efficacy, and academic performance.
- Is building resilience in young children a priority outcome for your organisation?
- Is providing children with the skills to recognise and manage their emotions, reducing anxiety a current priority for your organisation?
- Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes?