Zippy’s Friends

Intervention URL: Zippy’s Friends Website Address

Brief Description:

Zippy’s Friends is a school based mental health promotion programme for five to seven year old children. The programme aims to prevent the development of serious psychosocial problems later in life, including suicidal behaviour, through expanding children’s range of effective coping skills. It is designed to help all children, not just those who have difficulties or who are considered to be at risk. Zippy’s Friends usually runs for 24 weeks, with one 45-minute session each week. The program is built around a set of six stories. Zippy is a stick insect and his friends are a group of young children, and the stories show them confronting issues that are familiar to young children - friendship, communication, feeling lonely, bullying, dealing with change and loss, and making a new start.

Zippy’s Friends was developed and tested in the contrasting settings of Denmark and Lithuania. The program was found to have positive impacts on coping strategies, improved social skills (cooperation, empathy, assertion and self-control). One study also found significant decreases in externalizing behaviours. A large randomized controlled trial in Ireland replicated these findings and the first quasi-experimental trail in North American, testing a French version of Zippy’s Friends, found positive impacts on internalizing behaviours, improved cooperation, autonomy and perceived social support.

I. Basic Information

Primary Source Document

Type of Publication: Peer-reviewed journal

Author(s)/Contributor(s): Bale C, Mishara B

Document Title: Developing an international mental health promotion programme for young children.

Publication or Source: International Journal of Mental Health Promotion; 6(2): 12-16

URL of Publication or Source: http://www.tandfonline.com/doi/abs/10.1080/14623730.2004.9721926#.VE9fxfnF-So

Date of Primary Source Document: 2016-01-04

Language(s):

Keywords: International; mental health; promotion; young children

Web Links

To additional Web site information about the intervention:

Gudauskien V. Nine years on – What children remember of Zippy’s Friends. 2010.

To additional reports about the intervention:

Holen S, Waaktaar T, LervĂĄg A, Ystgaard M. Implementing a universal stress management program for young school children: Are there classroom climate or academic effects? Scandinavian journal of educational research 2013; 57(4), 420-444.

Dufour S, Denoncourt J, Mishara BL. Improving children's adaptation: New evidence regarding the effectiveness of Zippy's friends, a School Mental Health Promotion Program Advances in School Mental Health Promotion 2011; 4(3), 18-28.

Barry MM, Clarke AM. An evaluation of the Zippy's Friends emotional wellbeing programme for primary schools in Ireland. 2010.

Mun, W. Helping young children to develop adaptive coping strategies. Journal of Basic Education 2008; 17(1), 119-144.

Mishara, B. L., & Ystgaard, M. Effectiveness of a mental health promotion program to improve coping skills in young children: Zippy's Friends. Early Childhood Research Quarterly 2006; 21(1), 110-123.

Monkeviciene, O., Mishara, B. L., & Dufour, S. Effects of the Zippy’s Friends programme on children’s coping abilities during the transition from kindergarten to elementary school. Early Childhood Education Journal 2006; 34(1), 53-60.

To commentaries about the intervention:

SAMSHA – NREPP. (2012). Zippy’s Friends.

Saxena S, Garrison PJ. Mental health promotion: Case studies from countries. Geneva: World Health Organization, 2004.

To visual media-based documentation (photographs, videos, etc.) about the intervention:

Introduction to Zippy’s Friends Video.

Type of Practice

Best Practice

II. Intervention Focus

Intervention Goal / ObjectiveLevel(s) TargetedEquity Focus
Increase children’s capacity to cope with everyday difficulties, helping them to explore, find their own solutions and expand their range of coping strategies.
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
Enable children to identify and talk about feelings.
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
Encourage children to help others with their problems and to ask for and use help when they are in need.
  • Individual level
  • Interpersonal level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.

Priority/Target Population for Intervention Delivery

Life Stage

Ethnic/Culture/Language-specific Designations: No/no mention

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

Risk Reduction

III. Intervention Context

Intervention's Country of Origin: United Kingdom

Geographic Level of Intervention

Community Size where the Intervention has been Implemented: Communities of various sizes

Settings

Educational Settings

Other Community Settings

IV. Social Determinants of Health Focus

The population addressed in the intervention faces the following challenges/risks

V. Health Promotion Values, Theories, Strategies and Activities

Values Inherent in the Intervention

Theories/Conceptual Frameworks

Use of Health Promotion Theories

Type of Health Promotion Strategy

Specific Activities of the Intervention

VI. Intervention Outcomes

Outcomes

Short-term positive outcome(s) (appropriate for relevant objectives) - Intervention demonstrated short-term positive outcome(s) that were measured within six months beyond the intervention period that were appropriately related to the short-term nature of the primary objective(s).

