Emotional literacy programme in special schools for children with a learning disability in England: the ZF-SEND feasibility RCT
Authors: Stenfert Kroese Biza , Unwin Gemma , Hastings Richard , Jahoda Andrew , McNamara Rachel , Gillespie David , Segrott Jeremy , Ingarfield Kate , Gianatsi Myrsini , Randell Elizabeth , Mather Zoe , Barrett Barbara , Ganguli Poushali , Rose John , Sahle Mariam , Warren Emily , Da Cruz Nathan 
Published: December 2024

Abstract
Background
Children with a learning disability experience a range of inequalities and adverse life events that put them at greater risk of mental health problems. The construct of emotional literacy has been shown to be a moderating factor of how life stress affects mental health. Teaching emotional literacy in schools may therefore be an effective way to promote positive mental health. There is an identified need for adapted emotional literacy programmes in special schools.

Objectives
To evaluate whether it is feasible to conduct a large-scale randomised controlled trial of the effectiveness and cost-effectiveness of an emotional literacy programme (Zippy’s Friends special educational needs and disabilities) for children with a learning disability in special schools. The key aims were to assess the acceptability and feasibility of participating in the trial, data collection and the Zippy’s Friends special educational needs and disabilities intervention through quantitative and qualitative data collection.

Design
A feasibility, cluster randomised controlled trial that aimed to recruit and randomise 12 special schools to either deliver the intervention over 1 academic year or continue with practice as usual and to collect data from 96 pupils at baseline (pre randomisation) and 12 months post randomisation.

Setting
Special schools in England and Scotland.

Participants
Pupils with a learning disability, aged 9–11 years, attending special schools in England. Follow-up interviews were conducted with 8 pupils, 4 parents/carers and 11 school staff members.

Intervention
Zippy’s Friends for Special Educational Needs and Disabilities is a manual-based, classroom-based emotional literacy programme focused on a problem-solving approach to develop and improve children’s emotional literacy. The mainstream programme has been adapted for children with a learning disability by simplifying the activities, shortening the sessions and introducing more repetition.

Main outcome measures
Feasibility and acceptability of: (1) participation in the research trial; (2) the collection of the outcome measure data and (3) the Zippy’s Friends for Special Educational Needs and Disabilities intervention.

Results
A total of 8 schools and 53 pupils were recruited. Retention of schools after randomisation (100%) and retention of pupils (100%) met the prespecified progression criteria. For recruitment of schools (20.5% of those approached), pupil engagement with the intervention (50%) and collection of outcome and service use data (62.3%) the criteria were partially met. Fidelity of the intervention delivery (48%) fell just below the progression criteria. Thus, the feasibility and acceptability outcome progression criteria were largely met, suggesting that progression to a full trial is warranted with amendments to the study design.

Limitations
This feasibility trial was conducted during the COVID-19 pandemic, resulting in unusually high absences of pupils and teachers, different classroom arrangements (bubbles) and unprecedented stress and emotional challenges for pupils, parents and teaching staff. The findings are therefore specific to that period and all three main outcomes of this feasibility trial were adversely affected.

Conclusions
The findings of this study indicate that a large-scale randomised controlled trial is feasible provided that a number of amendments to the study design are made to improve: (1) the timing of the project to suit the demands of special schools’ yearly timetable; (2) recruitment and (3) outcome and service use data collection.

Future work
On the basis of the current findings, an application for a full trial will be prepared and submitted with a number of amendments.

Trial registration
This trial is registered as ISRCTN83610691.

Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129064) and is published in full in Public Health Research; Vol. 12, No. 15. See the NIHR Funding and Awards website for further award information.