Introduction
Mental Health in Middle Childhood
Wellbeing in Care Settings
Methods
Search Strategy
Data Extraction
Quality Evaluation
Results
Author, year | Intervention cohort | Intervention description | Intervention details and delivery |
---|---|---|---|
Bazyk and Bazyk (2009) | African American low-income children attending a faith-based after school program in Ohio, USA | Healthy Occupations for Positive Emotions (HOPE) is an occupational therapy group designed to meet children’s need for structured leisure activities, social-emotional learning, and close human connection | Researchers implemented HOPE to all children at a service in 9 small (n = 7 or 8) sex segregated groups in 1 h sessions, once a week for 9 weeks. Sessions consist of 3 segments: • Conversation time (10–15 min) in which a social-emotional theme is introduced, • Activity (30–40 min) which include short-term (e.g., leather stamping) and long-term (e.g., paper-mache) projects, and • Closure (10 min) where children are encouraged to think about the relationship between doing the activities and how they feel |
Fettig et al. (2018) | Students at risk for emotional and behavioural problems due to environmental factors, who attend an after-school program in the US | Super Friends, Super Readers (SFSR) is a language and social-emotional intervention that consists of dialogic story reading and social-emotional direct instruction | SFSR was offered by researchers to 4 children in 1 h weekly sessions over 6 months. Each session included: • Dialogic story reading (15–20 min) using scaffolded reading strategies, • Group activity (15 min) to extend and promote use of targeted social-emotional skill (e.g., role playing), and • Supervised free play (25–30 min) with limited adult support offered to children |
Gooding (2010) | Children attending a US non-profit inner-city after school care program who were a mixture of typically developing and those with social, conduct, or behavioural deficits | Intervention uses CBT group therapy strategies incorporating music therapy curriculum delivered by a music therapist | Music therapy was delivered in a small group setting once a week for 5 weeks, in 45 min sessions. Each session included: • Introduction/social-emotional concept review (10 min), • New skill introduction and warm up activity (20 min), • Specific skill activity (10 min), and • Wrap up (10 min) |
Kumschick et al. (2014) | Elementary aged children from 10 after-school centres in Germany were invited to participate | READING and FEELING aims to increase children’s emotional competence through reading and discussing a book with emotional content | Researchers read a book (Sheep with Boots by Matter (2003)) to small groups (n = 7) of children twice a week for 8 weeks, in 45 min sessions. Each session included: • Read a section of the book, • Discuss the identified emotional content, • Structured group activity (e.g., theatre), and • Individual quiet work (emotion diary) |
Minney et al. (2019) | Elementary aged children attending an after-school care site at 6 locations in Texas, USA | A social-emotional learning (SEL) intervention was developed using a hybrid of other SEL curricula and adapted for an after-school program setting | Group leaders at the after-school program were trained and given materials each week to deliver to the children in 10–15 min sessions each day at the beginning of the after-school care program. This intervention ran for the whole year |
Siddiqui et al. (2019) | Year 5 students at 68 schools across the UK participated | Children’s University (CU) is a charity trust that aimed to increase children’s aspiration, self-esteem, confidence, resilience, and social skills by providing outdoor activities and after school programs | Schools were funded to offer out of school activity groups in which children complete activities that are recorded in a passport. 15 h of activity must involve positive social action (community work, fundraising, etc.) and 15 h of non-specified extra-curricular activities |
