Intervention development and evaluation research projects:

When children play in an adventurous way, climbing trees, riding their bikes fast downhill, jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. Being able to experiment with these feelings by taking some age-appropriate risks in their play helps children to learn about fear, uncertainty, risk-judgement and coping. This learning may later help to protect children from becoming overwhelmed by anxiety when they are faced with a situation that is scary or uncertain.

Unfortunately, many children today do not have the same opportunities to play in an adventurous way that children did in the past. Over the past few decades there has been a decline in the amount of time children spend playing outdoors, where adventurous play most often takes place. There are many reasons for this decline but one important reason is the increased emphasis on keeping children safe from physical harm. Of course, we all want to keep our children safe but there is concern that we may be keeping children too safe. By overly protecting children from physical harm we may increase their risk for emotional problems by denying them to opportunities to learn through adventurous play.

Problems with anxiety during childhood are very common and some children feel so anxious that they cannot do some of the things they would like to do. The number of children experiencing problems with anxiety has increased significantly in recent years. This research explores whether we may be able to decrease the likelihood of children experiencing problematic anxiety by increasing their opportunities for adventurous play. The seven year programme of research is funded by a UKRI Future Leaders Fellowship, awarded to Professor Helen Dodd, and focuses on play in schools, but the team are interested in adventurous play more broadly.

To ensure that the research benefits society, the work is being planned and conducted together with organisations who affect play policy such as the Play Safety Forum, and those and who design children's play spaces, such as HAGS, as well as psychologists, parents and school staff. The research has the potential to dramatically affect the way that schools approach children's play and to significantly decrease anxiety problems as a consequence. This would improve the quality of life of the children across the UK and decrease the substantial societal costs associated with long-term mental health problems.

Main contacts: Helen Dodd and Rachel Nesbit.

The Adolescents and carers using mindfulness Therapy To END depression and anxiety (ATTEND) Project is investigating if a teenager-friendly version of Mindfulness-Based Cognitive Therapy (MBCT) might reduce recurrent depression in teenagers who still have symptoms of depression after treatment. Although MBCT is recommended by the National Institute for Care Excellence for adults who have had three or more episodes of depression, it is relatively untested with young people. Therefore, we created Mindfulness for Adolescents and Carers (MAC) which is an adapted from of MBCT which aims to support teenagers and their carers manage depressive symptoms and stay well.

There are 5 work packages within this project, Dr Vashti Berry and the Team at the University of Exeter are leading on Work Package 5 – The Implementation of MAC. They will scope the current, national use of MBCTs within Children and Adolescents Mental Health services, assess how best to implement MAC exploring the facilitators and barriers to implementing MAC, and utilise data from the randomised control trial (Work Package 3) to develop and refine implementation guidance for MAC scale up.

Main Contact: Dr Vashti Berry

The Children’s Health and Maternity Priority Programme is a three-year programme of research that seeks to find effective ways to implement evidence-based interventions to improve children’s and maternity services widely across England by supporting 4 implementation projects:

1. BRUSH - optimising toothBRUSHing pRogrammes in nUrsieries and ScHools
2. ESMI-III - The Effectiveness and Implementation of Maternal Mental Health Services
3. RIVA - Evaluating models of health-based Independent Domestic Violence Advisor (IDVA) provision in maternity services
4. Trauma-focused Cognitive Behavioural Therapy for children in care

Main contact: Vashti Berry

The experiences a young child has with her care givers in the first three years of life are crucial to brain development, subsequent health, academic success and wellbeing over the life course. Studies of group-based parenting programmes have found that disadvantaged families benefit less from early intervention programmes and any benefit seems to dissipate over time, suggesting a need for a more socially sensitive, trusted and sustainable approach to deliver positive parenting messages and support that is embedded in the local community.

In this NIHR-funded Fellowship, Kath is working with colleagues in Action for Children in Devon, exploring the ways in which they are training and supporting volunteers in the community (‘community champions’) to share evidence-based messages with parents to support children’s development. The work focuses on exploring the strategies used to disseminate messages, as well as the broader design of the intervention, its impact, implementation and sustainability.