Ongoing results from research and evaluation were collected and acted on?

Yes. Zippy’s Friends was developed and refined (e.g., the addition of an extra module and more emphasis on the development of coping skills) over the course of five years, with extensive pilot testing and evaluation of its implementation and impact.

Outcomes and Impact

Outcomes and Impact Chart
Level of ImpactDescription of OutcomeEquity Focus
Interpersonal LevelTeachers reported a significant improvement in social climate (Cohen’s d: 0.614) compared with classes that did not participate in the program.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
Interpersonal LevelTeachers reported a significant moderate reduction in bullying (Cohen’s d: 0.550) compared with classes that did not participate in the program.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
Individual LevelChildren’s academic skills, as assessed by the teachers, were significantly improved (Cohen’s d: 0.415).Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.

Strengths of the Intervention

Challenges of the Intervention

VII. Adaptation

Implementation History

Multiple implementations - Different settings/populations/providers - The intervention showed significant adaptability as it has been implemented in different settings or with different populations or by different provider(s). This can include multiple implementations during the same time period. Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.

Expertise Required for Implementation Within the Context of the Intervention

Specialized skills training provided as part of the Intervention - The intervention does not require individuals or groups with highly specialized training, but requires that individuals or groups be trained as part of the implementation of the intervention.

Do the results indicate that the intervention can be generalized to the general target population?

Yes
Experimental and quasi-experimental trials comparing diverse children in different settings who received the intervention to those who have not.

Has this intervention been replicated or adapted from or to another jurisdiction?

Replication specified:

Following the first major evaluation of the revised program in Denmark and Lithuania, the program was replicated in major studies in Ireland, Canada, China and Norway. A number of smaller studies have been conducted in other countries, and further studies are ongoing in Canada and Norway.

Holen S, Waaktaar T, LervĂĄg A, Ystgaard M. Implementing a universal stress management program for young school children: Are there classroom climate or academic effects? Scandinavian journal of educational research 2013; 57(4), 420-444.

Barry MM, Clarke AM. An evaluation of the Zippy's Friends emotional wellbeing programme for primary schools in Ireland 2010.

Mun W. Helping young children to develop adaptive coping strategies. Journal of Basic Education 2008; 17(1), 119-144.

Adaptation specified:

Parent materials have been translated from English into 23 languages. Classroom materials have been translated into 13 languages including Arabic, Chinese, Danish, Dutch, French, Icelandic, Konkani (India), Lithuanian, Norwegian, Polish, Portuguese, Russian, and Spanish. The program also has been adapted for use in schools for children with learning difficulties.

Dufour S, Denoncourt J, Mishara BL. Improving children's adaptation: new evidence regarding the effectiveness of Zippy's friends, a School Mental Health Promotion Program Advances in School Mental Health Promotion 2011; 4(3), 18-28.

Briefly describe in what ways the intervention must not be modified without compromising expected positive results
Teachers and facilitators follow 8 principles and six general modules, not a set curriculum.

Is the intervention ongoing or complete?: Complete, Total duration - One school year

Are there supports available for implementation?
Yes -

Standardized training for teachers includes skill practice and classroom observation, with accompanying PowerPoint presentations for the individual modules. Train-the-trainer events and international workshops are also available. On-site consultation is available during the first year of implementation, and phone and email support can be requested beyond the first year.

Typically, a partner organisation takes on the licence to run Zippy’s Friends in a given area. The partner organisation appoints a coordinator to liaise with participating schools and to arrange training and support meetings for teachers. Partnership for Children provides the initial training course and, optionally, runs the first year’s support meetings. Thereafter most partners feel able to run and promote the programme in their area, and organise subsequent training courses for new teachers themselves.

Are there resources and/or products associated with the interventions?
Yes - Manualized lesson plans for teachers; guide for parents; books for children.

Developers/Implementers of the Intervention

Developer: Befrienders Worldwide (formally Befrienders International)

Implementer: Partnership for Children

26-27 Market Place

Kingston upon Thames

Surrey KT1 1JH

England

Telephone: 00 44(0) 20 8974 6004

Email: info@partnershipforchildren.org.uk

Type of funding used to develop/implement the intervention

Other resources used to develop/implement the intervention

Duration/Timing for Implementation

Time used to develop the intervention: Time required for partner organization to: take on the licence to run Zippy’s Friends in a given area; appoint a coordinator to liaise with participating schools, to arrange training and support meetings for teachers; and two day training for teachers.

