The National i-THRIVE Programme met with Laverne Antrobus, Rachael Humphries, Natalie Kseib, Nicola Moses, Jessica Powell and Frederick Peel, from within the Tavistock and Portman NHS Foundation Trust, to hear more about the ‘Level Up’ Programme.
The Level Up: Safe Steps to Secondary School programme is funded by the Youth Endowment Fund (YEF) and supports Year 6 children who may be affected by youth crime, as they transition from primary to secondary school. The programme aims to equip these children with the social and emotional skills required to navigate, and feel connected to the safe, supportive and engaging aspects of their communities.
This project was borne from the thinking that transitions from Year 6 to Year 7 can generally be difficult to manage, however those from vulnerable backgrounds may be particularly affected, due to the increased level of instability and uncertainty that the transition may bring. Therefore, this project aimed to work with children who display some of the following typical characteristics: struggle with peer relationships, make risky and/or poor decisions, be driven by seeking peer approval and struggle to manage their emotional state. They might also have parents or carers that are worried about their move to secondary school and could benefit from some support to help with this transition.
The aim of the project is to enable these children to better understand and manage their behaviours, and to provide their families with strategies to support and sustain meaningful change. This is to be achieved via a 5-session group programme which runs from the last term of primary school, through the summer holidays and into the first term of secondary school.
The Level Up team have created a video introducing the programme which you can watch here.
Meet the Team
Laverne Antrobus Consultant Child and Educational Psychologist, and Team Manager
Rachael Humphries Specialist Community Nurse & CYP IAPT Systemic Family Practitioner
Dr Jessica Powell Child, Community and Educational Psychologist
Dr Natalie Kseib Clinical Psychologist
Jamie Williams Art Therapist
Nicola Moses Team Administrator
Andreea Constantin Team Administrator
The Level Up team work a variety of different hours on the project. Rachael works 4 ½ days a week for the team, Natalie and Jessica both 3 days a week and Laverne 2 days a week. Our administrative team both work one day a week for the team and Jamie will be joining us during the summer holidays to run the art groups. We aim to have at least one working day where we are all in the office together (or over Zoom during periods of lockdown), as we have found that this improves continuity and the quality of our work.
Pre-transition: Introduction to the team and familiarisation with the programme (Year 6)
- Introduction to parents (phone call and invitation to a coffee morning/drop in session)
- Sharing of flyers/leaflets/videos introducing them to the programme
- Introduction session with children (school based if possible)
Mid-transition: Developing strategies and exploring their thoughts about the move (summer holidays)
- 4 x online activities
- 4 x parent Sound Cloud podcasts
- 4 x 50 minute child groups via Zoom
- 4 x 50 minute parent/carer groups via Zoom
- Art tutorial videos and online art group (art materials provided)
Post-transition: Reflecting on the transition to secondary school and managing any concerns (Year 7)
- Contact with secondary school to explain pupils involvement in the programme
- 1 x 50 minute child group via Zoom
- 1 x 50 minute parent group via Zoom
- 1 x parent Sound Cloud podcast
- Sharing of useful resources/local organisations
Child sessions aim to:
- explore their worries and build on their strengths;
- prepare them for the different encounters they might have as their independence grows;
- encourage them to make safe and considered decisions;
- help to build their coping skills, and;
- explore the positive connections within their community.
Parent sessions aim to:
- provide support and information about building their child’s resilience, managing their growing independence and addressing some of the difficulties that they might encounter as a parent;
- provide a space to for parents to explore questions they might have about their child’s move to secondary school;
- connect parents to community organisations that may be of help for their child, and;
- reduce parental stress.
Timeline of programme development
Transition to remote working
The Level Up Programme was initially designed to be a school based preventative intervention however, due to COVID-19 restrictions, it was quickly converted into a programme that could be delivered online. With the help of a website developer and a co-production group of Year 6 and 7 children the Level Up team designed a series of online activities, videos and group sessions. They also put together a collection of informative Sound Clouds podcasts for parents, art videos and facilitated all of the group sessions, including the art groups, on Zoom.
We initially thought that once we were through the pandemic we would go back to face to face delivery, however the Youth Endowment Fund suggested that in order not to impact the evaluation of the programme it would need to continue being delivered online for both years of the programme.
To suddenly commit to a digital forum, something new to us as clinicians, felt like a huge commitment. We had to think about the feasibility of the programme, e.g. would the children have access to devices and internet, and whether this would mean we wouldn’t be able to work with the children that we had hoped to. We encountered some challenges with remote working and had to provide the children and parents with varying levels of support to access the online programme. For some families this included how to access the internet, get onto the programme, access the activities and get onto Zoom. The children and their families were very adaptable to this method of delivery and the overall experience was positive. Some learning within the team was that we found it most helpful having the clinicians who were running the sessions be in the same room, so we came into the Tavistock Centre to facilitate this.