Main contact: Kath Wilkinson

There is currently little to no stratification of MH interventions, meaning that ‘domains’ of health have been differentiated but interventions still cater for the ‘average’ patient. The “one size fits all” approach to patient treatment is increasingly recognised as ineffective and costly.

It can take over two years to be seen by Child and Adolescent Services, worsening children’s symptoms and leaving families feeling abandoned. Furthermore, the current available treatments are often inappropriate for specific conditions, which means at best they provide ineffectual care, and at worst, exacerbate symptoms and outcomes for children.

Personalised care ensures that patients receive the most appropriate treatment at the right time, tailored to their needs. New treatment approaches are desperately needed.

In Devon alone, there are somewhere in the region of 1-3 young people every month turning 18 who require a complex transition plan from CAMHS into adult services who do not easily fit into standard pathways. These cases take a disproportionate amount of professionals’ time, and the uncertainty can lead to considerable anxiety and distress for young people and their families. Getting this wrong can risk a long-term need for intensive service input which a better transition may have avoided.

In this ESRC-IAA Impact Co-Creation project, we have partnered with Children and Family Health Devon to apply research evidence around personalised approaches and transitions to inform the development and evaluation of their Complex Transitions Group pilot.

This work has enormous potential to improve children’s health and reduce longer-term economic costs, by helping them and their wider family networks to achieve the best outcomes in the prevention and management of MH conditions.

Main contacts:

Alice Garrood (University of Exeter)

Professor Tamsin Newlove-Delago (University of Exeter)

Professor Vashti Berry  (University of Exeter)

Our collaborators are:

• Children and Family Health Devon 
• Devon Partnership NHS Trust

Some 15% of UK children witness at least one form of domestic violence or abuse (DVA) during childhood; many more are exposed in other ways such as seeing the aftermath of abuse. Exposed children are more likely than those who are not, to experience mental health (MH) problems throughout their lives. There are programmes that try to prevent or reduce the damage that DVA causes to MH, but overall there has been very little research to work out whether these programmes improve outcomes and reduce costs associated with DVA. Programmes combining education, support and counselling (Psycho-education) are most widely available in the UK, but there is no good quality evidence to show if this type of support is helpful and good value for money.

We are interested in one particular programme called the Community Group Programme, CGP for short, because it has become quite well established in London and parts of Scotland. It was developed in Canada, and has been adapted for use in the UK. It is delivered by different types of professionals in community settings (e.g children’s centres). Children receive a 12-week group intervention, and a group work programme runs at the same time for mothers or female carers. Children are encouraged to recognise, name and explore feelings surrounding DVA, and to develop coping strategies to deal with conflict and other stressful situations. Sessions for mothers help them to support their children to come to terms with their experiences.

The study we are conducting with the University of East London (lead) and other partners, aims to find out if it is possible to conduct an experimental study, or trial, to compare whether children who take part in the CGP do any better than similar children who receive the support that would normally be available to them. For this reason it is called a feasibility study. It is needed as a first step because we are not sure if families or the people working with them would be willing to support a trial where only some children and mothers are able to access the programme we are testing.

This study commenced in January 2020.

Main contact: Vashti Berry

Puberty presents a significant challenge for adolescents involved in sport, dance in particular. During this developmental phase, young people contend with physical, psychological and social changes; many of which directly impact performance, technique, selection and retention at top training establishments, psychological well-being, and injury risk. Concurrently, the expectation for continued improvement remains and intensity of training increases. The challenges associated with pubertal change are further complicated by the significant variation in age of onset. Dance schools categorise and evaluate young dancers by chronological age, while individuals of the same chronological age may vary by up to five years in terms of their biological maturation. This approach overlooks individual differences in growth and maturation and has implications for the selection, retention and safety of young dancers.

