Evidence reviews for interventions to support children and young people during periods of transition
Evidence review I
NICE Guideline, No. 223
1. Effectiveness of transition support interventions
1.1. Review question
What are effective and cost-effective interventions to support the social, emotional and mental wellbeing of children during periods of transition (such as between schools, life stages or due to traumatic events)?
1.1.1. Introduction
Social and emotional skills are key during children and young people’s development that may help to achieve positive outcomes in health, wellbeing and future success. Going through a time of transition whether planned e.g. moving from primary to secondary school or unexpected e.g. family break-up can potentially impact negatively on wellbeing. Interventions aimed at providing support at these times of transition may help to reduce poor outcomes.
1.1.2. Summary of the protocol
Table 1
PICO Table.
1.1.3. Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual and in the methods chapter.. Methods specific to this review question are described in the review protocol in Appendix A and in the methods document.
Outcome measures
Where social and emotional outcome measures were reported in a study from multiple sources, the data used followed the following hierarchy of preference:
- Child/ young person reported
- Teacher reported
- Parent reported
However, for behavioural outcomes, measures reported by teachers were the preferred option as they are generally outcomes that are observed.
Cluster randomised controlled trials
Where cluster randomised controlled trials have been pooled with individually randomised controlled trials, the number of people included in the analysis from these trials have been adjusted using a reported or imputed intra-class correlation coefficient (ICC) for that outcome.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
1.1.4. Effectiveness evidence
1.1.4.1. Included studies
In total 19,749 references were identified through systematic searches for all 3 review questions in this review.. Of these, 349 references were considered relevant, based on title and abstract, to the protocols for transition support in schools and were ordered. A total of 25 studies from 28 references were included across the three review questions and 319 references were excluded. There were 2 studies where the full text was unavailable. Additionally, 5 studies on Managed Moves were added after the search was completed.
A total of 18 studies from 21 publications were included for this review question on the effectiveness of transition support interventions. Of these studies, 3 were individual randomised controlled trials, 8 were cluster randomised controlled trials and 7 were non-randomised controlled trials.
Of the studies identified, 13 focused on school transitions, 2 focused on family break-up and 3 focused on children and young people from immigrant and refugee families.
See Appendix D for full evidence tables.
1.1.4.2. Excluded studies
See Appendix J for a list of excluded studies.
1.1.5. Summary of studies included in the effectiveness evidence
Table 2
Summary of studies identified for school transitions.
Table 3
Summary of interventions for school transitions.
Table 4
Summary of studies identified for transition support during family break-up.
Table 5
Summary of interventions for transition support during family break-up.
Table 6
Summary of studies identified for transition support for children and young people from immigrant or refugee families.
Table 7
Summary of interventions for transition support for children and young people from immigrant or refugee families.
1.1.6. Summary of the effectiveness evidence
Table
School transitions: Intervention compared to control for social, emotional and mental wellbeing. Patient or population: Children and young people transitioning schools Intervention: School transitions: Intervention
Table
Divorce: Intervention compared to control for social, emotional and mental wellbeing. Patient or population: Children and young people whose parents are going through a divorce Intervention: Divorce: Intervention
See Appendix F for full GRADE tables
1.1.7. Economic evidence
A guideline wide search of published cost-effectiveness evidence was carried out for review questions 1.1, 3.1, 4.1, 5.1 and 6.1.
3504 records were assessed against eligibility criteria.
3433 records were excluded based on information in the title and abstract. Two reviewers assessed all the records. The level of agreement between the two reviewers was 100%.
The full-text papers of 71 documents were retrieved and assessed. 15 papers were assessed as meeting the eligibility criteria. However, this accounted for 13 distinct studies since some papers used the same underlying data.
Two reviewers assessed all full-text papers. The level of agreement between the two reviewers was 100%. There were no eligible studies for RQ 6.1 on Transitions.
The study selection process can be found in Appendix G.
The documents and reasons for their exclusion are listed in Appendix J – Excluded studies.
1.1.8. Economic model
A bespoke model was developed to capture the costs and consequences of an intervention, or combination of interventions, that promote social, emotional and mental wellbeing in children and young people in primary and secondary education. It covers more than 1 evidence review in the guideline so the full write up is contained in a separate document rather than in appendix I (see Evidence review J).
1.1.9. Evidence statements
Sufficient data were not extractable for the following studies and has therefore been reported as evidence statements.
School transitions
Social and emotional skills
Evidence from 1 RCT (Rutt 2015 [N= 557]) showed no difference in confidence and self-esteem for children receiving a targeted literacy programme compared to usual support as they transitioned from primary to secondary school (effect size = 0.14, 95%CI −0.03 to 0.32, p = 0.10). The risk of bias for this evidence was rated as some concerns.
Behavioural outcomes
Evidence from 1 NRCT (Johnson 2008 [N= 157]) reported a mean change in school related misconduct for both low-risk and high-risk pupils receiving an integrated universal and selected intervention compared to control (mean change high-risk 0.80 vs 2.55) (mean change low-risk −0.08 vs 0.41). The significance of the results were not reported. The risk of bias of this evidence was moderate.
Academic attainment and progression
Moderate quality evidence from 1 RCT (Rutt 2015 [N= 557]) showed no difference in reading scores for children receiving a targeted literacy programme compared to usual support as they transitioned from primary to secondary school. (Effect size 0.12 95% CI −0.02 to 0.25). The risk of bias for this evidence was rated as some concerns.
Evidence from 1 RCT (Corsello 2015 [N= 521]) reported a significant difference for reading and maths scores for young people receiving a universal programme as they transitioned from middle to high school. (MD and 95% CI not reported). The risk of bias for this evidence was rated as some concerns.
