A pilot evaluation of the Buddy Bench (Ireland)

Aware Programme (BBAP)

Penny Quinn and Sinéad McGilloway

Centre for Mental Health and Community Research,

Maynooth University Department of Psychology

Final Report

February 2018

Table of Contents

Section Page

About the authors 3Acknowledgements 3

1. Introduction 42. Background 4 2.1 The Buddy Bench Aware Programme3. Study Aims and Objectives 54. Method 55. Key findings: 5 5.1 Children 5 5.2 Teachers 9 5.3 Parents 96. Discussion 13 6.1 The children 14 6.2 Other stakeholders 6.3 Strengths and limitations of the study 6.4 Future research 6.5 Conclusion/key recommendations for future research and programme delivery7. References

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About the authorsPenny Quinn is a Research Assistant in the Centre for Mental Health and Community Research (www.cmhcr.eu), Maynooth University Department of Psychology. Penny led on the completion of this work and recently secured an IRC Postgraduate Enterprise-Based scholarship to continue her work in this area. This research will be supervised by Professor Sinéad McGilloway (see below) and Dr Catriona O’Toole (Maynooth University Department of Education).

Professor Sinéad McGilloway is Director of Centre for Mental Health and Community Research, Maynooth University Department of Psychology and is Principal Investigator on this study.

Acknowledgements

We would like to thank all of the children and their teachers and parents for kindly taking part in this study. We also extend our thanks to the school principals and administrative staff, who generously allowed us into their busy schools to collect the data.

This study was funded by an Enterprise Ireland Innovation Voucher which we acknowledge with thanks.

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1.Introduction

This report presents a summary of the findings of a pilot evaluation of the ‘Buddy Bench Aware Programme’ (BBAP) in Ireland. This new programme was developed in Ireland in 2015 and since 2015, has been delivered, to over 36,000 primary school children in the Republic of Ireland. This school-based, child-led, positive mental health promotion intervention/programme aims to help promote children’s emotional resilience by, for example, reducing stress and feelings of isolation and encouraging and teaching compassion, kindness and empathy.

2. Background

Positive mental health and well-being are essential to enable children and young people to lead fulfilling lives, personally, socially and academically (O’Toole et al. 2017). Mental health problems have become increasingly common amongst children and young people both in Ireland and elsewhere and an estimated one in four children and young people may experience a mental health problem at some stage, whilst up to 25% may experience social, emotional and behavioural problems especially in disadvantaged areas (Costello et al., 2003). These kinds of problems can lead to a range of negative outcomes including poor academic performance, school dropout, conduct disorders and poor mental health into adolescence and adulthood. The social and economic costs of such difficulties can also be significant (Snell, 2013). Thus, early intervention and prevention are critical in order to prevent a negative downward spiral of poor mental health and well-being into adolescence and adulthood (Costello, 2004).

Schools are increasingly considered to be important settings for mental health promotion and intervention as they provide ready access to large populations of children. The ‘reach’ and potentially crucial role of schools is also increasingly recognised in view of the minority of children/young people with mental health problems who access/use mental health services (Merikangas, 2009). School teachers are ideally placed to help promote mental health and emotional well-being in their pupils and also to identify young people who may be experiencing emotional distress (Department of Health and Children, 2013). In addition, the school environment can provide an ideal context within which to deliver prevention programmes, which have the potential to support positive mental health and well-being (Murray et al., 2015).

2.1 The Buddy Bench Aware Programme (BBAP) The Buddy Bench Aware Programme (BBAP) is a suite of universal, age appropriate, early intervention programmes which seek to promote a culture of self-expression, listening, tolerance, resilience, and mutual support. Each programme comprises: (a) one classroom-based workshop per year (of approximately 40 minutes’ duration) delivered by trained facilitators; (b) an interactive child-friendly workbook or activity book containing a comprehensive set of creative activities which the child can explore in their own time and at their own pace; and (c) a Teacher’s Resource Pack that outlines the thinking and practice behind the programmes and how it aligns with the Mental Health Foundation's '7 Core Competencies' as well as the HSE and Department of Health's '15 Protective Factors', which structure the Social Personal Health Education (SPHE) element of the primary school curriculum( Mental Health Foundation, 2002; DES,2015 ).

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The programmes are designed to be used in conjunction with a “Buddy Bench” – a concept that originated in Germany and was subsequently introduced to the USA in 2013; this describes a colourful child-friendly bench that is installed in the outdoor play areas of primary schools. This remains on site as both a visual reminder of the programme learnings, and also as a ‘safe space’ to encourage children to make, or spend time with, friends and to develop a positive self-image, whilst also learning tolerance. The BBAP was developed by Life Matters with input/expertise from a team of Irish psychotherapists and has been delivered to approximately 222 primary schools in the Republic of Ireland since 2015.

The BBAP programmes include: 1. Little Buddies (Age 3-6 years)2. Buddy Bench Aware (7-9 years)3. You are a Hero (10-12 Years)4. Transition Buddies (6th class only)

3. Study aims and objectives

The aim of this pilot study was to ascertain the perceived effectiveness of one of the above programmes - the Buddy Bench Aware Programme (BBAP) - by assessing the attitudes and views of a small selected sample of key stakeholders with experience of the programme, including mainly children and teachers as well as a small number of parents. To the best of our knowledge, this is the first mental health promotion/intervention to be designed around the concept of friendship and empathy, and which, uniquely, is supported and amplified through the use of an ordinary everyday object.

4. Method

The study involved a mixed methods design comprising a (child-friendly) survey of participating children and teachers and a small group interview with parents whose children had received the BBAP. A total of 117 children were recruited from three participating schools across a number of geographical areas including:

(1) Castlerahan National School, Co. Cavan (47%)(2) Cortown National School, Co. Meath (23%)(3) Cushinstown National School, Co. Wexford (30%)

All of the participating children were pupils of 2nd, 3rd and 4th classes only. In addition, all six teachers of the classes were asked to complete and return a brief Teacher Evaluation Form.

The group interview was conducted to explore the views and attitudes of a small number of parents whose children had received the BBAP. A semi-structured interview schedule was devised to guide the interview. Initially, five parents from Cushinstown National School were approached and had agreed to take part, but due to a number of factors, only two were available to be interviewed.

The study received ethical approval from the Maynooth University Social Research Ethics Sub-Committee.

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5. Key findings:

The findings are summarised below under separate headings. Please note that the denominators provided vary due to missing or incomplete data.

5.1 Children(1) Demographic/Background characteristics The sample of children was approximately equally divided between girls (49%) and

boys who ranged in age from 7-10 years. The sample comprised pupils from 2nd - 4th

class inclusive (21%, 33% and 46% respectively).

In total, 28% of the children reported ‘always liking school’ whilst 62% reported liking school only ‘some of the time’. When asked what they liked most about school, a large majority (80%) reported that playing with their friends was their favourite thing about school.

Almost one-third of the children indicated that they own a mobile phone.

Almost 55% of the children chose ‘playing outside’, and 21% chose ‘playing computer games/watching TV’ as their favourite activities outside of school whilst just over 16% chose ‘playing inside.

Almost 96% of the children reported that they were ‘happy’. In addition, the children were asked to select 1 of 8 steps (happiness index in ascending order) to indicate their happiness levels. The mean result (step chosen) was 6.15 (SD=1.71), indicating generally high levels of happiness amongst this sample and confirming the subjective responses of the children.

(2) The children’s concept of the Buddy Bench Overall, almost 96% (n=112) of the sample responded positively to having a Buddy

Bench in their school, with half (n=60) selecting the ‘liking it a lot’ category and 45% selecting the ‘liking it a little’ category. Over 90% of the children felt that there should be a Buddy Bench in every school.

All of the children (n=117) drew and named their own emoji to depict how they felt about having a Buddy Bench in their school; over two-thirds used the word ‘happy’ to describe their emoji.

When asked what they thought the Buddy Bench is for, 52% responded ‘helping sad children’ whilst almost 41% responded ‘making friends’. However, just over 60% (n=71) of the sample reported ‘never’ having sat on the Buddy Bench, although almost half (41%) reported that their friends do so.

A range of emotions was identified in relation to the physical action of sitting on the bench. For example, approximately half (n=52) reported that this was associated with ‘feeling sad’ whilst more than one in five (22%) felt that it was an action associated with being ‘bored;’ fewer than 16% associated being ‘happy’ with sitting on the Buddy Bench.

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When asked how they would respond to seeing a child whom they did not know sitting on the Buddy Bench, almost half of the children (n=56) said that they would ‘talk to the child, but not sit on the Buddy Bench’ whilst 43% said that they would ‘sit on the Buddy Bench and talk to the child’.

The children were asked to provide an example of one difference that having a Buddy Bench has made to (i) them, (ii) their friends and (iii) their school. These open-ended responses were categorised and summarised across three groups as shown in Table 1 below. Examples of some of the responses from each category are also provided in Box 1 below.

Table 1: Difference of having a Buddy Bench in their school (to the child, their friends and the school)

(i) Child (ii) Friends (iii) School (n=117) (n=117) (n=117) N % N % N %

Feeling happier 27 (23) 16 (14) 18 (15)Making friends 17 (14) 7 (6) 21 (18)No difference 10 (8) 7 (6)Not sure 13 (12) 28 (24) 12 (10)Other* 37 (32) 37 (32) 47 (40)Missing 13 (11) 22 (18) 19 (17)

*Other (for school) includes positive views (66%), school yard effects (17%), miscellaneous (11%) and not relevant (6%).

