Impact case study database
Super Skills for Life: Transforming access to evidence-based mental health interventions for young people
1. Summary of the impact
Professor Essau’s research on mental disorders in young people has underpinned the development and dissemination of Super Skills for Life (SSL), a manualised transdiagnostic mental health intervention for children and adolescents. Since 2014, SSL has influenced policy, informed practice, and ultimately led to significant mental health improvements for young people internationally. Through her work with international government agencies, Essau’s research has led to fundamental changes in mental health policies in Malaysia, Mauritius and Romania. Utilising a ‘train-the-trainer approach’, the SSL training has built the capacity and shaped the practice of 24,906 practitioners in 24 countries. SSL has also enabled the Surrey and Borders Partnership NHS Foundation Trust to offer targeted Child and Adolescent Mental Health Services. Delivery of SSL has produced positive mental health outcomes in approximately 600,000 young people.
2. Underpinning research
Essau’s previous research (2004-2014) demonstrated that young people have a limited understanding of mental health problems, and that only 25% of young people experiencing emotional distress seek treatment. With research grants from numerous funding bodies ( G1- G3), Essau’s subsequent research (2014 to date) has investigated the long-term impact of emotional problems and factors that can lead children and adolescents to develop mental health problems. Her research into anxiety and depression in young people in various countries has demonstrated that such problems occur frequently in young people, and commonly co-occur with behavioural problems ( R1, R2, R3).
Research led by Essau showed that anxiety disorders which develop during adolescence can significantly predict the development of anxiety, depression and substance use disorders during adulthood ( R1, R3), and are associated with impairment in various life domains, such as poor adjustment at work, poor family relationships, family unit problems, lower life satisfaction, poor coping skills, and additional chronic stress ( R1). Further research by Essau revealed that low self-esteem, cognitive dysfunction, and poor lifestyle, such as lack of sleep, unhealthy food and lack of exercise, all increase the risk of developing anxiety and depression ( R2, R3, R4).
To improve accessibility to evidence-based interventions, in 2013, Essau used the findings from her research to develop a manualised transdiagnostic intervention to prevent and treat emotional problems in children and adolescents, Super Skills for Life (SSL). An innovative, evidence-based intervention that works by targeting common risk factors of emotional problems, SSL uses the principles of cognitive behaviour therapy and behavioural activation, along with social skills training, video feedback and cognitive preparation ( R2, R3). This intervention builds confidence and reduces emotional problems in children and young people, giving them the skills to cope with difficult or challenging situations by teaching them cognitive, social and emotional skills. Further research by Essau demonstrated that SSL can be delivered effectively in a regular school setting ( R5) and in residential care institutions ( R6) by professionals with a range of skills and experience. The first iteration of SSL (launched in 2013) aimed to help equip children (6-11 year olds) with skills to deal with situations that cause them anxiety ( R5).
In 2016, SSL was expanded to promote behaviours that enable 12-18 year olds to stay physically and psychologically well, based on Essau’s research finding that adolescent-onset anxiety disorders lead to significantly more negative outcomes when compared to those developed during childhood ( R1). The adolescent version of SSL emphasises regular physical exercise, underpinned by Essau’s research that showed low involvement in exercise is associated with a long-term trajectory of increasing depression ( R3). Based on the research-derived and research-demonstrated benefits of the SSL programme, the intervention has been delivered in schools, residential children’s homes and clinical settings to address mental health problems in young people before they develop.
3. References to the research
R1 Essau, C.A., Lewinsohn, P.M., Olaya, B., Seeley, J.R. (2014) Anxiety disorders in adolescents and psychosocial outcomes at age 30, J. Affect. Disord., 163, pp.125-132 . https://doi.org/10.1016/j.jad.2013.12.033 Listed in REF2.
R2 de la Torre-Luque, A., Essau, C.A. (2019) Symptom network connectivity in adolescents with comorbid major depressive disorder and social phobia, J. Affect. Disord., 255, pp.60-68. https://doi.org/10.1016/j.jad.2019.05.015 Listed in REF2.