Alignment with the THRIVE Framework for system change (Wolpert et al., 2019)
The Level Up Programme has strong alignment with the principles of the THRIVE Framework, meeting the needs of children and families within the Thriving and Getting Advice and Signposting and Getting Help needs based groupings.
Within this grouping are children who live in socially, economically and ethnically diverse communities that have been affected by, or may be affected by, youth violence. The Level Up Programme works with children who have a Strengths and Difficulties Questionnaire (SDQ) total difficulty score between 6-18 and who meet at least one of the following criteria; struggle with peer relationships, have difficulty managing their emotional state, are easily influenced by others, are driven by gaining peer approval, make risky or poor decisions, and whose parents or carers are worried about their transition to secondary school. As outlined above, the programme engages with children and their parents providing a holistic range of prevention and promotion strategies that meet their needs at home, in the community and in an education setting.
An independent evaluation of the programme is being undertaken by the Anna Freud National Centre for Children and Families, which will provide evidence on the success of the prevention and promotion strategies and influence the national roll-out of the programme.
Getting Advice and Signposting
Although impacted by COVID-19, an integral part of the programme is building on the strengths, resources and resilience of the community by providing advice and signposting to community groups for emotional health and wellbeing support. By sharing information about what is available to children and their families in their community, Level Up is empowering children and families to find the best ways of supporting their mental health and wellbeing.
A key aim of the programme for its second year is to maintain links with other services such Mental Health in Schools Teams (MHST), Educational Psychology Service Youth Early Help, Outreach Teachers, Special Educational Needs Coordinator (SENCO) forums, and engage with more community organisations.
The Level Up Programme is a goals oriented intervention. Children are supported to self-define and monitor progress towards their goals throughout the programme, ensuring there is an explicit shared understanding from the outset of what a successful outcome would look like as a result of participating in the programme. It is an outcome informed intervention, making use of outcome measures to help identify the programme cohort, to evaluate the children’s progress towards their goals and to check that what is being tried is helping. By piloting the programme and externally evaluating it, Level Up hope to build an evidence base, demonstrating the effectiveness of the programme with a view to promoting wider implementation.
Co-production was key to shaping the content and ‘look and feel’ of the online activity aspect of the programme which ensured that the voice of children was central and the offer was needs-led.
Feedback from the co-production sessions included:
- “Didn’t mind the amount of text, but reduce the amount on each page so that it doesn’t feel overwhelming.”
- “Learnt that he is part of more communities than he thought of.”
- “Leant that he can talk to many more people than just the police.”
A great amount of work has been carried out by the programme to build and maintain effective partnership working across the system to support the children and families that they are working with. This includes supporting the transition by making contact with secondary schools in September to inform them which pupils have taken part in the programme, and to hand over any necessary additional information. A testament to the relationship building that has happened in the first year of the development programme is that 21 of the schools have signed up to take part in the second year of the programme.
Outcome data from the first cohort
The following findings were gathered through the independent evaluation of the feasibility study carried out by the Anna Freud Centre.
Level Up attendance:
There was a decline in attendance in the young people’s groups over the course of the programme and attendance to the parent groups was consistently low. 11 (31.4%) of the children attended all 5 of the group sessions, and only 2 parents attended all sessions. Completion rates of the online sessions also declined, with 29 (82.9%) young people completing the activities in week 1, and eight young people completing the final online activity in week 4.
- No significant differences were found in pre-intervention parent-report or child-report SDQs for those who did or did not complete the follow-up SDQ at the end of Level Up.
- No significant differences were found in SDQ total or subscale scores from pre- to post-intervention for those who completed both sets of questionnaires.
- 9 young people and 17 parents provided both pre- and post-intervention SDQ data. The low response rate for completing SDQs is thought to have had an impact on the data analysis.
Semi-structured interviews were conducted with:
- Level Up Team, n=4
- School staff referring young people to the programme, n=3
- Young people participating in Level Up, n=4
- Parents who participated in Level Up, n=5
Staff Analysis (teaching staff and Level Up team):
School and Level Up staff felt that Level Up would help or had helped young people by:
- Filling a gap during the summer holidays and in lost transition work with school closures.
- Preparing for the move to secondary school and giving young people a chance to think about their feelings and worries, and how they would overcome problems they may face.
- Peer support and shared concerns/worries to help normalise feelings about transitioning to secondary school.
- Feeling supported and having a positive experience of support from professionals and feeling comfortable reaching out to other sources of support.