Milton et al. (2023) | Children at 5 OSHC settings in New South Wales, Australia | Connect, Promote, and Protect Program (CP3) is a programming framework to co-design activities aiming to: Connect Communities, Build Wellbeing and Resilience, Inspire and Engage, and Broaden Horizons | Stage 1: consult and create 1. Community consultation with families 2. Educator and volunteer workshops to train CP3 and build participatory design 3. Participatory design workshops with children 4. Workshopped activities selected Stage 2: Test and refine 3 activities (physical activity, creative pursuits, and skill development) chosen and tested over a few weeks during a school term Stage 3: Implement and evaluate over a school term with full cohort of children • E.g., Woodwork Café: trained CP3 mentors (volunteers and educators) worked with children (Connect Communities) and taught woodworking skills to build a chicken coop for the service (cognitive challenge and fun—Build Wellbeing and Resilience). A volunteer brought a chicken for a site visit, an OSHC family provided 2 baby chickens and incubator to hatch the eggs (Inspire and Engage) and children could engage in person or via the web to watch the chickens’ hatch (Broaden Horizons) |
Author, year | Target skill | Participants | Study design/method | Outcome/effectiveness | Limitations |
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Bazyk and Bazyk (2009) | Aimed to identify and describe low-income children’s engagement in structured leisure activities that focused on group processes and social-emotional competencies | Purposeful sample of N = 10 from the group were interviewed • 60% female/40% male • 7–12 years old | Phenomenological qualitative study involving semi-structured time-series interviews (5 children interviewed 3 times, 3 interviewed twice, 2 interviewed once) between weeks 4–9 Also, random observation of 5 groups during sessions 4–8 for 10–30 min which focused on children’s occupational engagement, social interactions, group process, and setting • Interpretative phenomenological analysis | Researchers’ content analysis determined: 1. Groups are fun (occupational meaning) because of the new and creative activities in a supportive group (occupational form), which results in feeling happy and a desire to repeat the experience (occupational function), and 2. Children learned how to express feelings and respond to anger in healthy ways | • Didn’t directly measure whether SEL competencies improve • Small sample size • Limited language skills of the participants • No comparison group • Subject selection not randomised |
Fettig et al. (2018) | Sought preliminary data on effectiveness of story reading on children’s language and SEL skills (turn-taking, problem solving, and positive peer feedback) | First 4 children whose completed paperwork was returned were selected from respondents to the study advertising • All males • 5–6 years old | Mixed-method case study • Quantitative: observers tallied the number of times SEL target skills were observed and successfully enacted in each session. Expressed as a percentage (e.g., number of child facilitated turn-taking divided by total opportunities to practice turn-taking, multiplied by 100) • Qualitative: content analysis of interviews with parents | Quantitative: • Interobserver agreement calculated to be 73% across all behavioural skills • Child facilitated problem solving success increased 7% • Turn taking increased 10.1% • Positive peer feedback increased 10.2% Qualitative: • Main theme of emotional regulation (increased ability to articulate problems and solve problems) | • Only 4 children were given the intervention • Researchers stated difficulty in live observation • Non-randomised subject selection |
Gooding (2010) | Program targeted-specific social skill deficits: Peer relations (interpersonal skills, nonverbal communication, and verbal communication) and self-management skills | 20 children were included in the study, n = 10 in control and n = 10 in intervention • 60% female/40% male • 6–11 years old (M = 8.5) | Randomised pre- post-mixed-method design • Children’s social competence was assessed by site program director rating on the social competence (SC) and antisocial (AS) subscales of the home and community social behavior scales (HCSBS), • Children self-rated using the Social Skills Assessment–Elementary Age (SSA), and • Researcher observations of the intervention group during sessions using the Group On-Task/Off-Task Teacher Response Form A (GOT/OT) | • HCSBS: Social competence scores improved in both groups over time - No sig. difference between groups in pre-test SC (U = 66, p > 0.05) and AS (U = 46.5, p > 0.05) or post-test SC (U = 42.5, p > 0.05) and AS (U = 50.5, p > 0.05) scores between groups • SSA: Sig. increase in both groups (U = 68, p (one-tailed) = 0.032) • GOT/OT: On task behaviour increased 10% from 1st session to last - Significant positive difference between 5 sessions, χ2 (12, 4) = 23.5, p = 0.000 | • Small sample size • Researchers identified difficulty with inconsistent child attendance, space, and time constraints in extended education setting |