Support for immigrants and refugees
Social and emotional skills
Evidence from 1 cRCT (Rousseau 2007 [N= 123]) showed no difference for self-esteem in children from immigrant or refugee families participating in drama therapy compared to a control group. (MD and 95% CI not reported). The risk of bias for this evidence was rated as some concerns.
Behavioural outcomes
Evidence from 1 cRCT (Rousseau 2007 [N= 123]) showed no difference for behavioural problems in children from immigrant or refugee families participating in drama therapy compared to a control group. (MD and 95% CI not reported). The risk of bias for this evidence was rated as some concerns.
Economic evidence statements
There were no eligible published studies for this review on transitions.
Coote (2021) aimed to quantify the costs and effectiveness, and hence the impact, of introducing a range of mental health and wellbeing interventions. The large range of interventions on offer and the circumstances in which the interventions are implemented made it difficult to draw robust conclusions regarding the effectiveness of interventions and associated economic impact.
2. Acceptability of transition support interventions
2.1. Review question
Are interventions to support the social, emotional and mental wellbeing of children and young people during periods of transition (such as between schools, life stages or due to traumatic events) acceptable to:
- Children and young people
- Teachers/practitioners delivering the interventions
- Parents/Carers of children and young people receiving the interventions
- Schools/teachers dealing with the consequences of transition e.g. secondary schools dealing with a child’s transition from primary to secondary school
2.1.1. Introduction
Social and emotional skills are key during children and young people’s development that may help to achieve positive outcomes in health, wellbeing and future success. Going through a time of transition whether planned e.g. moving from primary to secondary school or unexpected e.g. family break-up can potentially impact negatively on wellbeing. Interventions aimed at providing support at these times of transition may help to reduce poor outcomes.
2.1.2. Summary of the protocol
Table 8
PICO Table.
2.1.3. Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual and in the methods chapter.. Methods specific to this review question are described in the review protocol in Appendix A and in the methods document.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
2.1.4. Qualitative evidence
2.1.4.1. Included studies
In total 19749 references were identified through systematic searches. Of these, 349 references were considered relevant, based on title and abstract, to the protocols for transition support in schools and were ordered. A total of 25 studies from 28 references were included and 319 references were excluded. There were 2 studies where the full text was unavailable. Additionally, 5 studies on Managed Moves were added after the search was completed.
A total of 10 studies from 8 publications were included for this review question on acceptability of transition support interventions.
Of the studies identified, 4 focused on school transitions (primary to secondary), 1 focused on children and young people from immigrant and refugee families and 5 focussed on Managed Moves.
See Appendix D for full evidence tables.
2.1.4.2. Excluded studies
See Appendix J for a full list of excluded studies.
2.1.5. Summary of studies included in the qualitative evidence
Support for school transitions
Table 9
Summary of qualitative studies identified for school transitions.
Table 10
Summary of themes and findings.
Table 11
Summary of qualitative evidence for school transitions.
Interventions to support children and young people from immigrant and refugee families
Table 12
Summary of qualitative studies identified for support for children and young people from immigrant and refugee families.
Table 13
Summary of themes and findings.
Table 14
Summary of qualitative evidence for support for children and young people from immigrant and refugee families.
2.1.6. Summary of the qualitative evidence
See Appendix F for full GRADE-CERQual tables
3. Barriers and facilitators to transition support interventions
3.1. Review question
- What are the barriers and facilitators to transition based interventions to promote social, emotional and mental wellbeing in children and young people?
3.1.1. Introduction
Social and emotional skills are key during children and young people’s development that may help to achieve positive outcomes in health, wellbeing and future success. Going through a time of transition whether planned e.g. moving from primary to secondary school or unexpected e.g. family break-up can potentially impact negatively on wellbeing. Interventions aimed at providing support at these times of transition may help to reduce poor outcomes.
3.1.2. Summary of the protocol
Table 17
PICO Table.
3.1.3. Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual and in the methods chapter.. Methods specific to this review question are described in the review protocol in Appendix A and in the methods document.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
3.1.4. Qualitative evidence
3.1.4.1. Included studies
In total 19749 references were identified through systematic searches. Of these, 349 references were considered relevant, based on title and abstract, to the protocols for transition support in schools and were ordered. A total of 25 studies from 28 references were included and 319 references were excluded. There were 2 studies where the full text was unavailable. Additionally, 5 studies on Managed Moves were added after the search was completed.
A total of 4 studies from 2 publications were included for this review question on barriers and facilitators to transition support interventions.
Of the studies identified, 4 studies focused on school transitions (primary to secondary) and 5 studies focused on Managed Moves. See Appendix D for full evidence tables.
3.1.4.2. Excluded studies
See Appendix J for a list of excluded studies.
3.1.5. Summary of studies included in the qualitative evidence
3.1.6. Summary of the qualitative evidence
See appendix F.2.1.3 for full GRADE-CERQual tables
4. Integration and discussion of the evidence
4.1. Mixed methods integration
4.1.1. Are the results/findings from individual syntheses supportive or contradictory?
The quantitative data was broadly mixed across all outcomes for school transition interventions. Effectiveness of interventions showed significant differences and non-significant differences for multiple outcomes. Qualitative evidence included themes around children and young people feeling supported and having worried alleviated by transition interventions, but this is not strongly supported by quantitative evidence. There was very limited qualitative data regarding support for refugees and immigrants, but this similarly included themes around benefits from derived from interventions. This somewhat contradicted the quantitative evidence, which showed no difference in social and emotional skills or behavioural outcomes.