Box 1: Selected comments from children

(1) “Can you name one difference that the Buddy Bench has made to you?” (n=104)

“Helped me make friends.”

“It has made the school better.”

“It made me feel more included.”

“Yes, I if I was sad, I would sit on it.”

“I know there is a place I can go when I feel sad.”

(2) “Can you name one difference that the Buddy Bench has made to your friends?” (n=95)

“Now we have it, I can go over and help.”

“It made my friends a lot happier.”

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“They can sit down on the Buddy Bench and I could go over to them.”

“They have a place to go now when they feel sad.”

(3) Can you name one difference that the Buddy Bench has made to your school?”(n=98)

“Everyone will have a buddy.”

“Children are happier.”

“We are all kinder.”

“I think the school is very happy.”

“ It made our school the best.”

“Everyone is playing together.”

(3) The Buddy Bench Aware Programme-The workshop Almost all of the children (93%, 108/117) reported having ‘liked learning’ about the

Buddy Bench in the BBAP workshop.

Overall, the response rate to the questions asking about the children’s favourite and least favourite moment of the BBAP workshop was relatively low, especially in the ‘least favourite’ section with 13% and 31% missing responses respectively. This is most likely due to recall difficulties, especially amongst the younger children.

Almost 35% of those who did respond to this question, reported that the ‘story’ was their favourite moment of the workshop, followed by the ‘puppets’ (20%). Just over 27% of the sample responded (when asked) as ‘not having any least favourite moment’.

Almost half of the children (47%) provided examples of things learned about feelings during their BBAP workshop. Just over 28% of the sample responded that they ‘couldn’t remember’ or ‘did not know’ whilst there were almost 25% missing responses. Examples of some of the completed open-ended responses about feelings are provided in Box 2 below.

Children were also asked if they were surprised by anything that they had learned in the workshop. Again, response rates were low here with 26% of missing responses recorded. Almost 24% reported not being surprised by anything; however, 8% were surprised by the use of puppets in the workshop whilst 15% were surprised to hear that a 12-year-old boy had first come up with the idea of a Buddy Bench.

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Box 2: A selection of quotes about feelings learned during the workshop

Can you tell us something you learned about feelings in the workshop?

“That it is ok to be sad.”

“Everyone has different feelings at different times.”

“Always care about people.”

“You can tell how someone feels by their body language.”

“That everyone needs time to think.”

(4) The Buddy Bench Aware Programme -The workbook[Please note that 4th class pupils (n=18) of Cortown National School had not received their BBAP workbooks at the time of data collection.]

Forty-four per cent of the children had used their workbooks during school time compared to 20% at home. Likewise, a similar proportion (21%) reported that someone at home had read their BBAP workbook, although only 8% reported that they had talked about what they learned at home, typically to a parent. A selection of representative quotes relating to what the children reported talking about at home, is provided in Box 3 below.

Box 3: Children’s quotes of representative examples of BBAP workshop learning discussed at home

Can you think of an example of something you talked about at home? (n=6)

“Always do something.”

“You talk to people when they are sad.”

“How you sometimes need to look at the big picture.”

“How I can help others in school.”

“The story of the Buddy Bench.”

“Cheering people up.”

When asked what they liked best about their BBAP workbook, almost 37% indicated that they liked the ‘drawing’ and 30% selected the ‘story’, whilst almost 8% selected ‘questions’. With regard to what they liked least, ‘questions’ (28%), ‘thinking’ (18%) and ‘something else’ (18%) were selected.

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5.2 Teachers Five out of the six teachers of the participating children in the three schools

completed a Teacher Evaluation Form and their responses were overwhelmingly positive, including comments on the workshop content, presentation and the facilitators’ ability to relate to the children during the workshop.

Three of the teachers reported that the children understood the concept of the Buddy Bench very well, whilst the remaining two felt that the children had ‘found the concept of the Buddy Bench difficult to grasp at first, but that ‘they figured it out’. All of the teachers reported that the BBAP had helped ‘a lot’ to facilitate a better understanding of the purpose of the Buddy Bench.

Four of the teachers described the BBAP as covering ‘some of the SPHE curriculum’ and one described the BBAP as covering ‘a lot of the SPHE curriculum’. Four out of the five said that they would be ‘very likely’ to recommend the BBAP to other schools.

The teachers scored (using a Likert scale) a selection of issues and sources of concern identified in their school (prior to the introduction of the BBAP) including: poor co-operation at playtime (n=2), intolerance (n=1), isolation (n=1), children ‘on the spectrum’ not integrating/being bullied (n=1).