- Seeing their parents take an interest and support them.
- Providing knowledge and language to talk about how they are feeling and understand how they are feeling and behaving.
- Increased confidence observed in group sessions.
Young people and parent interviews:
Many young people and parents interviewed did not see a need to do anything to improve the programme. Some minor suggestions given included:
- Moving to in-person delivery or having some in-person content during the programme or at the end.
- More flexibility in the dates or times of group sessions.
- Consistency in how the additional art sessions were delivered, in line with the main Level Up sessions. For example, sending links to the videos and activities, having reminders about the activities and some direct contact with art therapist.
- Making parents more aware of their involvement in the programme and the benefits for them of taking part, as well as for the young people.
Perceptions of the impact of Level Up:
- Both parents and young people found it helpful to share their anxieties about starting secondary school, knowing that they were not the only one having concerns, and being able to learn from other people’s insights and experiences.
- The young people, especially, described how helpful they found learning about ‘alarm brain’ and ‘thinking brain’ in understanding their reactions and behaviours.
- Finally, the young people and parents described how helpful it was to think about their community, safe places for the young person and where they can go for help if needed.
The young people and parents described a number of changes that they had noticed since taking part in Level Up including:
- Young people being more comfortable asking for help from parents, teachers, or other trusted people in their community.
- Smoother transition to secondary school through: increased confidence, fewer problems with anger, being able to make new friends, reduced worries about secondary school, and prior concerns being eased.
Everyone interviewed said that they would recommend taking part in Level Up to other young people and parents. Reasons given for this included:
- Having a positive experience for the reasons outlined in previous slides, including the benefits recognised by both parents and young people.
- A chance to meet new people.
- Helpful when it is your first child going to secondary school because as a parent you are not sure what to expect.
- Gaining knowledge and skills not necessarily covered in school.
Feedback from children and their parents
Reflections from the first year
Parental engagement was shown to be incredibly important, both through group attendance, responsiveness to texts/calls, support, and encouragement. It was clear that the first contact between schools and parents was fundamental in helping the team to engage parents, as this formed the basis of the therapeutic relationships and embedded a foundation of trust and willingness to learn. Both children and parents responded well to the group work and offered many contributions throughout the course of the intervention. Many of the families were incredibly resourceful and adaptable when it came to attending groups, with some siblings and family friends joining in place of parents or helping to translate.
Larger groups of children and parents worked particularly well, with both groups seeming to benefit from listening to each other’s experiences and offering advice or support to each other accordingly. There did not appear to be much difference in engagement between groups within the same primary school and those containing a mix of different schools, as they both seemed to work equally well. One consideration is in individual preferences as some children stated they would have preferred to complete the online activities as a group rather than independently, drawing further on the support from their peers.
Certain sessions appeared to work particularly well, including the ‘Thinking brain and the alarm brain’ session, which appeared to land well with both parents and children. It appeared to provide them with a shared language, with some parents and children reporting that they continued to talk about it outside of the session. We plan to take this into consideration when reviewing and amending our sessions in preparation for our second year.
Despite some initial technical difficulties using Zoom and the online activities, the clinicians and families appeared to adapt well to this change in delivery. Some children and parents did need additional support to transition to remote means, and the team were also concerned about access to computers and tablets, however this was not as problematic as initially anticipated. A small number of families were loaned laptops. It is unclear how much of an impact the use of a remote intervention had on dropout rates and whether some families were reluctant to take part in the intervention as it would not be face to face. This will need to be explored further during the second year.
Regarding the content of the intervention, there were some glitches with the online activity which will require further technical work prior to the next cohort engaging with the programme. Moreover, additional thinking is required regarding ‘Zoom etiquette’ and the use of housekeeping rules and expectations to ensure the success of the intervention, i.e. whether children should be given a choice as to keep their cameras on or off.
As the programme enters its second year there are a number of key considerations to take forward and areas in which there is room for progression and improvement.
The primary focus for the year ahead is increasing the number of children and parents who complete the programme, and maintaining these relationships with primary schools to identify children and engage parents. Moreover, the programme team are actively seeking to improve their partnership working with services such as Mental Health Support Teams, Youth Early Help and SENCO forums, and have a desire to engage more with community organisations in order to practice effectively across the system.
The programme team itself values the importance of streamlining their screening, referral and on-boarding process to better facilitate this growth and ensure a reliable and effective service can be provided. The programme team recognise the need to enact frequent session content reviews and updates where necessary to ensure that the programme accurately reflects the changing world and the ever-adapting evidence base.
If you would like to find out more about the Level Up Programme, please e-mail the team at email@example.com.
Edited by the National i-THRIVE Programme Team.
Written April 2021.