The NICE evidence reviews
The targeted support toolkit uses evidence reviewed by the National Institute for Health and Care Excellence (NICE).
The targeted support tool provides types of targeted support that have been thoroughly evaluated, aimed at providing support for students with mild to moderate mental health and wellbeing needs that can be provided in school or college.
These do not replace NHS CYPMH services, and any young person experiencing significant difficulties should be referred through normal referral routes.
The absence of evidence is not indicative of the absence of effectiveness, and this is by no means a comprehensive list - there are many ways to support children and young people that are highly efficacious but for which there is currently limited research.
Other valid approaches may be recommended and/or delivered by appropriately trained professionals and their effectiveness should be assessed within your overall monitoring approach.
Why is it important to have an evidence-based support programme?
When selecting targeted support programmes for your school or college, it is important to select one which has been shown to improve the mental health and wellbeing of young people you are aiming to support.
This is to ensure that the support programme actually works and doesn’t have unintended consequences (such as increasing anxiety in children).
The NICE evidence reviews
The studies included in the NICE evidence reviews were Randomised Control Trials (RCTs) or cluster RCTs.
What are Randomised Control Trials (RCTs)?
RCTs are considered to be the ‘gold standard’ of scientific evidence, because they aim to reduce the risk of bias in studies. An RCT is carried out by identifying individuals and randomly allocating them to either the support programme (sometimes called an ‘intervention’) that is being assessed, or something to compare the support programme to (e.g., ‘usual practice’ or no intervention).
A cluster RCT is the same concept but involves randomising whole schools or colleges instead of individuals. RCTs allow us to be able to assess whether a support programme is having the intended effect.
How did NICE decide on the evidence ratings?
The quality of the evidence included in the NICE review was often graded very low or low. This was mainly because the reviewers found a risk of bias in the studies - for example, studies where participants and school staff were aware of a young person’s allocation to the programme being assessed.
What are the GRADE ratings used in the NICE evidence review?
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.
Source: GRADE Working Group grades of evidence: NICE Guidelines
The targeted support tool filters
The targeted support tool can help you to identify evidence-based targeted support programmes which might be right for your school or college.
There are several filters in the library to help narrow down appropriate interventions:
1. Education phase
The NICE evidence reviews only found studies that had been carried out in primary and secondary schools, due to a lack of studies being carried out in FE colleges. However, we have mapped these by age group to identify support programmes which may be effective for FE colleges as well.
The NICE evidence review looked at the effectiveness of programmes for addressing different outcomes, e.g. behavioural, anxiety or depression. Once you have established priority areas for your school or college, you can select an outcome.
3. Delivery method
You can explore whether group-based, individual-based or computer-based support programmes will be most useful for your setting.
4. Delivered by
The final filter relates to who will deliver the support in your setting, e.g., an external specialist or a member of staff.
Please be aware that may not be a recommended targeted support option for every combination of school phase/outcome/delivery method or provider. This is due to the limits to the number of studies which were reviewed by NICE.