4.1.2. Does the qualitative evidence explain why the intervention is/is not effective?
The quantitative data for school transition interventions was broadly mixed and the qualitative evidence did not explain why these interventions were effective or not effective. Regarding support for immigrants and refugees, qualitative evidence highlighted regarding privacy and schools being perceived as busy and hectic. This may partly explain quantitative data did not show significant effects.
4.1.3. Does the qualitative evidence explain differences in the direction and size of effect across the included quantitative studies?
Collectively the qualitative data did not provide clear explanations for the variations in quantitative data. However, it did highlight areas that could contribute to making transition interventions successful or unsuccessful. These elements included good staff appointments and flexibility as factors for success and timetabling and staffing issues.
4.1.4. Which aspects of the quantitative evidence were/were not explored in the qualitative studies and which aspects of the qualitative evidence were/were not tested in the quantitative studies?
The overlap between the quantitative and qualitative findings for this review does not make any meaningful integration possible. This is predominantly because the qualitative evidence is very much focussed on process related understanding. Additionally, qualitative themes around the impact of the interventions are only perceptions of impact and not objective measures. The themes are very useful in understanding why the transition interventions worked (or did not work), but other than at a very superficial level they unable (without substantial speculation) to explain the pupil level outcomes.
4.2. The committee’s discussion and interpretation of the evidence
4.2.1. The outcomes that matter most
The committee categorised outcomes of interest as social and emotional wellbeing (SEW) outcomes and academic outcomes and agreed that more weight should be given to the social and emotional outcomes. This is because, in theory, improvement in social and emotional wellbeing may lead to improvements in academic progression and attainment. Ultimately, an improvement in social and emotional outcomes may lead to overall improvement in quality of life. Within the category of social and emotional wellbeing, the committee agreed that these could be sub-categorised into social and emotional skills, behavioural outcomes and emotional distress.
Within the category of social and emotional outcomes, the committee agreed that a measure of emotional distress (e.g. depression or anxiety) was the most important, as this is often the reason a child or young person is identified as needing additional support. Furthermore, a reduction in symptoms of emotional distress is likely to have an immediate impact on the child’s wellbeing and reduce the chance of being diagnosed with a mental health disorder. This reduction in emotional distress may lead to fewer experiences of mental health difficulties and may also help the child or young person to concentrate better in class and achieve their academic goals for that school year. The committee also felt that less weight should be given to behavioural outcomes in this context as these might be a result of experiencing emotional distress. The committee acknowledged that social and emotional skills are very important in order to build the resilience needed to help manage adverse circumstances that might otherwise lead to emotional distress.
As mental health difficulties can impact on school measures, outcomes such as poor school attendance and school exclusions may serve as a proxy for identifying mental health-related problems. School exclusions are often a result of behavioural problems linked with emotional distress. The consequences of school exclusions often include family distress which may have a negative impact on mental wellbeing.
4.2.2. The quality of the evidence
School transitions
Quantitative evidence
There were 13 studies identified that evaluated interventions that provide support at a time of school transition. Of these studies, 4 were carried out in the UK, 4 in the USA, 3 in Greece, 1 in Portugal and 1 in Australia. Most of the studies focused on the transition between primary and secondary school (n=9). Other studies (n=3) focused on the middle to high school transition (UK equivalent KS3 to KS4) and the final study focused on children who had recently transitioned to the first year of primary school (UK equivalent KS1). Although education environments vary across different countries, the committee acknowledged that the type and timing of the transitions in the evidence were equally important in the UK setting.
The interventions evaluated in the studies varied. They included universal approaches which included transition-specific content in the curriculum or focused on social and emotional learning skills such as emotional literacy. Some interventions took a more whole-school approach to transitions. Other studies focused on targeted populations that needed extra support during transitions due to reasons including below average scores in literacy, elevated depression symptoms or children with ASD. Many of the interventions were delivered by school staff such as teachers, teaching assistants and SENCOs. Other interventions required a specialist provider such as an educational psychologist. One of the targeted interventions was provided by a counsellor.
The studies used usual support or other undefined control interventions as the comparator but did not always explain in detail what the students received. The committee would have liked to have had this detail, to enable a better interpretation of the findings and how it might apply to or differ from the UK setting.
The duration of the interventions ranged between 5 -12 weeks with some being delivered throughout most of the school year. The committee noted that this fitted an older model of school term time whereas in the UK, schools are starting to move towards a 6-term academic year with each term lasting at least 6 weeks. The committee acknowledged that the 9 to 10-week timeframe for interventions in the evidence might not be generalisable to this system.
Of the studies identified, 4 were cluster randomised controlled trials (cRCT), 3 were individually randomised controlled trials (RCT) and 6 were non-randomised controlled trials (NRCT). In a cluster design, participant data cannot be assumed to be independent of one another and should be accounted for in the analysis of the cRCT. Failure to do so leads to a unit of analysis error and over-estimation in the results. Whilst this is a known concern about analysing data in cRCTs, not all the included studies reported how they adjusted their analyses for clustering which impacted on the overall confidence in the evidence for these studies.
All the outcomes reported in these studies were obtained through self-reported measures. The committee identified that this may have implications with regards methodological limitations. For example, it is likely that participants knew which intervention they were allocated to and therefore the use of self-reported outcomes may introduce bias in outcome reporting.
There were no studies identified that reported on school exclusions. There were no unintended consequences reported in the studies, but the committee noted that there was no evidence that the interventions led to any harm based on the outcomes that were reported.
All outcomes were rated moderate to very low confidence in GRADE with most studies being low. The main reasons for downgrading were risk of bias of the study and imprecision of the effect estimates.
