Therapeutic group work - evaluation case study

Emotional well-being and resilience group - Evaluation report – March 2015

Overview

The emotional well-being and resilience group was developed and delivered by Dr Dan Nicholls and Dr Kitty Howarth (Educational Psychologists) following discussions with a primary school regarding emotional support for their pupils. The aim of the group was to support children who may be experiencing low self-esteem, anxiety, low mood and who may be lacking in confidence.

A total of eight of pupils from Year 5 and Year 6 were selected to take part in the intervention group.

The group ran over a total of eight weekly sessions, although children were expected to complete activities between sessions (known as ‘takeaways’) to consolidate their learning. A member of school staff assisted within the sessions to ensure children received any additional support they needed. This member of staff was also available to children between sessions. 

The intervention is based on the principles of Cognitive Behavioural Therapy (CBT). CBT aims to help individuals make links between their thoughts, feelings and behaviour. This can enable people to notice how these factors influence each other and to actively challenge unhelpful ways of thinking or behaving which maintain their difficulties. Physiology or ‘body signals’ are also covered in the sessions so that children develop an awareness of how our bodies respond under stress.

CBT draws on the idea that the ‘same’ event can result in different emotions depending on how the individual interprets the event. Therefore, if we can help people change their interpretations of events then we can reduce distress and build confidence. CBT also draws on the idea that people behave in a way that is consistent with their beliefs and this can become unhelpful e.g. avoidance of situations where we feel anxious or under-confident. Therefore people may miss out on opportunities to gather evidence that might lead to new, more helpful ways of thinking. Once familiar with the CBT model, the group sessions included activities specifically aimed at challenging negative thinking and working towards personal goals in a step-by-step way. The final session aimed to consolidate children’s learning and celebrate their success.

Signed parental consent was obtained for each child before the first group session. A training session was delivered to all staff prior to the first group session, so that they were aware of the group and how they could support the participating children. Pre-intervention questionnaires were administered during the first group session, with follow-up questionnaires administered two days after the final session.

Session outline:

Week 1: Introduction, ground rules and goal setting.
Week 2: Feelings – exploring a range of feelings and how these link to situations. How these differ between people.
Week 3: Physiology (body signals). Fight or flight response. Similarities and differences between feelings.
Week 4: Thoughts – what they are and how to notice them. How they are linked to feelings/physiology.
Week 5: Thoughts – identifying helpful and unhelpful thoughts. Introduce activities to help challenge negative thinking.
Week 6: Doing things differently (behaviour) – creating a plan to test out negative assumptions and work towards goals. Linking thoughts to behaviour.
Week 7: Doing things differently – continue to work on plan. Use CBT model to understand personal challenges.
Week 8: Consolidation and celebration.

Outcomes

• A decrease in anxiety / worry levels for 6/8 children

Six out of the eight children who took part in the 8 week emotional wellbeing and resilience group rated that they felt less anxious and worried after engaging in the group intervention compared to before. This data was collected using pre and post raw and T scores collected through administering the BECKs youth inventory (a standardised self-rated scale, for more details see appendix A). Results also found that these shifts were at a significant level for five out of the eight children. For these five children a ‘category’ shift was seen, for example, results collected pre intervention suggested that individual children may have been categorised as experiencing either ‘moderately elevated’ or ‘extremely elevated’ levels of anxiety and post intervention the same children were recategorised as experiencing ‘mildly elevated’ or ‘average’ levels of anxiety. Anxiety is defined in this assessment as relating to specific worries about school performance, the future, negative reactions of others, fears including loss of control, and physiological symptoms associated with anxiety. 

• An increase in self-concept for 7/8 children

Seven out of the eight children who took part in the group felt their self-concept had increased over the course of the eight weeks. This data was collected using pre and post raw and T scores collected through administering the BECKs youth inventory (a standardised self-rated scale, for more details see appendix A). Results also found that these shifts were at a significant level for four out of the eight children. For these four children a ‘category’ shift was seen, for example, results collected pre intervention suggested that individual children may have been categorised as experiencing either ‘a lower than average’ self-concept’ or ‘a much lower than average’ self-concept and post intervention the same children were re-categorised as experiencing either a ‘lower than average’ or ‘average’ self-concept. Self-concept is defined in this assessment as relating to the child’s perception of self-worth, and self-competence.

