Guidebook

FRIENDS for Life (health-led)

FRIENDS for Life (health-led) is a school-based intervention for children aged between 7 and 13 years old. It is delivered by trained health facilitators alongside a teacher to groups of children for 10 to 12 weekly sessions.

The information above is as offered/supported by the intervention provider.

Population characteristics as evaluated

9 to 10 years old

Level of need: Universal
Race and ethnicities: White British

Model characteristics

Group

Setting: Primary school
Workforce: Psychologists or other allied health professionals, alongside a teacher.
Full evidence description (PDF)
View programme website
Evidence rating:
Cost rating:

Child outcomes:

  • Supporting children’s mental health and wellbeing
    • Reduced anxiety

UK available

UK tested

Published: April 2025
Last reviewed: March 2017

Model description

FRIENDS for Life is a school-based, universal intervention designed to help children develop resilience, coping skills, and improve mental health and wellbeing. Part of the FRIENDS suite of interventions (including Fun FRIENDS and FRIENDS for Youth), FRIENDS for Life targets children aged 7 to 13 years old and is based on cognitive behavioural therapy (CBT) and positive psychology principles. It aims to reduce anxiety and improve mental health through a developmentally appropriate, play-based, and experiential learning approach.

The interventions consists of 10 to 12 weekly sessions, each lasting one hour, delivered by a practitioner in a group format to a whole class. During each session, children are introduced to coping strategies through interactive activities such as stories, games, videos, and exercises. The intervention covers key areas:

  • Learning and behavioural skills: Children learn to develop six-step problem-solving plans, create coping step plans, and identify role models and support networks
  • Psychological skills: Sessions teach children to recognise physical cues of stress, use relaxation techniques, and practise self-regulation. Additionally, group sessions for parents are held at regular intervals to reinforce skills and support the child’s progress
  • Cognitive skills: Children are encouraged to use positive self-talk, challenge negative self-talk, evaluate themselves realistically, and reward themselves for achievements.

Activities include group work, role-plays, workbook exercises, and games, with some tasks designed to be completed at home with family members, allowing children to practise and reinforce the skills they learn in each session. This intervention has been developed and published with the full cooperation of the intervention provider.

Age of child

7 to 13 years old

Target population

All children aged between 7 and 13 years old.

Disclaimer: The information in this section is as offered/supported by the intervention provider.

Why?

Science-based assumption

Stressful and uncomfortable situations in life can create anxiety.

Science-based assumption

Coping skills increase a child’s resilience and protect children from developing anxiety.

Who?

Science-based assumption

All children aged 7 and 13 years old.

How?

Intervention

Children learn coping skills such as understanding and managing emotions to better respond to uncomfortable emotions in appropriate and helpful ways.

What?

Short-term

Children have better awareness of their emotions.

Medium-term

Children develop helpful emotion management techniques that enable them to better cope with stressful or uncomfortable situations.

Long-term

Children are less likely to develop anxiety disorders.

Who is eligible?

This intervention is a universal intervention targeting the general population of school children aged between 7 to 13 years old, irrespective of pre-existing anxiety symptoms.

How is it delivered?

FRIENDS for Life (health-led) is delivered in 10 to 12 weekly sessions of one hour’s duration each by one practitioner, to whole classes of children.

What happens during the intervention?

During each session children are taught skills, aimed at helping them to increase their coping skills, through stories, games, videos, and activities. Skills focus on the following:

  • Learning/behaviour – which involves helping children and adolescents to develop six-step problem-solving plans, using coping step plans, and to identify role models and support networks.
  • Psychological – involves teaching children and adolescents to be aware of their body clues, to use relaxation techniques and to self-regulate. It also involves group sessions for parents, which are scheduled at regular intervals throughout the duration of the intervention.
  • Cognitive – involves helping children and adolescents to use positive self-talk, challenge negative self-talk, evaluate themselves realistically, and reward themselves.

The sessions involve a mixture of group work, role-plays, workbook exercises, games, and interactive activities. Some tasks are completed at home with the participant’s family in order to practise new skills learned.