Qualitative evidence
There were 5 studies identified that contributed to the qualitative findings that included views and experiences of children moving between primary and secondary education. Two studies focused on those receiving a transition intervention. Three studies focused on curriculum support (universal literacy or maths and targeted support for both) at the time of transition through a programme that enhances the link between a secondary school and its feeder primary schools. These studies also included views and experiences of the teachers involved in the programmes, headteachers and education authority representatives. The themes identified included pre-intervention school transition expectations, the primary to secondary school link, impact on transition, post-intervention expectations of school transition and the post-intervention transition experience. Four studies also contributed to the findings for barriers and facilitators to implementing the intervention. The overall confidence in the evidence was moderate to high across all of the identified themes. The committee considered the evidence for managed moves separately from the general school transitions evidence because they agreed that managed moves might be a different case that made it more difficult for children and young people to integrate with their new school. They agreed that the evidence for managed moves raised the same kinds of themes that were found in the general data and were reassured that the recommendations they were making applied equally to people who were placed in schools as the result of a managed move.
Life transitions
Quantitative evidence
The committee reviewed some limited evidence about support for family break-up. There were 2 studies identified that evaluated interventions that provide support for children who are experiencing parental separation or divorce. Of these studies, 1 was carried out in the USA and 1 in The Netherlands. Both studies focused on primary school-aged children and were group interventions that specifically focused on divorce and parental separation. The interventions differed in the two studies in terms of who provided the group sessions. One study used school psychologists, social workers or the school principal. The other study used a psychiatric nurse, advanced clinical psychology graduate students or trained para-professionals. This does not reflect current practice and the committee were concerned about generalisability to the UK school setting.
Both studies used an undefined control intervention as the comparator did not further explain exactly what the children in the control group received. The committee would have liked to have had this detail, to enable a better interpretation of the findings and how it might apply to or differ from the UK setting.
There were 4 studies identified that evaluated interventions that provided support for young people who were from immigrant or refugee families. One study was carried out in Australia and three were carried out in Canada. One study included young people who had experienced war violence, one study included young people who were newly arrived immigrant and refugees. The remaining two studies included immigrant and refugee youth who had been assigned to special classes due to behavioural problems.
The interventions evaluated in the studies included drama therapy, theatre workshops, group tutoring and a CBT-based intervention. They were provided by a range of people including people from a variety of cultural backgrounds with training in psychology and/or creative arts therapies. One study used a core teacher and other studies used graduate psychology students. The interventions were delivered in sessions lasting 60-90mins.
The duration of the interventions were 8-12 weeks. As with school transition interventions, this fitted an older model of school term time and may not be generalisable to the newer model that schools are moving towards.
Five of the studies identified were cRCTs and the other was an NRCT. Not all the cRCTs reported how they adjusted their analyses for clustering which impacted on the overall confidence in the evidence from those studies.
All the outcomes reported in these studies were obtained through self-reported measures. The committee identified that this may have implications with regards to methodological limitations. For example, it is likely that participants knew which intervention they were allocated to and therefore the use of self-reported outcomes may introduce bias in outcome reporting.
There were no studies identified that reported on academic attainment and progression, school attendance or school exclusions. There were no unintended consequences reported in the studies, but the committee noted that there was no evidence that the interventions led to any harm based on the outcomes that were reported.
Qualitative evidence
There was one study identified that contributed to the qualitative findings for transition support for young people from immigrant and refugee families. This study explored the views and experiences of these young people who had received support from a secondary school-based mental health service. The themes identified in the study were the acceptability of the school setting, the role of teachers and impact of the intervention. Barriers to delivering the intervention were also identified in the study. The overall confidence in the evidence was moderate mainly due to just one study being identified.
4.2.3. Benefits and harms
School transitions
The quantitative evidence showed that interventions that used a transition-focused curriculum improved self-esteem and reduced loneliness and social dissatisfaction in children transitioning from primary to secondary school. An intervention that used a social and emotional learning curriculum showed an improvement in social skills and prosocial behaviour and a reduction in aggressive and disruptive behaviour in children who were in their first year of primary school.
Whole school approaches to transition showed no significant difference for bullying, depression symptoms, emotional symptoms, anxiety or stress.
Targeted approaches to transition may reduce behavioural difficulties for children moving from primary to secondary school but showed no significant difference for self-esteem or prosocial behaviour. A targeted intervention showed no significant difference for the number of young people above the clinical cut off for depression who were transitioning from middle to high school.
The qualitative evidence showed that children were mostly concerned about the fear of the unknown when moving from primary to secondary school. This was alleviated through increasing familiarisation with the new school environment and increasing preparedness with regards to the schoolwork that children and young people are expected to carry out in secondary education. These factors were key to the acceptability of the interventions aimed at supporting school transitions and were achieved through the implementation of an intervention that introduced cross-working between secondary schools and their feeder primaries. Considering this, the committee agreed that it was important for children to understand the culture and the environment of the school that they were moving into. They acknowledged that some of the interventions were curriculum-focused and this is important to schools, but they considered it important not to lose sight of the concerns of children undergoing transition. The committee also noted that because children and young people with SEND often require more support, it might be that extra opportunities for familiarisation of a new school would be needed for these children. Early transition arrangements are particularly important for SEND pupils.
The committee agreed that based on the evidence and extrapolating from it with their own experience and expertise it was clear that having a relationship with the child or young person would enable staff to understand the child or young person’s concerns and thoughts about changing schools and could plan ways to support them.
Some teachers in the qualitative evidence expressed concerns about the cross-working initially because of the risk of ‘stepping on the toes’ of teachers in the other schools. However, having a person in this role that can help build positive relationships between the schools can reduce these concerns and help to facilitate the intervention delivery. The committee would have liked more detail on what person would be ideal in this role but agreed that it did not have to be a teacher but could be another member of school staff. Whoever the person was, the appropriate sharing of information between schools can help smooth the transition for the child or young person, especially for those at risk of poor social, emotional and mental wellbeing.
