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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
Fun FRIENDS is a cognitive-behavioural, early intervention and prevention programme designed to build resilience, and promote socio-emotional development in children aged 4-7 years old. 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: F eelings; R emember to relax; I can try my best; E ncourage; N urture; D on’t forget to be brave; S tay happy. Session content include topics such as recognising, talking coping with your own emotions, understanding link between feelings and behaviour, noticing how your body feels and relaxation strategies, noticing and changing Unhelpful (Red) thoughts into Helpful (Green) thoughts, using these strategies to help trying new things, identifying role models and a ‘support team’ and planning for future success.
The Fun FRIENDS 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 to support whole school approach. 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, Fun FRIENDS 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 Fun FRIENDS 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
Fun FRIENDS can be delivered in schools, health settings, or community centres. 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. The facilitator manual allows for replacement of suggested activities with similar activities to suit the needs and strengths of children in the group.
Fun FRIENDS programme has been delivered in several countries including Australia, Brazil, Canada, Denmark, Germany, Ireland, Japan, New Zealand, Norway, Pakistan, Portugal, Singapore, Taiwan, Netherlands, UK, USA, Mexico and UAE. The programme is available in several languages including English, German, Spanish and Dutch.
Fun FRIENDS is one of the suite of four 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, analyse 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) and accreditation, access to online resources, 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 practitioners (i.e. primary facilitator and co-therapist) deliver the Fun FRIENDS programme to groups of participants. Both practitioners are required to have received the FRIENDS training before delivering the FRIENDS programmes. In health settings, Fun FRIENDS 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 Fun FRIENDS 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
Fun FRIENDS 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 extensively in the prevention and treatment of anxiety disorders.
Preschool: 3 to 5 years - Rating: 4
Research Design & Number of Studies
The best evidence for Fun FRIENDS, for families with children aged 3-5 years old, comes from two randomised controlled trials (RCT) and one with pre-test - post-test design study. All were conducted by the programme developers. The RCTs delivered Fun FRIENDS as a universally intervention in schools and included children aged between 4 and 6 years old (Pahl & Barrett, 2010) and 4 and 7 years old (Anticich et al., 2013). The third study provided Fun FRIENDS as a targeted intervention to children aged 5-7-year olds who had to met criteria for at least one anxiety disorder (Barrett et al., 2015). All 3 studies were conducted in an Australian city.
Outcomes Achieved
Child Outcomes
After controlling for baseline scores, the Fun FRIENDS group improved significantly more on measures of behavioural and emotional strength and behavioural inhibition than control group and an alternative treatment group at post-test and at 12 month follow up and improved significantly more on measures of behavioural difficulties, than control group at post-test and significantly more than alternative treatment group at 12 month follow up (Anticich et al., 2013).
Significant decreases in parent reported anxiety and shyness/inhibition were found from pre intervention to post intervention, these outcomes were maintained at 12-month follow up (Barrett, et al., 2015).
Significant positive improvement in parent-reported anxiety, behavioural inhibition and social-emotional competence at 12 months follow- up compared to pre-intervention scores (Pahl & Barrett, 2010).
Significant improvements on a measure of resiliency from pre intervention to post intervention (Barrett, et al., 2015).
Significant positive intervention effects for teacher-reported behavioural inhibition and social-emotional strength post intervention compared to waiting-list control group (Pahl & Barrett, 2010).
After controlling for baseline scores, the Fun FRIENDS group improved significantly more on teacher-reported social and emotional competence, from pre intervention to post intervention, this improvement was maintained at 12-month follow-up (Anticich et al., 2013).
Parent Outcomes
Parenting distress improved significantly from pre intervention to post intervention, this improvement was maintained at 12-month follow-up (Anticich et al., 2013).
Key References
Anticich, S., Barrett, P., Silverman, W., Lacherez, P., & Gillies R. (2013). The prevention of childhood anxiety and promotion of resilience among preschool-aged children: a universal school based trial. Advances in School Mental Health Promotion, 6(2), 93-121.
Pahl, K. & Barrett, P. (2010). Preventing anxiety and promoting social and emotional strength in preschool children: a universal evaluation of the Fun FRIENDS program. Advances in School Mental Health Promotion, 3(3), 14-25.
Barrett, P., Fisak, B. & Cooper, M. (2015). The treatment of anxiety in young children: Results of an open trial of the Fun FRIENDS program. Behaviour Change, 32 (4), 231-242.
Primary school: 6 to 12 years - Rating: 4
Research Design & Number of Studies
The best evidence for Fun FRIENDS, for families with children aged 6-12 years old, comes from two randomised controlled trials (RCT) and one with pre-test - post-test design study. All studies were conducted by the programme developers. The RCTs delivered Fun FRIENDS as a universally intervention in schools and included children aged between 4 and 6 years old (Pahl & Barrett, 2010) and 4 and 7 years old (Anticich et al., 2013). The third study provided Fun FRIENDS as a targeted intervention to children aged 5-7-year olds who had to met criteria for at least one anxiety disorder (Barrett et al., 2015). All 3 studies were conducted in an Australian city. Outcomes for 6- and 7-year olds were the same as for 3-5-year olds reported above. Separate outcomes for 6- and 7-year olds was not available.
Key References
Anticich, S., Barrett, P., Silverman, W., Lacherez, P., & Gillies R. (2013). The prevention of childhood anxiety and promotion of resilience among preschool-aged children: a universal school based trial. Advances in School Mental Health Promotion, 6(2), 93-121.
Pahl, K. & Barrett, P. (2010). Preventing anxiety and promoting social and emotional strength in preschool children: a universal evaluation of the Fun FRIENDS program. Advances in School Mental Health Promotion, 3(3), 14-25.
Barrett, P., Fisak, B. & Cooper, M. (2015). The treatment of anxiety in young children: Results of an open trial of the Fun FRIENDS program. Behaviour Change, 32 (4), 231-242.
Need
Comparable Population
Fun FRIENDS is an early intervention and prevention programme for children aged 4 and 7 years old. Evidence of its effectiveness comes from families whose children (aged between 4-7 year old) attended schools in an urban area.
Is this comparable to the population your organisation would like to serve?
Desired Outcome
Fun FRIENDS is designed to build resilience, promote socio-emotional skills, and reduce anxiety in children aged 4-7 years old. Programme delivery is associated with significant improvements in anxiety and behavioural inhibition (characterised as extreme reticence, fearfulness or avoidance in novel situations or with unfamiliar people).
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?
Need Score
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Fit
Values
Fun FRIENDS is early intervention and prevention programme, designed to build resilience, promote socio-emotional skills, and reduce anxiety in children aged 4-7 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
Fun FRIENDS 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 are encouraged.
Is building resilience, promoting socio-emotional skills, and reducing anxiety in children aged 4-7 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 Fun FRIENDS 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 4-7 years? Do existing initiatives have the delivery flexibility to suit participants’ needs?
Fit Score
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Capacity
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, Fun FRIENDS is delivered by allied health professionals including occupational therapists, speech therapists, psychologists, social workers and counsellors. In schools, Fun FRIENDS is delivered by e 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 the 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
Fun FRIENDS 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.
Capacity Score
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