5.3 Parents As outlined earlier, only two parents were available to take part in a group interview; one had a child in Second Class and the other, a child in Third Class at the time of programme delivery. The interview lasted approximately 45 minutes and took place in Cushinstown National School. One of the participating parents (a mother of 4 school going children) had a daughter in 2nd class whilst the other parent (a mother of 4 children) had a son in 3 rd class, at the time that the programme was delivered in Cushinstown National School. The data were recorded, transcribed verbatim and analysed using thematic analysis. Two main themes and sub-themes (described below) were identified (see Table 2), each of which is discussed below.

Table 2: Themes (and subthemes) of analysis

(1) Introducing the Buddy Bench concept to the schoolRole of the PTAFundraising and launch

(2) Components of the BBAPPositive effectsProgramme awareness and purpose of the Buddy BenchConsideration of child age and genderBBAP workshop and workbook

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(i) Introducing the Buddy Bench (BB) concept to the school community

Role of the Parent Teacher AssociationWhen asked how they first came to hear of their schools’ interest in the concept of a Buddy Bench (BB), the parents both agreed that the ‘seed started’ through the schools’ Parent Teacher Association (PTA), with a female member of the PTA being acknowledged as ‘the driving force’ behind introducing the concept initially to the school. This was the first time either parent had heard about the Buddy Bench concept itself: “One of the parents ... on the Parents’ Association ... would have been ... the driving force... so I would have been aware of it from back at the incubation stage... and I did think it was a great idea.” (Parent 1)

Subsequent written communications from the school were sent home with their children to inform parents of the schools’ intention to introduce the Buddy Bench (BB). However, when asked, neither of the parents could recall with any great detail the exact content of this information. However, both of them recalled a fundraising campaign which took place thereafter.

Fundraising and launch day The children’s awareness of the imminent arrival of the BB would have been reinforced by the school fundraising campaign (PTA initiated), which involved a ‘movie day’ for the children in order to raise money toward the costs of the ‘material for the BB’. The local Men’s Shed organisation (the founder is local to the area) made the bench for the school. Interestingly, the involvement of the Men’s Shed organisation in the project was described as being representative of the ‘mental health side of things’ by one of the parents.

The school (Cushinstown N.S.) launched the arrival of their new BB with a community event involving members of local government including ‘5 or 6 TDs,’ along with members of the BB team and parents. This event was described by one of the parents as being ‘huge - and all the local [news] papers were out’.

(ii) Components of the Buddy Bench Aware Programme

Positive effects of the BBAPOverall, both interviewees alluded to the positive effects of the BBAP in their child’s school, which they implied, were both short- and long-term. For example, for one of the parents, the positive short-term impact was described as helping to include others due to a greater awareness in contemporary society of ‘people being on their own’. The second parent described what might be considered longer-term benefits, in the sense that the intervention was seen as something of ‘a slow burner’. The latter suggests that some of the effects of the programme may not materialise in the short-term because its aim, ultimately, is not only to increase knowledge and awareness, but also to change attitudes which can typically take time and which are subject to considerable individual variability. In addition, one of the parents suggested that vulnerable children could particularly benefit from having a Buddy Bench:

“I ... think the bench... depends where you’re coming from. You’ve a child in a family... who’s quite confident, doesn’t care, whereas you’ve got a poor little soul that maybe things at home aren’t good today, maybe they’re a little lost, ...maybe they just lack confidence. It’s

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for children more so ... that are just a little bit more vulnerable that need to be watched.” (Parent 1)

The programme itself was described as something that ‘gets people talking’, thereby indicating that it is successfully beginning to raise awareness around some of the issues it is designed to address.

In addition to their positive feedback about the programme, both parents expressed the desire to see the BBAP as something that would continue to be delivered in their child’s school into the future. One of the parents expressed the view that the BBAP should become a ‘new culture’, in the school, thereby reflecting the importance of embedding these kinds of programmes in schools and ensuring that their effects are sustained in the longer term.

However, each of the interviewees made reference to being ‘cost aware’ in relation to the financial implications of running the BBAP and other routine programmes (e.g. Communion, Confirmation and the Transition programmes) in their child’s school over the course of the school year with competing programmes exerting pressure on both time and resources. One of the parents expressed the view that perhaps the BBAP could be ‘looked at maybe every second year’.

