Nurture Groups Research Articles

TBRI® Nurture Group©: tier 2 intervention for preschoolers born during the COVID-19 pandemic & experiencing economic hardship

ABSTRACT This study explored the effectiveness of Trust-Based Relational Intervention® (TBRI®) Nurture Group© to improve social-emotional development among preschool aged students who experienced economic hardship and the COVID-19 pandemic. A mixed-methods approach using the Strengths and Difficulties Questionnaire (SDQ) and focus group interviews with teaching staff were used to determine effectiveness of the intervention on pre-kindergarten and preschool students. Significant improvements in social-emotional development among pre-kindergarten children occurred, including reduced conduct and peer relationship problems, decreased emotional behavioral difficulties, and increased prosocial behavior. Preschool children showed positive changes in social-emotional development, though not statistically significant. There was a significant difference in the changes that occurred between classes in the domains of conduct problems and prosocial behaviors, as the pre-kindergarten children experienced significantly larger improvements in these domains. Qualitative findings indicated enhanced empathy and self-regulation skills among children participating in the Nurture Group© and consistency between TBRI® principles and the center’s curriculum. Overall, this study confirms the theory that TBRI® Nurture Group© positively impacts children’s social-emotional development, with implications for occupational therapy practitioners to promote trauma-informed approaches and protective factors through collaboration with educators.

Feasibility and Acceptability of a Trauma-informed Intervention to Leverage Caregivers in Preventing Opioid Use Among Youth Involved in the Legal System.

Youth in the legal system (YILS) report high rates of substance use (SU), complex family/social relationships, and chronic trauma. The current study tested the feasibility of a prevention intervention, Trust-based Relational Intervention® (TBRI®), that leverages family systems by strengthening connection and providing emotional and instrumental guidance and support. TBRI includes the primary TBRI Intervention, comprised of Caregiver Training, Youth Training, and joint youth-caregiver Nurture Groups, and TBRI Family Coaching. With a sample of eight youth-caregiver dyads, the study adopted a mixed-methods design with a multi-informant approach to fulfill two goals: (1) testing TBRI as a prevention intervention for opioid use (OU), other SU, and related issues, and (2) testing the feasibility and acceptability of the TBRI Intervention by virtual delivery. Session attendance and completion rates demonstrated feasibility of recruiting and retaining participants and intervention fidelity. Preliminary results were reported on intervention outcomes, including OU and other SU, illegal activities, and educational attainment. Pre- and post-intervention comparisons showed decreases in youth negative urgency, conduct problems, and hyperactivity. Caregiver and staff participants responded favorably to TBRI and its virtual delivery; youth were more capable of expressing their needs and acknowledged the importance of families in preventing problems after discharge from secure facilities. While acknowledging sufficiency of intervention content, caregivers expressed the desire for more sessions. Results demonstrate the feasibility and acceptability of a trauma-informed, attachment-based prevention intervention for youth and families in contact with the legal system. TBRI is a promising approach for preventing the initiation or escalation of OU among YILS.

How effectively can nurture groups be used in improving outcomes for young children with emotional, behavioural and social difficulties in primary schools?

Emotional, social, behavioral, and mental health disorders in young children are increasingly prevalent and may have long-term effects, persisting from preschool into primary school (Carroll & Hurry, 2018). Such challenges can significantly impact children's ability to adapt to the classroom and access learning opportunities. To address these challenges, Boxall (2002) developed the concept of nurture groups, where a small group of students is removed from their regular classes for a limited period during the school year to model positive attachment relationships, develop emotional literacy, and provide opportunities for social learning while maintaining access to education (Loinaz, 2015). This literature review aims to explore the effectiveness of nurture groups in improving outcomes for young children with emotional, behavioral, and social difficulties in primary schools. The study reviews existing literature, examining the positive effects of nurture groups on children's well-being, while also critiquing current research. The results suggest that children with a broad spectrum of social, emotional, and behavioral difficulties may benefit from nurture groups, thereby making a strong case for creating nurturing schools. However, one potential concern is that some students who thrive in nurturing schools may struggle when they return to mainstream classes. Therefore, further comparable studies on a larger scale are required.

Whole-school nurturing approaches: A systematic analysis of impact

Aims:This systematic analysis aims to address the research question – do whole-school nurturing approaches show any impact in the short or long term on (1) emotional/behavioural, (2) cognitive/educational or (3) teacher/school variables?Rationale:Trauma or Adverse Childhood Experiences can have long-term consequences though causing problems in attachment, which nurturing approaches seek to ameliorate. Whilst there is a good deal of international research evidence on the impact of Nurture Groups in schools, less is known about the impact of whole school nurturing approaches on pupils and schools. This paper aims to address that gap.Findings:A total of 146 papers were retrieved from four databases and 13 from other sources. After excluding 61 duplicate papers, 98 papers were screened in relation to inclusion and exclusion criteria, and only 13 papers were finally selected. Results suggest that nurturing approaches can have a positive impact on pupils’ social, emotional and behavioural needs, academic progress, other pupils in the mainstream class/school, parents and home life, and the whole school. Additionally, the length of time a nurturing approach is in place in a school contributes to its effectiveness.Limitations:Limitations include the quality of research available, lack of papers focusing on universal whole-school nurturing approaches and lack of international studies.Conclusions:The paper highlights the need for more robust research focusing on universal whole-school nurturing approaches to be carried out.

