Friends programme: Friends for Life

Summary

Introduction

As mental health challenges increase among children in various age groups, there is a need for preventive measures and low-threshold support to alleviate symptoms. The purpose of the Friends programme is to support mental wellbeing and strengthen resilience. Different versions designed to suit the needs of different age groups utilise peer learning and activity-based exercises. The programme suits a wide range of target groups and is easy to implement. It can be used either in the child’s developmental environment, such as school, or as part of health and social services, in which case it is targeted at children who exhibit symptoms. The Friends for Life version of the Friends programme is intended for children aged 9–12 years to prevent anxiety and depressive symptoms.

Objective and research question

This systematic literature review assesses the effectiveness of the Friends for Life version of the Friends suite of interventions on the basis of research literature. The review answers the following questions: In how much detail is the Friends programme described? Does the Friends for Life version of the Friends programme have evidence-based effectiveness, applicable to Finland, on the mental wellbeing of children aged 9–12, especially with regard to anxiety and depressive symptoms?

Data and research methods

This study used the Population, Concept and Context (PCC) strategy to search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: What research has been done on the Friends programme? The following keywords were used: P = children and adolescents, C = Friends. Context (C) was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the Friends for Life version of the intervention, although other types of studies were also included. A systematic search was carried out for the following six reference databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for publications in Finnish was performed via the Finna.fi service. The search was supplemented with a manual search.

Results

A total of 19 effectiveness study articles were included in the assessment. One of the studies was Finnish, three were Nordic and the rest were studies that met the inclusion criteria and had been carried out in high-income countries in accordance with the World Bank’s country classification. In addition, the literature searches identified two Finnish studies that are reported in the reflection section. Two systematic literature reviews, four meta-analyses and one study that was both a systematic review and a meta-analysis could not be assessed as such because they also included studies concerning countries other than high-income countries. Two of the studies also included other interventions besides Friends. Evidence of effectiveness has been obtained from Nordic studies as well as studies concerning other high-income countries. The quality of the studies was varied. The studies were focused on assessing the effectiveness of Friends for Life, which is the version of the Friends programme aimed at school-aged children. The studies were divided in terms of whether the intervention was assessed as 1) a universal intervention implemented for everyone in a particular school, or 2) a targeted intervention for children or adolescents with anxiety symptoms, either a) in school or b) in the context of a service providing psychosocial care. Effectiveness with regard to the wellbeing of children and adolescents was primarily measured in terms of the reduction of anxiety symptoms and, in certain studies, also changes in depressive symptoms and social skills. According to the assessment, the intervention was observed to have positive effects on the mental wellbeing of children and adolescents through the reduction of anxiety symptoms (d=0.008–0.70) and the reduction of depressive symptoms (d=0.04–0.63). No negative effects were observed. In particular, the programme appears to be beneficial for children who are already exhibiting symptoms. The studies provided indications that, in the school environment, especially interventions implemented by external professionals produced positive effects. The verification of preventive and long-term effects was made more difficult by the research design that is typical of intervention studies, where the control group was on a waiting list for participating in the programme. Support for the implementation of the intervention was assessed to be moderate. The intervention and its theoretical foundation are well-described, and the link between the core elements and the theory is satisfactorily explained.

Methodology evaluation

The Friends for Life version of the Friends suite of interventions receives a methodology evaluation score of 4/5. There is evidence of effectiveness with regard to improved mental wellbeing among children and adolescents in the 9–12 age group, particularly in terms of reduced anxiety and depressive symptoms. In several studies, the programme is compared with another intervention, a waiting list or standard care or support. The results provide indications of the usefulness of the intervention as part of communal activities in a child’s developmental environment. More research is needed on the effectiveness of universal interventions focused on the prevention of anxiety symptoms.