Programme awareness and purpose of the BBPerhaps somewhat surprisingly, neither of the interviewees was aware that the Buddy Bench itself was only one component of the BBAP, or that their children had participated in a workshop or, in the case of one parent, had received a workbook. One parent believed that ‘it was just a BB and fundraising’, whilst the other indicated that she was unaware that the BB ‘was only part of a whole programme that was being rolled out’. For both parents, the interview was the first time for them to hear about the existence of the workshop and the accompanying workbook which are central to the programme. While both interviewees recalled providing their written informed consent for their child to take part in the workshop, they were unable to accurately recall the details/purpose outlined therein. A possible reason for this, provided by one of the parents, was that it was likely that the actual Buddy Bench ‘had taken the whole profile off it’ (i.e. had detracted from the workshop).Reassuringly however, both interviewees were well-informed when asked to describe what they understood the purpose (function) of the Buddy Bench to be in the school setting. For example, one felt that if a child was sitting on the BB, they were effectively saying ‘Hello, would someone come down and sit beside me and talk to me?’ whilst the other commented as follows:

“If they’re outside and they have no one to play with, or they’re feeling lonely or feel down ... they can sit on the bench – and there’s an awareness then that if someone is sat on the bench, that they want someone to talk to or they want someone to play with, and that’s kind of my general kind of concept of it.” (Parent 1)

Consideration of child gender and ageSome concerns around the issues of age and gender were raised by both of the parents. Each suggested that the bench itself may be best suited to children in the younger cycle of the school, and they expressed the view that boys would be less likely to sit on it than girls. For example, one of the parents said that her daughter (aged 8) had told her that she had sat on the bench recently because ‘she was ...feeling bad today so I’m sitting down on it’. By contrast, the other parent described her son (aged 9) as being ‘dismissive’ of the bench in

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general due to possible stigma around the idea of being sad or having no friends to play with:

“From the boys end of things they’re a bit more dismissive of it...maybe because he’s a bit older... it’s nearly highlighting the fact that, ‘I’ve got no friends’...I still feel the social concept of sitting on a bench and declaring they have no one to play with is difficult, and especially in the older end of the school”. (Parent 1)

Thus, both interviewees expressed the view that the BB concept should be introduced to younger children in the school and, in particular, the Junior and Senior Infants classes in the hope that ‘when they ... get to third or fourth class ... it maybe won’t have that stigma attached...but at the moment definitely for boys and older [children] it’s harder’. Both interviewees agreed that if the younger children are introduced to the BB as early in the school system as possible, then they believe it will ‘become the culture’ so to speak and be more readily accepted by the children as they get older. This reflects the importance of intervening as early as possible in children’s lives as well as the need to embed a culture around the kinds of qualities which the programme is aiming to engender in young schoolchildren (e.g. empathy, kindness etc.).

The workshop and workbook As part of the BBAP, each of the interviewees’ children took part in a 40-minute workshop delivered by a trained facilitator from Buddy Bench Ireland. This is a child-friendly, interactive workshop involving story telling and role-play through the use of age- appropriate puppets. Neither of the interviewees’ children had relayed any details to their parents of the BBAP workshop in which they had taken part. It is unclear why this was the case, but it could be due to the relatively young age of the participating children, a lack of encouragement from the teacher (see below), or they may simply have forgotten to mention it to their parents.

The children also received an interactive workbook during their workshop. However, only one of the interviewees indicated that she was familiar with this workbook, having found it in her child’s school bag. The second interviewee had only seen the workbook very recently. Interestingly, both parents suggested that the teachers should encourage the children to use the workbook at home as a means of reinforcing the programme and to help avoid the BB being seen as ‘only a piece of wood” by the children. As one parent explained:

“If it’s not written in the journal, unless it’s part of the homework schedule, then it wouldn’t happen in my house.”(Parent 1)

One of the parents had actively tried to encourage her daughter to engage with the workbook at home on several occasions, but felt that the workbook was not ‘contemporary enough’:

“I actually kept it [the workbook] out… floating around the house, but she just - I don’t know if it’s attractive enough. I don’t think she got excited about it because you know kids, if its not animated…” (Parent 2)

The other parent suggested that the workbook ‘is not eye catching enough for kids ‘in this modern day era’ and should perhaps be amended to encourage the children to interact with, and use, it more effectively.

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6. Discussion

The aim of this pilot study was to assess the perceived effectiveness of the BBAP in a sample of primary schools in Ireland by assessing the attitudes and views of a small selected sample of key stakeholders, including mainly children and teachers as well as a small number of parents. To the best of our knowledge, this is the first study of its kind to focus on a school-based mental health promotion intervention (BBAP) designed around the concept of friendship and empathy, and, uniquely, supported through the use of an ordinary everyday object (a bench).

As previously mentioned, to the best of our knowledge, the concept of a ‘Buddy Bench’ originated in Germany and was subsequently introduced to the USA in 2013. The term ‘Buddy Bench’ is used interchangeably with the term ‘Friendship Bench’ in the English-speaking world. However, to date, there is no evidence of the effectiveness of this concept. Likewise, the new programme developed around it, has not yet been evaluated. This study provided an opportunity to obtain initial insights into the views of, and attitudes toward, the programme amongst a sample of young primary school-going children, as well as a useful snapshot of the views and experiences of a small number of teachers and parents. Overall, the preliminary findings reported here suggest that the BBAP was received positively by all stakeholders involved in this study.