Kumschick et al. (2014) | The intervention aimed to increase emotional vocabulary, the ability to identify masked feelings, explicit emotional knowledge, and the ability to discover mixed feelings | 208 children were included in the study, n = 104 in control and n = 104 in intervention group • 62.5% female/37.5% male • 7–9 years old (T1 M = 7.94, SD = 0.72, T2 M = 8.13, SD = 0.72) • 6% attrition rate | Controlled quasi-experimental design with pre- post-test Educators allocated willing participants to control or intervention groups, with 15 groups of 7 children allocated to intervention. Both groups assessed on all measures pre- and post-intervention • Emotional competence (emotional vocabulary, explicit emotional knowledge, recognition of masked feelings, recognition of mixed feelings) assessed pre- and post-intervention by a board game designed for the study (laboratory of feelings) • Language competence (receptive vocabulary, literacy, verbal fluency, narrative abilities) assessed pre-intervention by individual 1.5 h language competence assessment with research assistants • Text analysis capability assessed by an emotion-in-text task after intervention to test expected increase of children’s ability to analyse emotional aspects of literature | Overall sig. positive correlation between age and language competence (r = 0.22, p < 0.01), and interaction of group and sex variables (group (r = 0.067, p < 0.01), sex (r = 0.53, p < 0.01) • Emotional competence: regression analyses showed children in test group sig. improved: - Emotional vocabulary (B = 1.25, p < 0.001) - explicit emotional knowledge (B = 1.32, p < 0.05), - Recognition of masked feelings (B = 1.05, p < 0.001) - No sig. improvement in recognition of mixed feelings • Text analysis capability: Between subject group and sex factors ANCOVA showed no difference between groups (p = 0.51), showing emotional literacy skills not evident when presented with a new book | • Unclear if the board game was a validated emotional measure • Group selection not randomised |
Minney et al. (2019) | Three SEL skills were the focus of the study: self-management, self-awareness, and social awareness | 125 children at 6 randomly selected after-school care sites completed both pre- and post-surveys and were included in the study • 50% female/50% male • 4–11 years old (M = 7.25, SD = 2.0) | Quasi-experimental single group pre- post-test design in which participants completed a researcher developed survey created for the study based on CASEL model – • Self-management (2 items) • Social awareness (2 items) • Self-awareness (1-item) | Statistically sig. increases in • Self-management (p < 0.001), and • Social awareness (p < 0.001) But not • Self-awareness (p = 0.339) • Medium effect size 0.50 | • No control group included • Developed survey did not undergo validity testing • Self-report scales only provide partial understanding of skill improvement |
Siddiqui et al. (2019) | Cognitive (math and reading) and non-cognitive (teamwork, communication, motivation, self-esteem, confidence, reliance, civic mindedness, and future intentions) skills were the focus of the study | 68 schools were randomised to treatment (n = 36) or control (n = 32) and a total of 1231 children (654 in treatment, 557 in control) were included in this study Schools were able to offer the after-school program however they liked; 14 offered the program to the whole age cohort, 16 asked for volunteers, and 6 directed participation to the most disadvantaged students | • Baseline and post-intervention cognitive scores assessed by math and reading scores from the National Pupil Database • Author developed measure of non-cognitive skills using single items for each • Process evaluation to test intervention fidelity, implementation, and perceptions conducted by questioning while visiting schools • Intention to treat analysis with sub-analysis of disadvantaged students • Odds ratio to examine categorical variables | Headline findings: • Teamwork (ES = 0.02) and social responsibility (ES = 0.07) showed very small gains pre- to post-test • Larger gains seen by disadvantaged students in teamwork (ES = 0.17) and social responsibility (ES = 0.10) • Cognitive attainment effect sizes were small for treatment over control group between pre- and post-test for math (+ 0.15) and reading (+ 0.12) Increased participation of students from disadvantage was a key outcome | • Incomplete data reported in this publication • Mixture of random and non-random participant selection • Participation depended on school leadership • Issues highlighted by schools include lack of financial support, increased teacher workload, rural setting |