The committee acknowledged that the qualitative evidence was based only on secondary schools and their feeder schools and that there was a gap in the evidence for children who move to a secondary school from a non-feeder school. These children will often move to their new school without the support of existing friendships. The committee reflected the importance of supporting children and young people with the loss of important relationships caused by school transitions, in their recommendations.
Significant life changes
The quantitative evidence showed that group interventions used to support children who have experienced parental separation or divorce may reduce behavioural problems but showed no statistical difference in improving competencies or reducing emotional distress.
The quantitative evidence showed that interventions to support newly arrived immigrant and refugee youth, including those who were targeted for behavioural problems showed no significant difference in improving self-esteem or prosocial behaviour. There was also no significant difference in reducing behavioural problems.
The qualitative evidence showed that refugee and immigrant youth were acceptinge of mental health support taking place in the school setting. They valued the safety and the familiarity that schools provided compared to a clinical setting and said that it helped to remove the stigma of seeking mental health support. However, some pupils were concerned about the hectic nature of schools and the potential for lack of privacy. Pupils also acknowledged that teachers played an important role in mediating or supporting their contact with the mental health service.
The committee noted the paucity of the evidence about the role that schools could play in supporting children and young people through difficult life changes outside of school, but agreed that schools should try to address any reasonable needs identified by children or young people going through these kinds of transitions, with the help of internal specialists (for example the safeguarding lead) and external agencies.
4.2.4. Cost effectiveness and resource use
The committee noted that no published cost effectiveness evidence had been identified on interventions to support the social, emotional and mental wellbeing of children during periods of transition (such as between schools, life stages or due to traumatic events).
In the absence of published evidence, the committee agreed it would be informative to develop a bespoke economic model to support decision makers understanding of the potential economic and wellbeing implications of introducing a new intervention. The model adopted cost consequences analysis as well as cost benefit analysis out of concern that the QALY is limited with regard to capturing the wide variety of outcomes relevant to childhood current and future wellbeing. Expert views were taken into account in the model. The committee noted that data paucity considerably limited the assessment of impact and cost effectiveness.
The committee considered the findings of the model which showed the interventions could be cost effective and what the key drivers of cost effectiveness were. However, they were mindful that the outcomes used in the model are associated with great uncertainty. They observed that children and young people’s outcomes could be positive or negative or a combination of the two. and that there was no evidence available to know the combined effect of an intervention across different outcomes. For positive outcomes they considered the model may over-estimate the overall benefit whereas for negative outcomes it may underestimate the total benefit. The committee believed it crucially important schools and other education settings take account of any potential adverse consequences in deciding whether to fund an intervention.
The committee were particularly concerned by the lack of studies on the long-term impact of intervening. They agreed that improvement in social and emotional wellbeing could lead to improvements in quality of life as well as improvements in academic progression and attainment. They also agreed there were likely to be benefits to the wider system including helping young people to become happy and successful adults, prepared for the opportunities, responsibilities and experiences of adult life. That the model was unable to capture these potential benefits due to an absence of data was considered a major limitation. From this view, the model could underestimate the benefit of all interventions. Other limitations noted include an oversimplification of the effect of an intervention by dichotomising continuous variables above and below a determined threshold and the lack of evidence on utility values. This could result in either underestimates or overestimates of the cost effectiveness outcomes.
They were also aware that the lack of data meant it had not been possible to adopt a holistic approach which captures the importance of a supportive and secure environment (e.g. supportive peers, role models, personal feelings of safety - to feel safe from being bullied, safe to report things without fear of stigma) and an ethos that avoids stigma and discrimination in relation to mental health and social and emotional difficulties.
The committee agreed that the potential cost effectiveness of an intervention is impacted by a myriad of factors including those relating to the intervention such as the local cost of delivery and who delivers the intervention as well as external factors such as family and peer relationships. It was also acknowledged by some that this is a relatively new field of science by which very minor changes in context or circumstance can dramatically impact the findings. Taken together with the substantial variability in the interventions available, the heterogeneity across schools and the limitations of the evidence the committee considered it unwise to draw broad conclusions from the model. Rather the committee agreed decision makers should make use of the economic model to understand the potential economic and wellbeing implications when considering the introduction of a new intervention in school and help identify any gaps in current research. The committee believe this could also help guide future research with the aim of improving the mental health and wellbeing of children and young people.
The committee highlighted that schools and higher educational settings have a statutory duty to address mental health issues – by teaching about and promoting mental well-being and ways to prevent negative impacts on mental well-being.
Finally, whilst the committee considered that implementing interventions might incur additional costs where these are not already in place, they believe that an integrated approach, using universal, whole school, targeted and transition interventions could prevent outcomes which can lead to costly consequences for wider system including the NHS, social services and the criminal justice system.
4.2.5. Other factors the committee took into account
The committee discussed the environment in primary schools where children frequently have close supervision from a trusted key adult and learn in small groups in a safe and nurturing environment. This environment should help with providing the framework for implementing extra support for social and emotional wellbeing. In contrast the environment in secondary school where children and young people work in different groups with multiple teachers and where there are generally different expectations, requires them to take care of themselves more. The qualitative evidence supports this view in that pupils moving from primary to secondary school were anxious about the new daunting and complex environment. This type of dynamic environment may contribute to a delay in identifying children and young people with poor social and emotional competencies. The committee agreed that children and young people need to be supported through those changing relationships.