• An increase in resilience levels relating to a sense of mastery in 7/8 children

Seven out of the eight children who took part in the group felt they were more resilient after completing the eight week course when compared to before. This scale particularly related to the young person’s feelings of being optimistic, self-efficacious and adaptive to new situations. This data was collected using pre and post raw and T scores collected through administering the Resiliency scales (a standardised self-rated scale, for more details see appendix A). Results also found that these shifts were at a significant level for three out of the eight children. For these three children a ‘category’ shift was seen, for example, results collected pre intervention suggested that individual children may have been categorised as experiencing either ‘below average’ or ‘low’ optimism, self-efficacy and adaptability and post intervention the same children were re-categorised as experiencing either a ‘below average’ or ‘average’ optimism, self-efficacy and adaptability (depending on where they started). 

• Children’s views

Consistent with the standardised data reported above, when asked the question ‘how has the group helped you?’ children reported the following:

• It’s made me more confident…
• I’ve put my hand up more in class…
• They (the group sessions) made me more happy…
• It’s helped me lots to get my confidence…
• Well, I have started to put my hand up in class. Thank you…
• (I’m now) speaking to more people, you are excellent. Thanks
• I’m more confident…
• I’ve been more confident…

The children also provided comments about how the group could be improved next time. These included suggestions around less talking and more fun games. We are really grateful for this feedback and will ensure that we act on these suggestions:

Teacher’s views

Also consistent with the standardised data and children’s comments reported above, the teacher of the five year 6 children who took part in the group reported the following:

• Child A is answering more questions in class and asking for help when she needs it
• Child B is engaging in more class lessons and is answering questions more
• Child C is joining in well in lessons and concentrating in class
• Child D is definitely trying hard to join in class more
• Child E is making an effort to answer questions more in class

This qualitative data was taken from the Strengths and Difficulties Questionnaire (SDQ) used to evaluate impact (see appendix A for further info).
Qualitative data was not gathered from the teacher of the three children in year 5 on this occasion. Quantitative data taken from the SDQ showed that the class teacher of the five year 6 children who took part in the group perceived that these children also presented as being less emotionally distressed, and overall experiencing lower stress levels.

APPENDIX A - Standardised assessments used to evaluate the emotional wellbeing and resilience group.

The following assessments were used to investigate the impact of the emotional wellbeing and resilience group ran in the Spring term of 2015 over 8 weeks at a Devon Primary school:

The Beck Youth Inventories for Children and Adolescents -Second Edition

The Beck Youth Inventories -Second Edition are designed for children and adolescents ages 7 through 18 years. The full scale comprises five self-report inventories that can be used separately or in combination to assess symptoms of low mood (depression), worry (anxiety), anger, disruptive behavior, and self-concept. The five inventories each contain 20 questions about thoughts, feelings, and behaviors associated with emotional and social impairment in youth. Children and adolescents describe how frequently the statement has been true for them during the past two weeks, including today. On this occasion inventories relating to worry (anxiety) and self-concept were used.

Anxiety Inventory: Reflects children's and adolescents’ specific worries about school performance, the future, negative reactions of others, fears including loss of control, and physiological symptoms associated with anxiety.

Self-Concept Inventory: Taps cognitions of competence, potency, and positive self-worth.

Resiliency Scales for Children and Adolescents

The Resiliency Scales are designed for children and adolescents aged 9-18 years old. It comprises three standalone scales that look at the following three areas:

• Sense of Mastery Scale: which assesses the child’s levels of optimism, self-efficacy and adaptivity 
• Sense of Relatedness Scale: which measures the child’s levels of trust, support, comfort, and tolerance 
• Emotional Reactivity Scale: which measures the child’s levels of sensitivity, recovery and impairment

As with the BECKs youth inventories the three scales each contain a number of questions about thoughts, feelings, and behaviors associated with emotional and social impairment in youth. Children and adolescents describe how frequently the statement has been true for them during the past two weeks. On this occasion inventories relating to sense of mastery were used only.

The Strengths and Difficulties Questionnaire (SDQ)

The SDQ is a brief behavioural screening questionnaire for 3-16 year olds. The SDQ asks about 25 attributes, some positive, some negative. These 25 items are divided into 5 areas: emotional, conduct, hyperactivity, peer relationships and prosocial behaviour. On this occasion data was collected from school staff