Milton et al. (2023) | CP3 guiding principles are to 1) build wellbeing and resilience, 2) broaden horizons, 3) inspire and engage, and 4) connect communities | Children were the target population. Adults in the OSHC community were consulted Formative: • N = 16 children, 4–12 years old (M = 7.9, SD = 1.9), female 60.7%, male 39.3% • N = 32 adults (n = 10 educators, n = 6 volunteers, n = 9 parent/guardian, n = 7 other), 18–65 + years old, female 13.3%, male 86.7% Process: • N = 58 children, M = 7.9 years old (SD = 1.9) • N = 24 adults (n = 3 parent/guardians, n = 2 volunteers, n = 15 educators, n = 4 coordinators/managers) | Mixed method naturalistic formative and process evaluation of the CP3 program Formative quantitative survey: • Children only: language spoken at home, year at school • Adults only: relationship to OSHC site • All: gender, age, postcode, satisfaction with OSHC service, social connectedness (1-item Inclusion of Community in Self scale) and quality of life (Personal Wellbeing Index) Process quantitative: • Changes in educator completed Strengths and Difficulties Questionnaire at baseline and follow-up Both qualitative: • Six-step qualitative thematic analysis of surveys, interviews, and focus groups with adults and children | Formative: • Engagement was high: 10–15 children per session • Appropriateness and acceptability very high based on child, educator, and CP3 volunteer feedback. Children endorsed CP3 target areas between 84 and100% • Workplace satisfaction questions assessed feasibility, showed satisfied to very satisfied educators, with paperwork and being part of decision making at OSHC showing lowest satisfaction Process: • Effectiveness assessed by matched SDQ data (66%) showed 81% female, M = 7.9 (SD 1.9) years. Matched-sample T-test analysis found significant increase in prosocial behaviours (MD = 0.64, p = 0.04, t57 = − 2.06, 95% CI − 1.36 to − 0.02) and significant decrease in peer problems (MD = − 0.69, p = 0.01, t57 = 2.57, 95% CI 0.14–1.13) • No other significant changes in other scales Qualitative Themes included: • Program satisfaction • Child Outcomes: met all 4 CP3 principles • Educator and Volunteer Outcomes: provided professional development, increased job satisfaction, feelings of pride | • Evaluation only, target skills not the focus • Small sample size in formative evaluation • High attrition (52.5%) in matched samples |
Summary of Interventions
Quality Appraisal
Author, year | Qualitative | Randomised control trial | Non-randomized | Mixed methods | Quality score | ||||||||||||||||
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1.1 | 1.2 | 1.3 | 1.4 | 1.5 | 2.1 | 2.2 | 2.3 | 2.4 | 2.5 | 3.1 | 3.2 | 3.3 | 3.4 | 3.5 | 5.1 | 5.2 | 5.3 | 5.4 | 5.5 | ||
Bazyk and Bazyk (2009) | Yes | Yes | Yes | Yes | Yes | 100% (5/5) | |||||||||||||||
Gooding (2010) | Yes | Yes | Yes | No | Yes | 80% (4/5) | |||||||||||||||
Kumschick et al. (2014) | No | Yes | Yes | Yes | Yes | 80% (4/5) | |||||||||||||||
Siddiqui et al. (2019) | Yes | Yes | No | No | No | 40% (2/5) | |||||||||||||||
Minney et al. (2019) | Yes | Yes | Yes | No | Yes | 80% (4/5) | |||||||||||||||
Fettig et al. (2018) | Yes | Yes | Yes | No | No | 60% (3/5) | |||||||||||||||
Milton et al. (2023) | Yes | Yes | No | Yes | No | 60% (3/5) |
Discussion
Strength of Evidence for Interventions
Intervention | MMAT (%) | JBI Levels of Evidence | Positive changes | Did not change |
---|---|---|---|---|
Extended education SEL groups (Minney et al., 2019) | 80 | Level 2.c | Self-management and social awareness | Self-awareness |
Dialogic reading interventions (Kumschick et al., 2014) | 80 | Level 2.c | Emotional vocabulary, explicit emotional knowledge, recognition of masked feelings | Recognition of mixed feelings |
CP3 (Milton et al., 2023) | 60 | Level 3.e | Prosocial behaviours and decreased peer problems | Emotional symptoms, conduct problems, hyperactivity |
SFSR (Fettig et al., 2018) | 60 | Level 3.e | Turn taking, problem solving, positive peer feedback | |
CU (Siddiqui et al., 2019) | 40 | Level 2.c | Teamwork, social responsibility | |
OT leisure activities (Bazyk & Bazyk, 2009) | 100 | Level 3.e | Did not measure SEL | |
CBT music therapy (Gooding, 2010) | 80 | NA | No sig. differences between groups |