The committee considered that key information about the pupil should be transferred when they start a new school but should be used in a non-stigmatised way. This information should focus on the pupil’s strengths as well as their needs. The committee considered parent involvement in discussions around the information that is transferred between schools. They noted that is was good practice for schools to be working in a person-centred way which would involve scheduling a transition meeting with parents to consider their child’s social and emotional wellbeing if a possible need for support has been identified.
The committee noted that in practice, access to peer support such as mentors and ‘buddy’ systems is key to successful school transitions, though training needed to be given to the mentors and made recommendations to this effect. They considered that primary schools could focus on building friendships ahead of these pupils meeting new peers. They also considered that it was important to continue the transition support once the child was at their new school and the new school had a responsibility to make sure that each child and young person was thriving in the new environment. The committee therefore made a recommendation to continue provide support after transitions have taken place. They were of the opinion that children who were known to be at higher risk of poor social, emotional and mental wellbeing should be monitored more often. They acknowledged that the new statutory guidance “Relationships education, relationships and sex education (RSE) and health education” (Department for Education) will help to schools enable pupils feel comfortable and confident during school transition.
Finally, the committee discussed managed moves, where a child or young person is placed in a new school by the local authority or by school-to-school voluntary agreement. They agreed that in their experience these transitions should be treated in the same way as other transitions and therefore all of the recommendations would apply to them.
4.2.6. Recommendations supported by this evidence review
This evidence review supports recommendations 1.5.1 to 1.5.7 and the research recommendation on Transitions.
5. References – included studies
- Bagley, C. and Hallam, S. (2015) Managed moves: school and local authority staff perceptions of processes, success and challenges. Emotional and Behavioural Difficulties 20(4): 432–447
- Bagley, Christopher and Hallam, Susan (2016) Young people’s and parent’s perceptions of managed moves. Emotional & Behavioural Difficulties 21(2): 205–227
- Bagnall, Charlotte Louise, Fox, Claire Louise, Skipper, Yvonne et al. (2021) Evaluating a universal emotional-centred intervention to improve children’s emotional well-being over primary-secondary school transition. Advances in Educational Research and Evaluatio. 2(1): 113–126
- Blossom, JB, Adrian, MC, Stoep, AV et al. (2019) Mechanisms of Change in the Prevention of Depression: an Indicated School-Based Prevention Trial at the Transition to High School. Journal of the American Academy of Child and Adolescent Psychiatry [PMC free article: PMC6920576] [PubMed: 31228560]
- Brouzos, Andreas, Vassilopoulos, Stephanos P, Vlachioti, Antigone et al. (2020) A coping?oriented group intervention for students waiting to undergo secondary school transition: Effects on coping strategies, self?esteem, and social anxiety symptoms. Psychology in the Schools 57(1): 31–43
- Bryan R; Treanor M; MVA C (2007) Evaluation of pilots to improve primary to secondary school transitions *EAST AYRSHIRE*. Scottish Executive
- Bryan R; Treanor M; MVA C (2007) Evaluation of pilots to improve primary to secondary school transitions *EASTBANK ACADEMY*. Scottish Executive
- Bryan, Ruth; Treanor, Morag; MVA, Consultancy (2007) Evaluation of pilots to improve primary to secondary school transitions *NORTH LANARKSHIRE*. Scottish Executive
- Bunn, Helena and Boesley, Lauren (2019) My New School: Transition to high school for children with special educational needs in England-Findings and ideas for practice. Support for Learning 34(2): 128–147
- Coelho, Vitor Alexandre; Marchante, Marta; Jimerson, Shane R (2017) Promoting a Positive Middle School Transition: A Randomized-Controlled Treatment Study Examining Self-Concept and Self-Esteem. Journal of youth and adolescence 46(3): 558–569 [PubMed: 27230119]
- Corsello, Maryann and Sharma, Anu (2015) The Building Assets-Reducing Risks Program: Replication and Expansion of an Effective Strategy to Turn Around Low-Achieving Schools. i3 Development Grant. Final Report. Grantee Submission: 1–59
- Corsello, Maryann; Sharma, Anu; Jerabek, Angela (2015) Successful Transition to High School: A Randomized Controlled Trial of the Barr Model with 9th Grade Students.: 1–11
- Craggs, Holly and Kelly, Catherine (2018) School Belonging: Listening to the Voices of Secondary School Students Who Have Undergone Managed Moves. School Psychology International 39(1): 56–73
- Cross, D., Shaw, T., Epstein, M. et al. (2018) Impact of the Friendly Schools whole-school intervention on transition to secondary school and adolescent bullying behaviour. European Journal of Education 53(4): 495–513
- Dawes, M, Farmer, T, Hamm, J et al. (2019) Creating Supportive Contexts for Early Adolescents during the First Year of Middle School: impact of a Developmentally Responsive Multi-Component Intervention. Journal of youth and adolescence [PubMed: 31705384]
- Fazel, Mina; Garcia, Jo; Stein, Alan (2016) The right location? Experiences of refugee adolescents seen by school-based mental health services. Clinical child psychology and psychiatry 21(3): 368–80 [PubMed: 26907460]