The sessions cover the following topics:

  • Session one: Introduction to FRIENDS for Life; understanding and accepting difference
  • Session two: Introduction to feelings
  • Session three: Introduction to body clues and relaxation
  • Session four: Self-talk: helpful (green) and unhelpful (red) thoughts
  • Session five: Changing unhelpful (red) into helpful (green) thoughts
  • Session six: Introduction to coping step plans
  • Session seven: Learning for our role models and building support teams
  • Session eight: Using a problem-solving plan
  • Session nine: Using the FRIENDS for Life skills to help ourselves and others
  • Session 10: Review, generalising skills, and planning for the future.

Who can deliver it?

The practitioner who delivers FRIENDS for Life (health-led) is a psychologist or other allied health professional, who deliver the intervention alongside a teacher.

What are the training requirements?

The practitioners have two days of intervention training. Booster training of practitioners is recommended.

How are the practitioners supervised?

It is recommended that practitioners are supervised by one accredited FRIENDS trainer. Supervision is delivered bi-weekly to groups to review session aims, content, and to address any problems with implementation.

What are the systems for maintaining fidelity?

Intervention fidelity is maintained through the following processes:

  • Training manual
  • Other printed material
  • Other online material
  • Video or DVD training
  • Face-to-face training
  • Fidelity monitoring.

Is there a licensing requirement?

No

Contact details*

Contact person: Casey Dick
Organisation: Friends Resilience
Email address: licensing@friendsresilience.org
Website: https://friendsresilience.org/

*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.

FRIENDS for Life (health-led)’s most rigorous evidence comes from a singular RCT which was conducted in the United Kingdom. The programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.

This study identified statistically significant reductions in symptoms of anxiety and low mood.

Child outcomes

Reduced social anxiety

Long term – a year later

Improvement index

+5

Interpretation

0.41-point improvement on the Revised Child Anxiety and Depression Scale.

Study

1

Reduced generalised anxiety

Long term – a year later

Improvement index

+8

Interpretation

0.77-point improvement on the Revised Child Anxiety and Depression Scale

Study

1

Reduced child anxiety and depression

Long term – a year later

Improvement index

+7

Interpretation

2.66-point improvement on the Revised Child Anxiety and Depression Scale

Study

1

Search and review

Identified in search5
Studies reviewed1
Meeting the L2 threshold0
Meeting the L3 threshold1
Contributing to the L4 threshold0
Ineligible4

Study 1

Study designCluster RCT
CountryUnited Kingdom
Sample characteristics

This study involved 1,362 children aged 9 to 10 years from state-funded junior schools in South West England.

Race, ethnicities, and nationalities

92% White British

Population risk factors

Participants included schools with slightly lower-than-average eligibility for free school meals and lower rates of absenteeism than the national average. High family affluence levels were recorded for most participants.

Timing
  • Baseline
  • Post-intervention.
Child outcomes

Reduced symptoms of anxiety and low mood (Child report)

Other outcomes

None

Study rating3
Citations

Stallard, P., Skryabina, E., Taylor, G., Phillips, R., Daniels, H., Anderson, R. & Simpson, N. (2014).Classroom-based cognitive behaviour therapy (FRIENDS): A cluster randomised controlled trial to Prevent Anxiety in Children through Education in Schools (PACES). The Lancet Psychiatry. 1 (3), 185–192.

The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.

Liddle, I. & Macmillan, S. (2010) Evaluating the FRIENDS programme in a Scottish setting. Educational Psychology in Practice. 26 (1), 53–67.

Ruttledge, R., Devitt, E., Greene, G., Mullany, M., Charles, E., Frehill, J. & Moriarty, M. (2016) A randomised controlled trial of the FRIENDS for Life emotional resilience programme delivered by teachers in Irish primary schools. Educational & Child Psychology. 33 (2).

Stallard, P., Simpson, N., Anderson, S., Carter, T., Osborn, C. & Bush, S. (2005) An evaluation of the FRIENDS programme: A cognitive behaviour therapy intervention to promote emotional resilience. Archives of Disease in Childhood. 90 (10), 1016–1019.

Stallard, P., Simpson, N., Anderson, S. & Goddard, M. (2008) The FRIENDS emotional health prevention programme. European Child & Adolescent Psychiatry. 17 (5), 283–289.

Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.

Cost ratings:

Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.

Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.

Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.

Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.

Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.

Set up and delivery cost is not applicable, not available, or has not been calculated.

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Child Outcomes:

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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Preventing obesity and promoting healthy physical development: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.

Evidence ratings:

Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.

Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.

Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.

Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.

Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.

Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.

Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.

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