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## Breadcrumb

            -  Evidence for Program Improvement 
            -  Self-Regulation Relational 
            -           Increase frequency of sessions      

# Increase frequency of sessions

## Outcome

### Self-Regulation

## Intervention Family

### Relational Interventions

Relational Interventions       Conduct sessions more than once per week   Use delivery staff with specialized training

## Increase Frequency of Sessions

## Evidence

The 10 relational interventions **delivered more than once per week**showed greater improvements in children’s self-regulation skills than those meeting less frequently. These interventions took place in traditional and alternative schools and used both group and individualized formats.

Relational interventions that meet more frequently may be better able to impact self-regulation outcomes than those with less frequency. In our evidence base, programs that met more than once per week had larger impacts than those that met less frequently. Given that many relational programs involve therapy, counseling, or mentoring, increasing the frequency of sessions can provide more time to build trusting relationships and rapport with your participants, which is the foundational mechanism of change for relational interventions. The more frequent contact may also provide the opportunity for clinically-oriented programs to dive deeper into the complex cognitive patterns that may engender attention problems. More frequent contact also provides more opportunities to reinforce self-regulation. For group-based interventions, meeting more than once per week can allow for positive peer relationships to develop among group members, which may also have therapeutic benefits.

Finding ways to increase the frequency with which your relational programs meet with children and youth may involve making changes to the structure of your program, and it may involve negotiating with the host setting (e.g., a school) to find more opportunities during the week to meet with the children and youth in your program. Increasing the frequency of the intervention will be contingent on the flexibility of the school’s schedule and the strength of your relationship with school administration.

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## Assess Feasibility

                          - Program objectives.  Revisit what your program is trying to achieve and the reasons for the current dosage of your program. Is it realistic to expect that the desired outcomes can be achieved given the current frequency of sessions?
                          - Current program structure.  Assess the frequency of your current services and determine if it could increase. How many times per week do children and youth meet with a provider or receive program services? Would it make sense to increase frequency of sessions given the current length of the program, or would you also need to increase the length (i.e., the number of weeks the program lasts)?
                          - Program resources.  Consider what resources would be necessary to increase the number of times per week you meet with children and youth. Would you need to hire additional staff, negotiate with current funders, or identify additional resources?
                          - Program setting.  Consider any constraints presented by the intervention’s setting. If you are in a school, determine if there is flexibility in the schedule to meet with participants more frequently, and identify what it would take to build support for the change among administration and teachers.
                          - Current program content.  Review current therapeutic plans or program guidance and assess how increasing the frequency of sessions would affect the scope of the content. How would you use the extra time? Would you expand on current content in a more in-depth way, or would you add new content?
                          - Recruitment and retention.  Consider how increasing the number of sessions might affect participation and responsiveness among children and youth. Would you need to focus more on keeping participants engaged over time? What barriers might families and their children face when asked to attend sessions more than once per week, and what can your organization do to reduce those barriers?

## Take Action

Consider any of the following depending on the results of your feasibility assessment:
                          - Increase the frequency with which you hold program sessions, ideally to more than once per week. For example, consider increasing sessions to two times per week for most children and youth, and up to daily for a smaller subset. Or consider mixing one-on-one formats with group formats during the week to maximize opportunities to have contact with participants.
                          - Decide what enhancements are realistic and try incremental changes. For instance, gradually increase the frequency of sessions over the duration of the program or try it with a smaller number of your participants first before rolling it out across the program.
                          - Consider additional supports  needed to maintain engagement in the program and commitment to more than once per week contact. For example:                             - Send multiple reminder texts, calls, and emails to the child’s caregiver or directly to older youth, as appropriate.
                            - Follow up with children and youth (or their caregivers) who miss a session and offer make-up sessions.
                            - Include fun activities and play to keep the sessions positive and engaging.
                            - For group sessions, cultivate a supportive environment where participants encourage each other to attend.
                            - Offer incentives for attending sessions, snacks, and assistance with transportation or other identified barriers.
                            - Consider whether virtual sessions are an option, but work with your participants to ensure they have access to necessary technology. For example, explore community resources and local businesses that may be able to provide free internet access.