Background: Children with a learning disability experience a range of inequalities and adverse life events that put them at greater risk of mental health problems. The construct of emotional literacy has been shown to be a moderating factor of how life stress affects mental health. Teaching emotional literacy in schools may therefore be an effective way to promote positive mental health. There is an identified need for adapted emotional literacy programmes in special schools.
Objectives: To evaluate whether it is feasible to conduct a large-scale randomised controlled trial of the effectiveness and cost-effectiveness of an emotional literacy programme (Zippy's Friends special educational needs and disabilities) for children with a learning disability in special schools. The key aims were to assess the acceptability and feasibility of participating in the trial, data collection and the Zippy's Friends special educational needs and disabilities intervention through quantitative and qualitative data collection.
Design: A feasibility, cluster randomised controlled trial that aimed to recruit and randomise 12 special schools to either deliver the intervention over 1 academic year or continue with practice as usual and to collect data from 96 pupils at baseline (pre randomisation) and 12 months post randomisation.
Setting: Special schools in England and Scotland.
Participants: Pupils with a learning disability, aged 9-11 years, attending special schools in England. Follow-up interviews were conducted with 8 pupils, 4 parents/carers and 11 school staff members.
Intervention: Zippy's Friends for Special Educational Needs and Disabilities is a manual-based, classroom-based emotional literacy programme focused on a problem-solving approach to develop and improve children's emotional literacy. The mainstream programme has been adapted for children with a learning disability by simplifying the activities, shortening the sessions and introducing more repetition.
Main outcome measures: Feasibility and acceptability of: (1) participation in the research trial; (2) the collection of the outcome measure data and (3) the Zippy's Friends for Special Educational Needs and Disabilities intervention.
Results: A total of 8 schools and 53 pupils were recruited. Retention of schools after randomisation (100%) and retention of pupils (100%) met the prespecified progression criteria. For recruitment of schools (20.5% of those approached), pupil engagement with the intervention (50%) and collection of outcome and service use data (62.3%) the criteria were partially met. Fidelity of the intervention delivery (48%) fell just below the progression criteria. Thus, the feasibility and acceptability outcome progression criteria were largely met, suggesting that progression to a full trial is warranted with amendments to the study design.
Limitations: This feasibility trial was conducted during the COVID-19 pandemic, resulting in unusually high absences of pupils and teachers, different classroom arrangements (bubbles) and unprecedented stress and emotional challenges for pupils, parents and teaching staff. The findings are therefore specific to that period and all three main outcomes of this feasibility trial were adversely affected.
Conclusions: The findings of this study indicate that a large-scale randomised controlled trial is feasible provided that a number of amendments to the study design are made to improve: (1) the timing of the project to suit the demands of special schools' yearly timetable; (2) recruitment and (3) outcome and service use data collection.
Future work: On the basis of the current findings, an application for a full trial will be prepared and submitted with a number of amendments.
Trial registration: This trial is registered as ISRCTN83610691.
Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129064) and is published in full in Public Health Research; Vol. 12, No. 15. See the NIHR Funding and Awards website for further award information.
Keywords: EMOTIONAL LITERACY; FEASIBILITY STUDY; INTELLECTUAL DISABILITY; MENTAL HEALTH; SPECIAL EDUCATIONAL NEEDS.
Emotional literacy (the ability to understand, express and manage your own feelings and be aware of other people’s emotional needs) is important for mental health. There are no programmes where research tells us that emotional literacy programmes for children in special schools ‘work’. Zippy’s Friends is an emotional literacy programme widely used in mainstream schools. Zippy’s Friends for Special Educational Needs and Disabilities is adapted for use in special schools. Eight special schools were involved. Five used Zippy’s Friends for Special Educational Needs and Disabilities in at least one class over a school year. They were compared with three that used standard teaching programmes only. Teachers, parents and children completed questionnaires to measure changes in children’s emotional literacy, mental health and behaviour over the school year. We also interviewed teachers, parents and children to find out about their experiences of taking part in the study and Zippy’s Friends for Special Educational Needs and Disabilities. This study was designed to find out: How willing schools are to take part If Zippy’s Friends for Special Educational Needs and Disabilities can be delivered as planned If the questionnaires are suitable. Fifty-three pupils were recruited; none dropped out. Teachers returned questionnaires for 62% of children at the end of the school year. Feedback on Zippy’s Friends for Special Educational Needs and Disabilities from pupils, parents/carers and teachers was very positive. This study took place during the COVID-19 pandemic. Although this made it more difficult, it was feasible. The results tell us that a larger-scale version of this study can be done, provided that we make changes to improve: (1) the timing of contacting schools; (2) how we collect information and (3) how we work with parents/carers. With these improvements, a larger study may be able to tell us whether Zippy’s Friends for Special Educational Needs and Disabilities can improve emotional literacy in children in special schools to help them cope with problems and have better mental health.