Fox, Pauline

Hughes, Bronach

Jayman, Michelle

Ohl, Maddie

English

UWL Repository

The Pyramid project at the University of West LondonWednesday 18th November 2015University of PortsmouthJayman, Ohl, Hughes and Fox, 20151Pyramid is a manualised, school-based intervention that supports quiet, withdrawn, isolated children who find it difficult to make friends, and are between 5 to 14 years old, to develop their social and emotional competence and wellbeing.What is Pyramid?Jayman, Ohl, Hughes and Fox, 20152How it operatesUniversal screening of a year group of childrenMeeting to discuss needs, select children for clubs/alternative supportPyramid ClubsThe Pyramid ModelJayman, Ohl, Hughes and Fox, 20153•Developed by an Educational Social Worker in London in 1970s •Based on Schiffer’s 1976 work on latency period children’s need for peer group acceptance, and Kolvin’s 1970s Newcastle work on playgroups•National Pyramid Trust set up in 1992 to expand the work beyond Hillingdon, Bristol and CardiffOrigins of PyramidJayman, Ohl, Hughes and Fox, 20154• Expansion across England, Wales and Northern Ireland to around 60 local schemes • Most schemes funded at Local Authority level via the Children’s Fund, Healthy Schools, TaMHS etc – ring fenced government funding to support social-emotional wellbeing in schools • Evidence base mostly unpublished or in the ‘grey’ literaturePyramid Timeline to 2008Jayman, Ohl, Hughes and Fox, 20155• Publication of data from both University of West London and the research team at Ulster University led by Dr Tony Cassidy in peer-reviewed journals• 2010 coalition elected – Children’s Fund discontinued and increased devolution of education spending to the schools, with rise in academies/free schools outside local authority controlPyramid Timeline 2008-2013Jayman, Ohl, Hughes and Fox, 20156What happened next?Jayman, Ohl, Hughes and Fox, 20157Pyramid: A school-based community interventionhttp://www.uwl.ac.uk/pyramid/welcomeJayman, Ohl, Hughes and Fox, 20158National agenda – Future in Mind (DH/NHS England, 2015), Chief Medical Officer’s Annual Report 2012 (Department of Health, 2013) etc.– What works in enhancing social and emotional skills development during childhood and adolescence?,  (Early Intervention Foundation, 2015)– Mental Health and Behaviour in Schools (DfE, 2014)– No health without mental health: a cross-governmental mental health outcomes strategy for people of all ages. (Department of Health, 2011)Context into which Pyramid currently fitsJayman, Ohl, Hughes and Fox, 20159•On-going applied community research programme •Valuable experiential placements for students, improving employability •Opportunity for community engagement•Partnerships with local authorities and national and local voluntary sector organisationsHow Pyramid benefits the UniversityJayman, Ohl, Hughes and Fox, 201510•A stable environment in which it can flourish•A dedicated research team•A steady supply of student volunteers•A valuable association with a Higher Education Institution (HEI)•Opportunity to network with other HEIsWhat the University offers PyramidJayman, Ohl, Hughes and Fox, 201511•Pyramid has recently been identified by the Early Intervention Foundation as a Standard 3 (Standard 4 being highest) targeted school-based socio-emotional intervention•Registered with Project Oracle and preparing to submit to Standard 5External ValidationJayman, Ohl, Hughes and Fox, 201512•From the start, has been delivered in partnership with schools/local partners rather than building a large, expensive infrastructure•Allows for adaptation to meet local needs (geography, ethnicity, socio-economics etc.)•Draws on and supplements existing local resourcesPracticalities of delivering Pyramid - 1 Jayman, Ohl, Hughes and Fox, 201513• Depends on schools to do it properly!• Risk of becoming a dumping ground through inappropriate referral • Subject to fluctuations in funding• Huge task to take it out to individual schools• Difficulty of extracting research data from schools• Fads and fashions at national levelPracticalities of delivering Pyramid - 2 Jayman, Ohl, Hughes and Fox, 201514• A non-stigmatising, non-clinical, fun intervention for children because of the delivery place and method• When schools engage well, it works wonderfully• We learn and improve all the time, based on feedback from local partners• Now have a huge network of ambassadors who have volunteered for us in the past• Schools ‘own’ it and so do the follow-up with