6.1 The children Reassuringly, the vast majority of the children involved in this pilot study reported that they were happy, and they expressed both positive views of, and attitudes toward, each component of the new programme. There are some interesting findings in this respect. For example, whilst 60 per cent of the children reported that they had never sat on the bench, an overwhelming majority believed that every school should have one. This suggests that, whilst most of the children may not be actively using the bench, it may still be fulfilling an important function in their eyes perhaps in the form of a ‘comforter’ or reassurance; thus, most children may not feel the need to physically sit on the bench, but its presence may be a sufficient visual reminder to them of the importance of being empathetic and kind to their peers. In addition, a significant minority did sit on the bench and it would be interesting to explore in more detail, the experiences of those children who used the bench for its intended purpose.

The workshop element of the BBAP was viewed very positively, but very few of the children appear to have spoken about the content of their workshop to their parents/guardians. It is difficult to know why this was the case. It is possible that children of this age (7-10 years) may have difficulty in processing and recalling novel concepts, having had only a relatively brief exposure to them (40 minutes approximately). For example, other teacher-delivered mental health support programmes in Irish primary schools (and elsewhere), such as ‘Zippy’s Friends’, ‘Friends for Life’ and the Incredible Years Teacher Classroom Management (IYTCM) programmes, are delivered by teachers over a number of sessions and usually include booster/refresher sessions (Department of Education and Science, 2012). At the same time however, these programmes are very different from the BBAP. Thus, the BBAP is designed to be delivered in a single session by skilled external facilitators, an approach which essentially seeks to reduce the burden on teachers and school resources (including administration and teacher training costs). In addition, a single-session workshop is considered as being easily incorporated into the school curriculum and timetabling system, with the BBAP workbook serving to support the aims and ethos of the programme thereafter.

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The children’s attitudes and views of the BBAP were assessed using specially designed child friendly questionnaires, informed to some extent, by the Growing up in Ireland (GUI) study. The questionnaire incorporated the use of colour, diagrams and child friendly emojis to promote active child participation. According to the research literature, children aged 7+ are more likely to be able to complete these kinds of assessments (Borgers, de Leeuw & Hox, 2000) and this was also generally the case here. However, some of the younger children had difficulty in recalling, for example, their ‘favourite thing about the workshop’ or provided varying degrees of understanding in their responses the question about ‘what they had learned about feelings’ in the workshop. The former may have been due, at least in part, to time lag between the programme delivery (in the case of almost one third of the children) and data collection. Future research might make more clear and explicit, the language around feelings and emotions to aid understanding and also help to identify the best way to assess children’s understanding of these types of concepts.

In addition - and as mentioned above - the relatively brief exposure of the children to some of the concepts in the BBAP workshop may also be a factor here. Some of all of these factors may have accounted for the relatively large proportion of missing responses to some of the questions. However, it seems reasonable at this juncture, based on the overall findings from the child cohort, to suggest that the visual daily reminder in the form of the Buddy Bench - as well as sitting on the bench in a significant minority of cases - in conjunction with the elements of information/concepts gleaned from both the workshop and the workbook, will have increased awareness and given the children the foundational skills with which to ‘ start the conversation’ around important concepts such as friendship, empathy, kindness and tolerance.

6.2 Other stakeholdersThe teachers provided predominantly positive feedback on the programme and all but one reported that they would ‘recommend the programme’ to other schools. When asked to indicate their primary sources of concern in the school prior to the BBAP, they mentioned child isolation, poor co-operation in the school yard and bullying, all of which the programme is designed to target (implicitly or explicitly).

Currently, and as previously mentioned, the BBAP is delivered as a universal preventative approach and, in contrast to other well-known programmes (e.g. Zippy’s Friends and the IYTCM programme), the teachers are not involved in programme delivery. However, it can be reasonably suggested that to ensure programme effectiveness, the teachers should be encouraged to play an active role in reinforcing the concepts underlying this programme during school time by perhaps incorporating the most relevant elements into the SPHE classes. Notably, a new mental health initiative was recently launched in the United Kingdom by Heads Together (a charitable organisation) called ‘Mentally Healthy Schools’. This website based support system (which is expected to ‘go live’ shortly) will be a source of information and practical resources for primary school teachers to assist them in supporting any pupils experiencing mental distress (Heads Together, 2018). It could also serve as a valuable resource in supporting the implementation of the BBAP in Irish primary schools.