Time used to implement the intervention: One school year

Time used to evaluate the intervention: One school year; longer for longitudinal evaluation designs

Implementers

VIII. Quality and Type of Evidence

Type of Publication: Peer-reviewed journal

Author(s)/Contributor(s): Holen S, Waaktaar T, Lervag A, Ystgaard M

Document Title: Implementing a universal stress management program for young school children: Are there classroom climate or academic effects?

Publication or Source: Scandinavian Journal of Educational Research; 57(4): 420-444

URL of Publication or Source: http://www.tandfonline.com/doi/abs/10.1080/00313831.2012.656320#.VE9lefnF-So

Date of Primary Source Document: 2013-01-04

Language:

Stakeholder Information Sources (in the Evaluation Study)

Was the evaluation participatory?

No information available on this topic

Who conducted the evaluation?

Academic institution: University of Oslo

Government agency: Centre for Child and Adolescent Mental Health, Norway

Research protocol was reviewed by an ethics committee and/or included a set of ethical guidelines: Yes, Research protocol approved by the Norwegian Data Inspectorate and the Regional Committee for Medical Research Ethics of Eastern and Southern Norway.

Research Limitations

Limitations identified by authors:

The children who participated in the study were very young, and it can be questioned whether they had the cognitive capability to answer the questionnaires presented to them. Although the FEESS scale was developed for young children, factor analyses indicated that negative items were problematic to interpret in the children’s reports. These items formed a separate method factor that was most distinct at the first data collection. At the second data collection, when the children were about eight years of age, the method factor was less clear. This may suggest that the questionnaire worked better as the children grew older.

Although the teachers reported improvements in both academic achievement and classroom social climate, there was concern about teachers both implementing the program and evaluating their own achievements. The intervention was not blinded and evaluating one’s own efforts may lead to biased estimates.

Another challenge is that there is a lack of formal assessment measuring treatment fidelity, thus the project had to develop the assessment that it used. Additional neutral observations during program implementation would have been valuable in order to further assess the treatment fidelity and other challenges to the implementation process.

Because all participating schools were recruited from geographic target areas administratively chosen for disseminating the Zippy’s Friends program, they may not be representative of the country as a whole. However, analyses showed that schools from both urban and rural areas in the northern, middle, and southern parts of Norway were included. Norway has a rather egalitarian society, which was reflected in the low level of variance in outcome variables between schools.

Although the schools were randomly assigned to intervention or control groups, they were not randomly selected to participate in the study. All schools from the target areas were voluntarily enrolled in the program, and they may therefore be slightly more typical of schools that are open to this kind of intervention. However, because this would apply to all schools that enrolled in the program, differential motivation at the school level cannot explain the difference observed in the study between the intervention and control groups.

Nature of Processes

Quality assurance methods were used: Yes, An assistant helped children who had any problems completing questionnaires.

Evaluation Study Design

Quantitative Study: Experimental Design, Randomized Control Trial

Experimental Design, Randomized Control Trial

Sample: The people assigned to the experimental group(s) have similar characteristics as those in the control group(s). (E.g. they were similar in age or experience or gender or education, etc.) - Yes

Measures: The outcome measures were objective (e.g. biochemically validated nicotine levels) or tangible (e.g. number of cigarettes smoked per day) - No/no mention

At least one of the outcome measures were validated (e.g. against a gold-standard measure, assessed for reliability, content validity, or based on previous population surveys or measurement studies) - Yes

Blinding: No/no mention

Data Collection: The data was collected in the same way for both intervention and control groups - Yes

Loss to Follow-up: The participants (intervention and control groups) were followed for roughly the same time - Yes

If there were different follow-up times, adjustments were made to allow for different follow-up times. (E.g. used a conversion like person-years) - No/no mention

Loss to Follow-up: More than 80% of the participants completed both pre- and post-intervention data collection points (loss to follow-up less than 20%) - Yes

There was an equal number of participants who were lost to the post-intervention data collection among both intervention and control groups - No/no mention

Analysis - Groups Differences: There were no differences between the intervention and control group prior to the intervention.

Results - Group Differences: There were significant positive differences between intervention and control group results. - Yes