childrenPracticalities of delivering Pyramid - 3 Jayman, Ohl, Hughes and Fox, 201515• Pyramid school data collected from 7 schools in London and Greater Manchester• Children’s socio-emotional status measured pre and post intervention and at 12 month follow-up using the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997)• Significant reductions (P<.05) in SDQ Total Difficulties Scores and Emotional Symptoms and Peer Difficulties sub scales for the Pyramid attendees over time compared to the comparison group• These improvements maintained at 12 month follow-upEvidence Base Years 3 and 6Jayman, Ohl, Hughes and Fox, 201516• Pyramid clubs in primary schools have demonstrated improvements in SE well-being by equipping attendees with coping and resilience skills (Ohl et al, 2008; 2012; Lyons et el 2013; McKenna et al, 2014)• A “critical age” for intervention effectiveness? (Barrett et al, 2005)• Does SE well-being impact on other domains, e.g. school performance? (Zins et al, 2004; Durlak et al, 2011)• Developmentally appropriate theoretical model to inform intervention practice and guide policyResearch in Secondary SchoolsJayman, Ohl, Hughes and Fox, 201517• How effective is Pyramid on the emotional health of pupils in early secondary education?• Does Pyramid impact on school performance?• What are the elements involved in Pyramid that might bring about change?• Is there a ‘critical age’ for Pyramid to be an effective intervention?Addressing the research questionsJayman, Ohl, Hughes and Fox, 201518Mixed Methods DesignEvidence base to reliably inform future implementation decision making and applied practiceStrengths and Difficulties Questionnaire (SDQ) (Goodman, 1997; 1998); The Well-being Questionnaire (WBQ); (NPC, 2010); academic ability self-concepts; academic levels Focus groups: Pyramid attendees; club leaders“Programmes designed to promote emotional health and well-being need to be rigorously evaluated.” (NICE, 2008)Research in progressJayman, Ohl, Hughes and Fox, 201519• Wide geographical spread of participating schools• Research considerations:• Ethical issues• Practical constraints (e.g. school year; access; intervention cycle)• Attrition: a challengeData collection: September 2013 (autumn term) – July 2015 (summer term)1. Wrexham2. LB Ealing3. LB Ealing4. Colwyn Bay5. Llandudno6. Bracknell7. LB Ealing8. LB EalingPilot study resultsJayman, Ohl, Hughes and Fox, 201520Table 1: Pyramid group SDQ mean scores (teacher-rated) T1 and T2 (N=6) ScaleBase-line Mean (SD)Post-Club Mean (SD)Difference: Baseline to postEmotional difficulties7.67 (1.5)4.17 (.98) -3.5Peer difficulties5.67 (3.78)2.83 (2.48) -2.84Pro-social (strength)6.5 (1.87)6.83 (1.94) 0.33Conduct difficulties.67 (.82).67 (.82) 0Hyperactivity difficulties3.83 (2.04)3.67 (2.58) -0.16Total Difficulties17.83 (4.79)11.33 (5.28) -6.5Table 2: Pyramid and Comparison TD scores (teacher-rated) T1, T2 and T3 (N=12) Key: "Caseness" bandsNormalBorderlineAbnormal“Understanding how and why programs work, not simply whether they work, is crucial.” (Dixon-Woods et al, 2011)Pilot study resultsJayman, Ohl, Hughes and Fox, 201521Pyramid attendees’ responses post-club to how they think Pyramid has changed them as a person: • “I find it easier to talk to people,” • “I’m more likely to get involved in activities,” • “I’m more confident now.”Deductive thematic analysis: club users; group leadersTheme: Delivering outcomes.  Subtheme: acquiring new socio-emotional skills.“It helped me with my confidence, for making new friends and stuff like that.”  (Jessica, L221)Theme: Making a difference. Sub-theme: individual success stories“…he was the one, right at the front who introduced the whole assembly. To think, would he have done that before? Probably not.” (GL1, L13-14)SDQ results (8 schools)Ohl, Hughes and Fox, 201522Figure 1: Teacher-rated mean TD scores T1 and T2 for Pyramid and comparison group• The interaction between the two conditions and the change over time was significant:F (1, 115) = 28.08,  p< .001• The mean TD score from T1 (M = 13.38, SD = 4.88) to T2 (M = 9.06, SD = (5.37)  was significantly different for the Pyramid group:t (65) = 7.62, p< .001 but not for the comparison group: t (50) = -.03, p> .05Table 3: Pyramid group SDQ mean scores (teacher-rated) T1 and T2 (N=66)SDQ sub-scales pre- to post-testOhl, Hughes and Fox, 201523ScaleBase-line Mean (SD)Post-Club Mean (SD)Difference: Baseline to postEmotional difficulties5.03 (2.58)3.09 (2.35) -1.94Peer difficulties4.67 (2.33)2.73 (2.40) -1.94Pro-social (strength)6.12 (2.38)7.24 (2.28) 1.12Conduct difficulties0.88 (1.26)0.64 (1.03) -0.24Hyperactivity difficulties3.42 (2.52)2.80 (2.0) -0.62Total Difficulties13.98 (4.88)9.06 (5.37) -4.92Results from a repeated measures t-test:• Significant difference in Total Difficulties scores at baseline and post-club:  t(65) = 7.62, p<.001Subscale analysis:• Significant difference in emotional difficulties scores at baseline and post-club: t(65) = 6.35, p<.001• Significant difference in peer difficulties scores at baseline and post-club:  t(65) = 4.07, p<.001(ASL =.0125)Key: "Caseness" bandsNormalBorderlineAbnormalOne of the key main themes elicited from a deductive thematic analysis (club membersand group leaders):Theme: Pyramid legacy. Sub-themes: sense of achievement¹; increased engagement²; impact on performance³; impact on group leaders¹• “I’ve achieved what I hoped for which is confidence in lessons.”¹ (School 3, CR7, L199)• “Usually like, I don’t participate but now I join in more stuff.”²  (School 2, Hermionie, L332)• “ [Before] in class you wouldn’t usually talk, you’d be shy to talk and say it in front of everyone and stuff but now when you go to class you usually put your hand up.”³ (School 8, Ariana, L315-7)• “I think it helped my confidence as well as the children’s.”¹  (School 3, GL5, L314)• “I’ve definitely gained something from it.”¹  (School 2, GL1, L143)Focus group data analysisJayman, Ohl, Hughes and Fox, 201524• Both quantitative and qualitative measures indicate an improvement in the socio-emotional well being of vulnerable young people who attended Pyramid club.• Success of Pyramid club facilitated by: a supportive group environment; structure and consistency within a flexible programme; small pupil to adult ratio and well-trained group leaders.• Barriers to optimum programme delivery : practical issues; lack of robust procedures to ensure the most suitable pupils are selected and/or attend; attrition across the duration of the programme.• An impact on academic performance in Maths and English was not evidenced at short-term follow-up but an impact on ability self concepts was; qualitative analysis identifies an impact on school engagement and performance.Summary of key findingsJayman, Ohl, Hughes and Fox, 201525• Shifting focus to early detection and prevention of MH concerns.• More evidence-based interventions delivered in educational settings.• Explicit links between emotional well-being, school performance and outcomes.• Developmentally appropriate theoretical models; real-world implications.• Enabling emotionally healthy children and young people achieve their potential.“I used to get bullied and stuff which basically put me inside of a shell but Pyramid helped to break that shell.” (Year 7 Pyramid club member, 2015).Implications and future directionOhl, Hughes and Fox, 201526References Department for Education (2014).  Mental Health and Behaviour in SchoolsDepartment of Health/NHS England (2015) .  Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeingDepartment of Health (2013). Chief Medical Officer’s Annual Report  2012:  Our children deserve better: Prevention Pays.  Department of Health (2011).  No health without mental health: a cross-governmental mental health outcomes strategy for people of all ages.  Early Intervention Foundation (2015).  What works in enhancing social and emotional skills development during childhood and adolescence?Kolvin, I et al (1981) Help Starts Here. London: TavistockPyramid at the University of West London:  http://www.uwl.ac.uk/pyramid/welcomeSchiffer, M. (1976) ‘The Synergy of Children’s Groups Psychotherapy and Child Growth and Development’, Group Therapy – An OverviewOhl, Hughes and Fox, 201527Questions?Jayman, Ohl, Hughes and Fox, 201528

Department for Education

Early Intervention Foundation (2015). What works in enhancing social and emotional skills development during childhood and adolescence? Kolvin, I et al

Focus group data analysis Jayman, Ohl, Hughes and Fox,

I used to get bullied and stuff which basically put me inside of a shell but Pyramid helped to break that shell.” (Year 7 Pyramid club member,

No health without mental health: a cross-governmental mental health outcomes strategy for people of all ages.

Summary of key findings Jayman, Ohl, Hughes and Fox,

The Pyramid Project at the University of West London

The Pyramid Project at the University of West London

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