The GuiDANCE project (Growing up in dance: Enhancing education and creating sustainable practices in growth and maturation in the dance sector) is a collaboration between the University of Exeter, One Dance UK, the Royal Ballet School and the Royal Academy of Dance led by Dr Siobhan Mitchell. The project aims to address the challenges associated with the pubertal transition in dance for young people. There are four key aims to the project:

1. To develop a dataset on the growth and development of young people in dance training which can underpin recommendations going forward.
2. To review practices and protocols in the dance sector around growth and development.
3. To evaluate and refine the education available on this topic within the dance sector.
4. To work with partners to co-create a model of best practice for managing growth and development in dance and share this through an online resource and dissemination event.

Main Contact: Siobhan Mitchell

External Collaborators:

• One Dance UK
• The Royal Ballet School
• The Royal Academy of Dance

The INTEGRATED (Integrating Financial Wellbeing Support and Parenting Support) Study is a programme development grant funded by NIHR. 

This exploratory study is working with Family Hubs (government funded community-based services for families) to understand how parenting and financial wellbeing support is currently being delivered, how it can be best combined, and who would be best to deliver it to families. The study is also exploring what data Family Hubs collect from families, and how this data could be used in a future evaluation.

Our long-term aim is to test whether combining parenting and financial support is more effective than providing each type of support separately. This study will run for one year from 1^st March 2024.

For further information on the study please email INTEGRATED@exeter.ac.uk.

Main Contact: Amy Bond - A.R.Bond@exeter.ac.uk

This exploratory feasibility study investigates how and why use of Parental Minds, a Community Interest Company based in East Devon, impacts on caregivers of young people with mental health problems.

A combination of qualitative interviews and service use data will be collated and analysed in order to:

1. understand who Parental Minds supports and which of the support options are used;
2. understand how and why this support is perceived to impact on caregivers or young people’s lives; 
3. describe what the perceived improvements are for those accessing Parental Minds (and any detriments), and
4. assess service evaluation data already opportunistically collected by Parental Minds in their usual delivery of services. In addition, we will:
5. aim to assess what outcomes should be measured (and how) if there were to be a future evaluation of the efficacy of Parental Minds, and 
6. develop the logic model of how involvement in Parental Minds is hypothesised to change behaviour and thus outcomes.

Main contact: Dr Abby Russell

Mental health and well-being of during adolescence is vitally important for young people to flourish and for the health and prosperity of society. Yet evidence suggests that poor mental health is on the rise and that the most vulnerable or disadvantaged in society suffer the most. Our stretched and constrained mental health systems are typically designed to react to problems once they have become severe.

As a partnership of leading scientists, designers and practitioners working alongside communities, we are testing an approach called Kailo – which means connected or whole. Kailo is an evidence-informed framework that will support local partnerships to co-design strategies that address underlying causes of mental ill health in their area. #

This five-year initiative, funded by a UK Prevention Research partnership (UKPRP) Consortium award of £5.3 million, will initially support the development and evaluation of Kailo in two distinct disadvantaged communities: rural, sparsely populated North Devon and urban, densely populated Newham, in East London. A bold programme of developmental research will test the feasibility of Kailo across these contexts, informing refinements and subsequent wider implementation and evaluation in new areas.

Main contact: Vashti Berry

Website: Kailo - UKPRP

Our external project partners are:

• University College London
• Dartington Service Design Lab
• Shift
• Anna Freud National Centre for Children and Families

Parenting Support Programmes and Domestic Violence & Abuse: We received funding from the Medical Research Council’s Confidence in Global Mental Health fund to develop networks in the UK and South Africa of researchers, programme developers, policy-makers and practitioners, to think together about the application and adaptation of parent support programmes for children and families affected by domestic abuse (DV&A).

We held workshops in 2018 in London and Pretoria bringing people together. We have subsequently worked with Prevention Collaborative to produce a review for practitioners and policy-makers examining the evidence for parenting support in the context of DV&A. The review will be published early in 2020. Vashti Berry also received GCRF funding to travel to South Africa to attend design training by the d-school at Cape Town, which will be used to inform the development of workplace carer support and wellbeing programme to prevent family violence.