Only two parents (out of an initial five) agreed to take part in a focus group, both of whom were members of the school PTA. Both expressed positive attitudes toward, and an appreciation of, the underlying concepts associated with this programme, and alluded to the positive effects of the BBAP in their child’s school, both in the short and longer term. Both of the parents expressed the desire to see the BBAP as something that would develop as part of the school culture, with suggestions that the Buddy Bench (and the associated concepts)

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be introduced to children as soon as they begin primary school. This, they believe will result in the BB becoming more readily accepted and becoming the ‘cultural norm’ in the school. Interestingly, parental interest and engagement are encouraged as part of the previously mentioned ‘Friends for Life’ programme (DES, 2012).

However, some of the parents’ responses suggested that they were not fully informed about the content and aims of the BBAP. Whilst the sample of parents is too small to allow for generalisability, the findings suggest that there may be some barriers to effective communication between the school and the parents in relation to the programme, but also, possibly between the school and those delivering the programme. Arguably, both parents and teachers have a vital role to play in the success of this programme in terms of successful implementation, support and acceptance. For example, if they are better informed, they may be more likely to engage with the programme and to interact with, and seek feedback from, their child about elements of the BBAP (e.g. workshop content), thereby helping to ‘keep the conversation going’ both at home and at school. Furthermore, the successful implementation of any form of mental health promotion in primary schools requires ‘a whole school approach’ involving pupils, staff and parents (DES, 2015).Lastly, and as previously mentioned, the BBAP is only one of a suite of similar (age-related) mental health promotion programmes currently being delivered in Irish primary schools by Life Matters. Future research exploring the relative effectiveness of these programmes would be beneficial.

6.3 Strengths and limitations of the studyThis is the first study of its kind to be carried out on the BBAP, a new mental health promotion intervention being delivered in a number of primary schools in Ireland. Recent national policy in Ireland highlights a need for more evidence-based intervention programmes, such as ‘Zippy’s Friends and the Incredible Years programmes (DES, 2015). Thus, more research is required to provide evidence around new and emerging interventions and programmes such as the BBAP. A key strength of the current study was the use of mixed methods and the involvement of multiple stakeholders (which allowed for the inclusion of different perspectives), albeit only small numbers of teacher and parents participated due to the nature of the study and attendant resource constraints. However, all three schools were highly engaged with the research (which is not always the case) and were distributed across a number of geographical areas.

The study was undertaken on a pilot basis only and therefore, had several limitations, which should be kept in mind when interpreting the findings. Firstly, only three schools were available to take part (albeit from three different counties) so the sample of children may not be representative of all children in schools across the country where the programme is being implemented. Secondly, the qualitative element of the study was limited due to the small number of parents who were available to take part. Only two out of the original five parents arrived to participate in the focus group on the day. This was most likely due to the time of year (before Christmas). Having said that, both parent participants were engaged, well informed and closely associated with the school’s PTA so it is possible that their views are not atypical. Further research is required in this respect.

An additional limitation is related to the challenges of involving younger children in research of this nature. In order to address these challenges, researchers often use a wide range of methods to elicit children’s views (e.g. drawings) (Clark, 2005b). In the current study, there were relatively high incidences of missing data on some of the questions and the children had some difficulties with recall. Although every effort was made to promote child

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participation (i.e. the use of a child-friendly questionnaire), other methods (e.g. interviews, include more diagrammatic representation in the questionnaire) could be considered in future research in order to fully capture and understand the children’s views of the BBAP and its perceived benefits (or lack thereof).

6.4 Some directions for future research This pilot study was conducted to provide an initial indication of the effectiveness of the BBAP. Further (quantitative and qualitative) research is warranted. For example, it would be useful to carry out a larger more representative survey or before-after study across more schools. Additional in-depth interviews with school principals, teachers (whose children participate in the BBAP), parents, programme developers and other key stakeholders, are required to explore the future development, implementation and perceived effectiveness of the programme (including barriers/challenges). For instance, teachers are perhaps best placed to suggest how the programme might, for example, be adapted or modified going forward. In addition, it would be interesting to interview some of the children (across the age range) directly after taking part in the programme to assess their immediate views and opinions and indeed to assess their overall understanding of the BBAP. This would also help to build on and expand questionnaire/survey-based data.

A two-year evaluation of the BBAP has just commenced (January 2018), funded jointly by the Irish Research Council (IRC) of Ireland and by Life Matters (Quinn, McGilloway and O’Toole). This new study will allow us to build on the research reported here and to use a range of methodologically rigorous methods to more fully inform the development and implementation of the programme and to assess its overall effectiveness (including an assessment of differential sub-group effects, such as age and gender etc).

6.5 Conclusion/key recommendations for future research and programme delivery

Role of the Parent Teacher AssociationRecognise the pivotal role of the school’s PTA in facilitating and supporting the BBAP. For example, this might involve the preparation of a presentation pack aimed at PTA members and school principals.