- Flitcroft, D. and Kelly, C. (2016) An appreciative exploration of how schools create a sense of belonging to facilitate the successful transition to a new school for pupils involved in a managed move. Emotional and Behavioural Difficulties 21(3): 301–313
- Harris, B., K. Vincent, P. Thomson ART (2006) Does Every Child Know They Matter? Pupils’ Views of One Alternative to Exclusion. Pastoral Care in Education: 28–38
- Humphrey, Neil and Ainscow, Mel (2006) Transition Club: Facilitating Learning, Participation and Psychological Adjustment during the Transition to Secondary School. European Journal of Psychology of Education 21(3): 319–331
- Johnson, Valerie L, Holt, Laura J, Bry, Brenna H et al. (2008) Effects of an integrated prevention program on urban youth transitioning into high school. Journal of Applied School Psychology 24(2): 225–246
- Makover, H, Adrian, M, Wilks, C et al. (2019) Indicated Prevention for Depression at the Transition to High School: outcomes for Depression and Anxiety. Prevention science 20(4): 499–509 [PubMed: 30852711]
- Mandy, William, Murin, Marianna, Baykaner, Ozlem et al. (2016) Easing the Transition to Secondary Education for Children with Autism Spectrum Disorder: An Evaluation of the Systemic Transition in Education Programme for Autism Spectrum Disorder (STEP-ASD). Autism: The International Journal of Research and Practice 20(5): 580–590 [PMC free article: PMC4887819] [PubMed: 26304678]
- Ooi, Chew S., Rooney, Rosanna M., Roberts, Clare et al. (2016) The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial. Frontiers in psychology 7: 1641 [PMC free article: PMC5086861] [PubMed: 27843435]
- Pedro-Carroll, J.L., Alpert-Gillis L (1997) Preventive Interventions for Children of Divorce: A Developmental Model for 5 and 6 Year Old Children. Journal of Primary Prevention 18: 5–23
- Pedro-Carroll, JoAnne L; Sutton, Sara E; Wyman, Peter A (1999) A two-year follow-up evaluation of a preventive intervention for young children of divorce. School Psychology Review 28(3): 467–476
- Pelleboer-Gunnink, Hannah A, Van der Valk, Inge E, Branje, Susan J T et al. (2015) Effectiveness and moderators of the preventive intervention kids in divorce situations: A randomized controlled trial. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) 29(5): 799–805 [PubMed: 26121535]
- Qualter, P., Whiteley, H. E., Hutchinson, J. M. et al. (2007) Supporting the Development of Emotional Intelligence Competencies to Ease the Transition from Primary to High School. Educational Psychology in Practice 23(1): 79–95
- Rousseau, Cecile, Beauregard, Caroline, Daignault, Katherine et al. (2014) A cluster randomized-controlled trial of a classroom-based drama workshop program to improve mental health outcomes among immigrant and refugee youth in special classes. PloS one 9(8): e104704 [PMC free article: PMC4134233] [PubMed: 25127251]
- Rousseau, Cecile, Benoit, Maryse, Gauthier, Marie-France et al. (2007) Classroom drama therapy program for immigrant and refugee adolescents: a pilot study. Clinical child psychology and psychiatry 12(3): 451–65 [PubMed: 17953131]
- Rutt, Simon; Kettlewell, Kelly; Bernardinelli, Daniele (2015) Catch Up? Literacy: Evaluation Report and Executive Summary.: 1–33
- Vassilopoulos, Stephanos P.; Brouzos, Andreas; Koutsianou, Athina (2018) Outcomes of a Universal Social and Emotional Learning (SEL) Group for Facilitating First-Grade Students’ School Adjustment. International Journal of School & Educational Psychology 6(3): 223–236
- Vassilopoulos, Stephanos P., Diakogiorgi, Kleopatra, Brouzos, Andreas et al. (2018) A Problem-Oriented Group Approach to Reduce Children’s Fears and Concerns about the Secondary School Transition. Journal of Psychologists and Counsellors in Schools 28(1): 84–101
- Vincent, K., B. Harris, P. Thomson ART (2007) Managed Moves: Schools Collaborating for Collective Gain. Emotional and Behavioural Difficulties 4(12): 283–298
5.1. Effectiveness and qualitative
5.2. Economic
No economic studies were included.
Appendices
Appendix A. Review protocols
A.1. Review protocol for transition support (PDF, 236K)
Appendix B. Literature search strategies
Please see below for Medline strategy. For full search strategies refer to the searches document on the guideline webpage. Source: MEDLINE
Database: Ovid MEDLINE(R) <1946 to January 22, 2020>
Search Strategy:
------------------------------------------------------------
- ((school* or year or class or “key stage*”) and transition*).ti,ab. (21405)
- “education* transition*”.ti,ab. (63)
- (school adj2 (adjust* or maladjust* or engagement* or intergrat* or connected* or belonging)).ti,ab. (1354)
- ((school* or academic) adj2 (achieve* or attain* or progress* or success or motivat*)).ti,ab. (7916)
- or/1-4 (30311)
- ((start* or move or moving or change or changing or enter or entering or entry or admission* or transfer* or settle or settling or transition*) adj2 school*).ti,ab. (3949)
- (“ready child*” or “ready school*” or “ready famil*”).ti,ab. (4)
- “school readiness”.ti,ab. (457)
- (school* and (exclud* or exclusion* or refus* or isolat*)).ti,ab. (8276)
- (admission* and (casual or “in year” or in-year or fair) and school*).ti,ab. (59)
- (life adj2 (chang* or transition* or disrupt*)).ti,ab. (7422)
- “adverse childhood experience*”.ti,ab. (1072)
- Life Change Events/ (22457)
- ((famil* or parent* or marital or marriage) adj3 (break* or split or divorce or separat*)).ti,ab. (5920)
- Family separation/ or Divorce/ (4648)
- child abuse/ or child abuse, sexual/ (29836)