R3 Essau, C.A., de la Torre-Luque, A., Lewinsohn, P.M., Rohde, P. (2020) Patterns, predictors and outcome of the trajectories of depressive symptoms from adolescence to adulthood, Depression and Anxiety, 37, pp.565-575. https://doi.org/10.1002/da.23034
R4 de la Torre-Luque, A., Fiol-Veny, A., Essau, C.A., Maria Balle, M., Bornas, X. (2020) Effects of a transdiagnostic cognitive behaviour therapy-based programme on the natural course of anxiety symptoms in adolescence, J. Affect. Disord., 264, pp.474-482. https://doi.org/10.1016/j.jad.2019.11.078
R5 Fernández-Martínez, I., Orgilés, M., Morales, A., Espada, J.P., Essau, C. (2020) One-Year follow-up effects of a cognitive behavior therapy-based transdiagnostic program for emotional problems in young children: A school-based cluster-randomized controlled trial, J. Affect. Disord., 262, pp.258-266. https://doi.org/10.1016/j.jad.2019.11.002
R6 Karishma Ramdhonee-Dowlot, K., Balloo, K., Essau, C.A. (2020) Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial, J. Affect. Disord., 278, pp.327-338. https://doi.org/10.1016/j.jad.2020.09.053 Listed in REF2.
G1 Anxiety symptoms across two generations of the same families in Japan and in the UK, £34,570 British Council PMI2 Strategic Alliances and Partnerships Project Research Co-operation, 2008 – 2009, PI (RC87).
G2: Anxiety among adolescents in Pakistan: From epidemiology to prevention, £59,937 Higher Education Commission, Pakistan and British Council International Strategic Partnerships in Research and Education Strategic Partnerships Fund, 2011 – 2014, PI (SP-216).
G3: A multi-perspective analysis of university students' personal mental health and well-being capital and its effect on their life outcomes, £217,581 Economic and Social Research Council UK, 2020 – 2022, Co-I (ES/T002255/1).
4. Details of the impact
- **Improving the mental health of children and adolescents through Super Skills for Life
Professor Essau’s research-derived intervention, SSL, was first used at 12 schools in London in 2013; this initial implementation allowed Essau to formally demonstrate positive impacts of SSL on children with significant anxiety problems. In 2015, Essau worked with Caritas Salford Schools Service Cathedral Centre UK to roll out SSL within 27 schools in 13 local authority areas within the diocese ( IMP1). Based on its effectiveness in reducing targeted emotional problems in children in school and residential care settings internationally ( R4- R6), implementation of SSL was expanded internationally in 2015. The expansion has been facilitated by a train-the-trainer approach whereby Essau has delivered SSL training to practitioners who themselves go on to train fellow practitioners. Through this model, between 2014 and 2020, 24,906 practitioners (youth workers, mental health practitioners, teachers) in 24 countries have received SSL training, and the intervention has been implemented in at least 215 schools, 18 residential childcare/juvenile homes, 43 clinical/counselling services settings and 38 community centres, across 13 countries ( IMP2).
The ultimate beneficiaries of SSL are young people. Since 2015, SSL has improved the mental health and wellbeing of 10,661 children and adolescents, through direct SSL provision in schools, residential children’s homes, community centres, hospitals and public health services in Cyprus, Germany, Greece, India, Malaysia, Mauritius, Mexico, Nigeria, Pakistan, Poland, Turkey, Spain, and the UK ( IMP2- IMP6). Children and adolescents in Australia, Canada, Croatia, Cuba, Kenya, Northern Cyprus, Portugal, Romania, Singapore, Somalia, and the United Arab Emirates, have also benefited from SSL through practitioner training in these countries, but specific numbers on SSL provision to young people are not available. As such, many more children and young people have benefitted from the wider dissemination and delivery of SSL. For example, in Malaysia one practitioner alone has delivered SSL to 718 young people and trained 781 other practitioners ( IMP2). Data reported by practitioners using SSL in international settings ( IMP2), along with post-training survey responses from practitioners ( IMP7) indicates each practitioner reaches 25 children/young people on average via delivery of SSL. Through the train-the-trainer model, an estimated total of 600,000 young people have benefitted from the dissemination and delivery of SSL across the 24 countries.
The young people who have participated in SSL show increased self-confidence, enhanced social and communication skills, lifestyle improvements and decreased use of mental health services ( IMP1, IMP2, IMP6, IMP8). The positive changes fostered by SSL were observed by teachers, parents and the young people themselves. One teacher reported that SSL had ‘a huge impact in our school, really improving outcome[s]… the measurable impact is that we have children who would have been possibly excluded in the last 12 months and they haven’t. They remain engaged’ ( IMP2). A parent also observed how SSL helped their child ‘to be more relaxed and face different circumstances calm[ly]. He is not as anxious as he was before, and he knows what to do when he has to cope with a situation using relaxation techniques’ ( IMP8). As for the children themselves, one observes, ‘The SSL program helped me to manage my anxiety. First of all, I was taught to have self-esteem and control my feelings. Next, I have learned how to relax. The social skills we have learned from this program helped me to communicate better with other kids. This program helped me to improve my life.’ ( IMP8). SSL has led to improved educational attainment for children and adolescent participants, including higher grade averages, reduced school truancy, and increased interaction with teachers and peers ( IMP2). Children who participated in SSL were also better able to cope with the impact of the COVID-19 pandemic in 2020: they had lower anxiety, mood and sleep problems compared to children who have not participated in SSL ( IMP2, IMP7).