AccessEstablish a standard method of both identifying and initiating first contact with the target schools and relevant personnel; this is important in addressing any gatekeeper issues that can often arise, both for those delivering and researching the programme.

Parental involvement - ‘continuing the conversation’Consider the importance of informing and educating all parents. Parents need to be fully informed about all elements of the BBAP. There may be scope to provide materials specifically designed for parents (resources permitting) to help them support their children in learning some of the concepts underpinning the programme (e.g. provide a link to a short video on the company website). In addition, consider linking in with the schools to provide a text -to -parent alert, immediately before and after the intervention is being delivered in a school to remind parents that this is happening to increase parental awareness and encourage programme-related discussions at home with the children.

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The teacher’s role in successful programme implementation The underlying message/concepts associated with the BBAP need to be reinforced by teachers once the BBAP has been delivered to the children, by means of a ‘whole school approach’. The teachers have an invaluable role to play in trying to establish intervention concepts and embed these as part of the school ethos. For example, perhaps the BBAP workbook could be used more regularly during class time, even once weekly as part of the SPHE class. The teachers could also be asked to identify any at risk/potentially vulnerable children who may possibly benefit from ‘booster’ workshop sessions. However, this would need to be carefully managed in terms of how children might feel by being singled out for special attention.

Modifications to the intervention/programmeConsider designing and rolling out the programme in the same manner as the Department of Education: i.e. to Junior and Senior infants, 2nd and 3rd class, etc., and adjust the language and concepts accordingly, with due consideration given to the age, retention levels, and cognitive abilities of the target children.

The duration of the BBAP workshop is typically 40 minutes. Consider adjusting the time, and volume of content for the younger participating children who may find it difficult to fully comprehend the novel concepts to which they are being introduced. For example, the concept of ‘feelings’ might be considered too ‘information heavy’ for younger children.

The importance of follow upConsider establishing a follow-up process with both parents and teachers once the intervention/programme has been delivered. For example, it may be possible to send parents and teachers an online link that directs them to a short evaluation form on the company website.

Embedding the programme and its concepts Recognise and explain that some of the anticipated effects of the programme may not be immediate and may only materialise in the longer term. This suggests that further follow-up booster sessions may be required to ensure that the BBAP concepts are embedded and sustained as part of the school ethos and culture.

7.References

Borgers, N., De Leeuw, E., & Hox, J. (2000). Children as respondents in survey research: Cognitive development and response quality 1. Bulletin de methodologie Sociologique, 66(1), 60-75.Clark, A. (2005). Listening to and involving young children: a review of research and practice.

Early child development and care, 175 (6), 489-505.Costello, E. J., Egger, H. L., & Angold, A. (2004). The Developmental Epidemiology of Anxiety Disorders. In T. H. Ollendick & J. S. March (Ed.), Phobic and anxiety disorders in children and adolescents: A clinician's guide to effective

psychosocial and pharmacological interventions (pp. 61). New York, NY:Oxford University Press.

Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalenceand development of psychiatric disorders in childhood and adolescence.Archives of General Psychiatry, 60(8), 837-844.

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Department of Education and Skills. (2015). Guidelines for Mental Health PromotionWellbeing in Primary Schools. Dublin, Ireland: The Stationary Office.

Heads Together (2015). ‘Mentally heathy schools’. Retrieved from https://www.headstogether.org.uk/schools/?utm_source=Centre+for+Mental+Health+Core+List&utm_campaign=7817dbb24a-EMAIL_CAMPAIGN_2018_01_30&utm_medium=email&utm_term=0_c0ac5acb39-7817dbb24a-207871825

Mental Health Foundation (2002). The Mental Health Needs of Young People with Emotional and Behavioural Difficulties. Bright Futures: Working with Vulnerable Young People. London: Mental Health Foundation.

Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology ofmental disorders in children and adolescents. Dialogues in clinicalneuroscience, 11(1), 7-20.

Murray, N.G., Low, B.J., Hollis, C., Cross, A.W., & (2015). Coordinated school health programs and academic achievement: a systematic review of the literature. Journal of School Health, 77(9), 589-647.

O'Toole, C., Furlong, M., McGilloway, S., & Bjørndal, A. (2017). Preschool andschool-based mindfulness programmes for improving mental health andcognitive functioning in young people aged 3 to 18 years. Cochrane Databaseof Systematic Reviews, 1, 1-16.

Snell, T., Knapp, M., Healey, A., Guglani, S., Evans‐Lacko, S., Fernandez, J. L., ... &Ford, T. (2013). Economic impact of childhood psychiatric disorder on publicsector services in Britain: estimates from national survey data. Journal ofChild Psychology and Psychiatry, 54(9), 977-985.

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