- ((domestic or family or child* or physical or emotional or sexual) adj3 (abuse* or violence or exploit*)).ti,ab. (36111)
- (child* adj3 (neglect* or mistreat* or maltreat* or molest*)).ti,ab. (7596)
- puberty.ti,ab. (24407)
- Puberty/ (13149)
- (grief or death or bereave* or mourn*).ti,ab. (603096)
- bereavement/ or grief/ (12975)
- ((parent* or carer*) adj3 (depress* or anxiet* or “mental health”)).ti,ab. (5746)
- ((family or parent*) and ((alcohol or drug or substance) adj2 (use* or misuse* or abuse* or addict*))).ti,ab. (18248)
- ((parent* or carer*) and (prison* or imprisoned or incarcerat*)).ti,ab. (624)
- ((move or moving) adj2 (home or house)).ti,ab. (164)
- (migrant* or migrat* or immigrant* or refugee* or “asylum seek*”).ti,ab. (292420)
- Refugees/ or “Transients and Migrants”/ or “Emigrants and Immigrants”/ (30760)
- ((homeless* or housing or street) adj3 (child* or teen* or youth* or “young person*” or “young people” or adolescen*)).ti,ab. (2173)
- (runaway* adj3 (child* or teen* or youth* or “young person*” or “young people” or adolescen*)).ti,ab. (232)
- Homeless Youth/ (1250)
- ((poverty or impoverish* or poor or “low income”) and (child* or teen* or youth* or “young person*” or “young people” or adolescen* or famil* or parent*)).ti,ab. (92323)
- Poverty/ (36646)
- ((chronic or “long term” or long-term) adj2 (illness or ill-health or “ill health” or disease* or condition*)).ti,ab. (197760)
- Chronic Disease/ (259476)
- Disabled Children/ (6109)
- ((disabled or disabilit* or handicap*) adj3 (child* or teen* or youth* or “young person*” or “young people” or adolescen*)).ti,ab. (14318)
- or/6-37 (1546787)
- (school* or pupil* or teacher or teaching or headteacher* or headmaster* or headmistress*).ti,ab. (367463)
- (((city or technical) and (academy or academies or college*)) or sixth-form* or “sixth form*” or “6th form*” or “lower six*” or “upper six*” or “post 16” or post-16 or “further education”).ti,ab. (4715)
- (“secure children* home*” or “young offender* institution*” or “secure training cent*” or “secure school*”).ti,ab. (50)
- (“year one” or “year 1” or “year two” or “year 2” or “year three” or “year 3” or “year four” or “year 4” or “year five” or “year 5” or “year six” or “year 6” or “year seven” or “year 7” or “year eight” or “year 8” or “year nine” or “year 9” or “year ten” or “year 10” or “year eleven” or “year 11” or “year twelve” or “year 12” or “year thirteen” or “year 13” or “key stage one” or “key stage 1” or “key stage two” or “key stage 2” or “key stage three” or “key stage 3” or “key stage four” or “key stage 4” or “key stage five” or “key stage 5” or KS1 or KS2 or KS3 of KS4 or KS5 or “grade one” or “grade 1” or “grade two” or “grade 2” or “grade three” or “grade 3” or “grade four” or “grade 4” or “grade five” or “grade 5” or “grade six” or “grade 6” or “grade seven” or “grade 7” or “grade eight” or “grade 8” or “grade nine” or “grade 9” or “grade ten” or “grade 10” or “grade eleven” or “grade 11” or “grade twelve” or “grade 12” or “first grade” or “1st grade*” or “second grade*” or “2nd grade*” or “third grade*” or “3rd grade*” or “fourth grade*” or “4th grade*” or “fifth grade*” or “5th grade*” or “sixth grade*” or “6th grade*” or “seventh grade*” or “7th grade*” or “eighth grade*” or “8th grade*” or “ninth grade*” or “9th grade*” or “tenth grade*” or “10th grade*” or “eleventh grade*” or “11th grade*” or “twelfth grade*” or “12th grade*”).ti,ab. (101504)
- schools/ or school health services/ or school nursing/ or school teachers/ (55762)
- or/39-43 (468490)
- (medical or medicine or dental or dentist* or doctor* or physician* or nursing or “teaching hospital*” or undergraduate* or graduate* or postgraduate* or preschool* or pre-school* or nursery or “higher education” or university or universities).ti,ab. (2180256)
- 44 not 45 (280236)
- 5 and 38 and 46 (2418)
- limit 47 to (letter or historical article or comment or editorial or news or case reports) (50)
- 47 not 48 (2368)
- limit 49 to english language (2285)
- limit 50 to yr=“1995 -Current” (2025)
- remove duplicates from 51 (2017)
Appendix C. Effectiveness and qualitative evidence study selection
Download PDF (118K)
Appendix D. Effectiveness and Qualitative evidence
D.1. Effectiveness evidence (PDF, 892K)
D.2. Acceptability and barriers and facilitators evidence (PDF, 306K)
D.3. Managed Moves (PDF, 259K)
Appendix F. GRADE and GRADE-CERQual tables
F.1. GRADE tables (PDF, 207K)
F.2. GRADE CERQual tables (PDF, 189K)
Appendix G. Economic evidence study selection
Download PDF (255K)
Appendix H. Economic evidence tables
No published economic evaluations were identified for RQ6.1 on Transitions.
Appendix I. Health economic model
A bespoke model was developed to capture the costs and consequences of an intervention, or combination of interventions, that promote social, emotional and mental wellbeing in children and young people in primary and secondary education. It covers more than 1 evidence review in the guideline so the full write up is contained in a separate document rather than in appendix I (see Evidence review J).
Appendix J. Excluded studies
Table
Not a systematic review Qualitative study conducted outside of the UK
Excluded economic studies
Appendix K. Research recommendations – full details
K.1. Research recommendation (PDF, 141K)
K.2. Research recommendation (PDF, 144K)
Appendix L. Conceptual framework model
Download PDF (188K)
Final
Evidence reviews underpinning recommendations 1.5.1 to 1.5.7 and research recommendations in the NICE guideline
These evidence reviews were developed by developed by the Public Health Guidelines team
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.