- Informing the practice of youth mental health and education practitioners
More than 4,502 practitioners (including teachers) have been trained directly by Essau in SSL in 24 countries. Through the train-the-trainer model, the reach of these benefits has been extended to a further 20,404 practitioners being trained by their colleagues, resulting in 24,906 practitioners being trained in SSL globally ( IMP2). This training and the SSL programme have enhanced their ability to identify and address mental health problems in children and adolescents and shaped their views and practice on these issues. When surveyed, 98.5% of practitioners trained directly by Essau in 2020 (128 respondents) indicated that they found SSL training useful or very useful for enhancing their ability to support children/adolescents’ wellbeing, and 91.4% reported they were confident that as a result of the SSL training they had the necessary level of knowledge needed to prevent mental health problems in children and adolescents ( IMP7). Furthermore, practitioners reported that SSL would help them to directly address issues generated by the COVID-19 crisis and associated social distancing by allowing them to educate young people about mental health issues so they could deal with Coronavirus-induced anxiety and depression. Practitioners who have trained fellow teachers, carers and government officials also report their colleagues have experienced improved knowledge of, and confidence to address, mental health problems in children and adolescents, allowing for better connections with young people and greater professional satisfaction ( IMP2).
The benefits of SSL training for practitioners are demonstrated by the experience of UK-based Catholic education service, Caritas Salford. Essau has worked with Caritas Salford since 2015, when the organisation first implemented SSL, and still delivers annual workshops in youth mental health for the service. The Service Manager at Caritas Salford attests that SSL training has, ‘enhanced the skills that my team members need to work with the children and to cope with stressful situations. Not only have the training [sessions] imparted to staff a greater knowledge about mental health problems in children, but they have also reported feeling more confident when discussing mental health and self-esteem with children’ ( IMP1). As a result of these benefits, since 2019, Caritas Salford has embedded the SSL programme within their service offer across their Diocese-wide Schools’ Service supporting young people throughout Greater Manchester and Lancashire ( IMP1).
Essau’s research has contributed on an international scale to public understanding and skills through presentations and workshops to public officials, policy makers and youth mental health practitioners ( IMP2- IMP5). Since 2014, Essau has delivered 94 invited workshops, lectures and keynotes in 24 countries, including lectures at the South Australian Department for Education and Child Development in Australia, the Ministry of Youth and Sports in Malaysia, the Ministry of Youth Empowerment, Sports and Recreation and Ministry of Defence, Home Affairs and External Communications in Mauritius, and the Ministry of Health in Singapore ( IMP9). These sessions have raised awareness about mental health problems in young people, and the importance of early mental health prevention ( IMP2- IMP5), reaching a total estimated audience of 29,595 youth mental health practitioners, public officials, and/or policy makers ( IMP9).
- Influencing policy
Essau’s research on youth mental health ( R1, R3) has been directly embedded into the mental health policies of Malaysia, Mauritius and Romania. In February 2019, Essau was invited by the Deputy Chief Minister II of Penang to conduct SSL training for 600 educators ( IMP3). Since 2019, Malaysia’s Deputy Ministry of Youth and Sports, in collaboration with the Ministry of Education and Ministry of Home Affairs, has implemented SSL to its ‘at-risk youth’ (e.g., those involved in the justice system) in selected juvenile homes as well as mainstream and reform schools in seven states in Malaysia. SSL now forms the core of the country’s ‘Inspirasi Anak Muda’ (‘Inspiring Young People’ programme), which supports ‘disconnected’ youth. By July 2019, 240 SSL-trained facilitators were selected to deliver the programme to young people in 50 schools in seven Malaysian states, resulting in 735 adolescents accessing mental health interventions from August-December 2019 ( IMP4).
In recognition of SSL’s results, value for money and potential to deliver long-term, cost-effective and evidence-based mental health support on a national scale ( R4- R6), the Malaysian Ministry of Youth and Sports decided that SSL would be implemented across all 13 states in Malaysia from January 2020 ( IMP4). To facilitate the roll-out, 600 core SSL facilitators from the initial training sessions in Spring 2019 cascaded SSL training through the Penang Education Council, with approximately 19,000 educators trained by December 2019. As a result, SSL now acts as a fulcrum for all of the Ministry’s youth empowerment activities ( IMP4). As the Deputy Minister of Youth and Sport attests: ‘Due to the positive impact that Super Skills for Life has on youth’s targeted behaviour, and in enhancing staff’s knowledge in the prevention of youth mental health problems, the Ministry of Youth and Sports has decided to roll out Super Skills for Life programme across all the 13 states in Malaysia from January 2020, thus embedding it in government mental health policy’ ( IMP4).