Main contact: Vashti Berry

We conduct research on ADHD across health, education and social care.

Our research is designed to understand the needs of young people with ADHD, and to provide evidence for health and education services about how they can better support those with ADHD and other neurodevelopmental difficulties.

As such, SAND brings together academics, clinicians, people with lived experience of ADHD and other neurodevelopmental differences, and the people who support them.

Main contact: Anna Price

Website: SAND website

The Stand Together Trial is a large randomised controlled trial (RCT) evaluating whether a school-based anti-bullying programme called KiVa reduces levels of bullying in UK primary schools and if so, whether it results in improvements in children’s mental health, school liking and attendance, and teacher confidence in dealing with bullying.

Over the next two years we will be working with 120 primary schools in four areas; i) North Wales and Cheshire, ii) the West Midlands, iii) South East and iv) South West England. Half of the schools will be randomly selected to use the KiVa programme, the remaining 60 schools continue with teaching as usual and will not access the programme during that school year.

Main contact: Rachel Hayes

The Supporting Teachers And childRen in Schools (STARS) 2 study is a large cluster randomised controlled trial funded by the Education Endowment Foundation (EFF) examining the impact of the Incredible Years Teacher Classroom Management (IY-TCM) course on primary school children’s math attainment, classroom behaviour and mental health. The study involves 140 primary schools across Bristol, Cornwall, Dorset, Liverpool, Portsmouth, Reading and Southampton and is being conducted in collaboration with the National Foundation for Educational Research (NFER).

Main contact: Rachel Hayes

Website: STARS website

Twitter: @IY_STARS

Teacher-student relationships are an important part of any UK classroom, being shown to predict a child’s future mental health, behavioural problems and academic attainment. However, there are few suitable measures to assess the quality of these relationships within the UK context. This study has adapted the Student-Teacher Relationship Scale (STRS; a well validated measure in the US) to make it more suitable for use in UK classrooms. The study aims to assess the reliability of this new, adapted scale to see whether it is a useful way to examine teacher-student relationships in the UK.

If you are a teacher teaching in the UK and would like to help us with this research, please follow this link and complete the questionnaire anonymously.

Main contact: Rachel Hayes

Many children struggle in school, and school is particularly problematic for children who have traits of attention deficit/hyperactivity disorder or ADHD. ADHD traits include things like impulsive behaviour, not being able to pay attention, and hyperactivity.

In this 5-year NIHR fellowship research project, we are working with young people with ADHD, schools and parents to develop a toolkit of strategies to help children cope better in school. The toolkit will target things like inattention, self-esteem, conflict with teachers and peers and organisational skills. It will be something that teachers can use to work with individual children or the wider classroom, and we hope it will help to improve the school environment for those who are struggling in these areas. After developing the toolkit, we’ll be testing it and improving it in eight Primary schools in the South West.

Please see the Tools for Schools website for more information and updates, and information on how you can get involved

Main contact: Dr Abby Russell

Under the Umbrella is an immersive and fun training experience which shows what it might be like to be a neurodivergent child at school.

The experience is made up of a series of short tasks which are designed to mirror parts of the school day, with tweaks to give a small taste of what neurodivergent children may experience.

Whilst the experience will present some negative scenarios, it will also show how positive outcomes can be encouraged and will provide resources that may be helpful for schools.

The tasks are designed in a way that can be engaged with momentarily or as a full narrative, meaning that individuals can drop in and test out the experience when they have some time.

Elements of the experience will be presented at the Futures Festival on the 28^th and 29^th September for members of the public to take part in.

If you would like to find out more about the Under the Umbrella experience or would like to volunteer to be involved in the project please contact Katie Emmison on k.emmison@exeter.ac.uk

For more information about the Futures Festival please visit https://www.exeter.ac.uk/research/publicengagement/eventsandfestivals/futures/