Essau’s research-based intervention for improved youth mental health has also been embedded into the Ministry of Youth Empowerment, Sports and Recreation in Mauritius. SSL has been incorporated into ‘Carrefour des Jeunes’, the Ministry’s youth development programme aimed at empowering vulnerable adolescents. SSL modules were integrated into the series of interventions carried out within this programme in May 2019: ‘because we deem Super Skills for Life a useful tool in consolidating skills related to the promotion of resilience, self-confidence, social competence and stress management’ ( IMP5). Similarly, the Office of the Mayor of Iasi in Romania has made a definite commitment to implement SSL in all of its 74 schools in the region of Iasi in 2021 ( IMP10).
- Improving NHS mental health services
Through SSL, Essau’s research has influenced practice in Child and Adolescent Mental Health Services (CAMHS) at Surrey and Borders Partnership NHS Foundation Trust, enabling the trust to provide evidence-based mental health interventions to children and adolescents. The integration of SSL has fundamentally altered the pathway of treatment for those referred to this service. As the assistance offered by CAMHS commonly operates over-capacity, resulting in a waiting list of approximately 18 months, CAMHS trialled the use of SSL in 2019 with 25 young people to assess whether Essau’s research-based intervention might prove a resource- and cost-saving solution. They observed notable improvements in confidence and decreases in anxiety in these young people ( IMP6). In response to this successful trial, the organisation integrated SSL into its services in September 2019 and now offers SSL as the first choice of treatment to children and adolescents who are referred. Subsequently, only those who do not respond to SSL are referred on to more specialised treatments (e.g. a clinical psychologist), reducing waitlists from 30 to just 2‐3 young people. SSL has therefore helped to reduce pressure on the NHS by improving targeted service delivery by the Trust ( IMP6). Essau continues to work with the Trust to enable SSL to be implemented across all of its four quadrants.
5. Sources to corroborate the impact
IMP1 Testimonial from Service Manager, Caritas Schools' Service at the Diocese of Salford dated 9 January 2020. Evidences SSL being embedded in the service offer and benefits from the intervention.
IMP2 Evidence pack containing feedback and testimonials of benefits from SSL provision from mental health and education practitioners in Cyprus, Greece, India, Malaysia, Mexico, Nigeria, Pakistan, Spain, Turkey and the UK, and numbers of practitioners trained and young people who have benefited in each setting, 2014-2020.
IMP3 Testimonial from Deputy Chief Minister II of Penang, Malaysia dated 12 February 2019. Outlines the delivery of SSL training for school counsellors, teachers, trainee teachers and dissemination via train-the-trainer across Penang State.
IMP4 Testimonial from Deputy Minster, Ministry of Youth and Sport, Malaysia dated 7 November 2019. Supports SSL being implemented in schools, juvenile homes and via ‘Inspirasi Anak Muda’ across all 13 states in Malaysia.
IMP5 Testimonial from Director of Youth Affairs, Ministry of Youth Empowerment, Sports and Recreation, Mauritius dated 12 December 2019. Evidences the implementation of SSL via ‘Carrefour des Jeunes’ and benefits from the intervention.
IMP6 Testimonial from Acting Deputy General Manager, Child and Adolescent Mental Health Services at Surrey and Borders Partnership NHS Foundation Trust dated 17 December 2020. Supports the integration of SSL into CAMHS services, and subsequent client improvements and alleviation of pressure on the NHS service observed.
IMP7 Evaluation survey data from practitioner training events in April, July and November 2020: summary statistics, evaluation survey questions and raw response data.
IMP8 Evidence pack containing feedback from children, adolescents and parents of young people who have benefitted from SSL in Cyprus, Greece, Malaysia, Turkey, and the UK, 2014-2020.
IMP9 Details of 94 invited workshops, lectures and keynotes delivered to public officials, policy makers and youth mental health practitioners in 24 countries from May 2014 to December 2020.
IMP10 Testimonial from the Mayor of Iasi, Romania dated 23 October 2020; evidence of Mayor’s commitment to implement SSL in 74 schools in the Iasi region from 2021.
Additional contextual information
Grant funding
Grant number | Value of grant |
---|---|
RC87 | £34,570 |
SP-216 | £59,937 |
ES/T002255/1 | £217,581 |