Promoting Social-Emotional Development In Children Experiencing Economic Hardship Using TBRI® Nurture Group©

ABSTRACT The purpose of this study was to examine the effect of occupational therapy group intervention using Trust Based Relational Intervention® (TBRI®) Nurture Groups© on preschool children’s social, emotional, and behavioral development in a Head Start program. This study used a retrospective mixed method, quasi-experimental design with non-equivalent groups and pretest-posttest measures. The intervention site teaching staff participated in 16 hours of TBRI® Caregiver training and the children participated in 12 weeks of Nurture Group© interventions. The Strengths and Difficulties Questionnaire (SDQ) and Teaching Strategies GOLD® (TSG) assessment measured child development in social, emotional, and behavioral domains. The intervention site teaching staff participated in a focus group to determine their perceptions of the intervention’s effectiveness. This data was evaluated using grounded theory methodology. SDQ: The children experienced statistically significant changes in the emotional symptoms and prosocial behavior domains. TSG: Results indicated a statistically significant main effect of site on objectives of Forms Relationships with Adults, Responds to Emotional Cues, and Balances Needs & Rights of Self and Others. Themes identified from qualitative analysis illustrated how the teachers highly valued the TBRI® training and adapted their teaching strategies to incorporate the TBRI® principles of empowering, connecting, and correcting. Teaching staff reported increased perceived social-emotional skills in the children and detailed how the children’s behavior changed to demonstrate these skills. Occupational therapy group intervention supports the social-emotional development of children attending Head Start. Occupational therapy practitioners need to engage in universal and targeted approaches to promote resiliency in this population of at-risk children.

The effectiveness of nurturing approaches on primary-aged children in the UK: A systematic review

Nurturing approaches (NA) derived from the need to support children’s social, emotional and behavioural development and their ability to build secure relationships with others (Boxall, 2002). This systematic review follows Hughes and Schlösser’s (2014) review of the effectiveness of nurture groups (NGs). The purpose was two-fold: To assess whether the issues highlighted by Hughes and Schlösser (2014) have been addressed; and to evaluate the quality of evidence supporting the implementation of NAs in primary schools across Scotland. Both NGs and whole-school nurture were included, reflecting current nurturing practices in Scotland. 647 articles were initially sourced from a range of databases. Following eligibility screening, eight peer-reviewed articles were identified for appraisal and synthesis using the Downs and Black (1998) research quality checklist and National Institute for Health and Care Excellence (2012) guidelines. A range of methodological approaches and findings were reported, such as: Improvements in relationships, social skills, emotional regulation, academic engagement and attitudes towards school. Overall, NAs have been shown to relate to positive outcomes for primary school-aged children. However, due to a number of methodological issues, the reliability and generalisability of these findings were questionable. The findings were discussed in relation to the current Scottish context. The rise of whole-school approaches; the importance of inclusive practice; considerations for the use of quantitative and qualitative research in education; and considerations around the impact of the current Covid-19 pandemic were included. Implications for educational psychology practice and future research were discussed, in addition to the limitations of the current review.

The effectiveness of Nurture Groups in improving outcomes for young children with social, emotional and behavioural difficulties in primary schools: An evaluation of Nurture Group provision in Northern Ireland

Concerns have grown regarding the increased prevalence of social, emotional and behavioural difficulties observed in young children in primary school settings. Contributory factors are multiple and varied but one consistent emphasis has been on the negative effects of children’s poor attachments with significant others which, due to contextual factors, may not have developed sufficiently. Some groups of children are more at risk of not developing strong attachments, particularly children in care whose ‘pre-care’ and ‘in care’ experiences make it more likely that their attachments will have been adversely impacted. Reflecting this increasing concern, there has been a growth of school-based interventions that aim to strengthen attachments in order that children can develop social and emotional skills; thus enabling them to be better placed to access learning opportunities and reach levels of educational achievement and attainment similar to their peers. One such intervention is Nurture Groups, modelled on attachment theory. Nurture Group provision is a short-term, schools-based intervention targeted at individual children beginning school who are already displaying social, emotional and/or behavioural difficulties. This article reports the findings of one of the first larger-scale evaluations of the effectiveness of Nurture Group provision in improving outcomes of children, and the first to explore the differential effects of Nurture Groups in relation to school-, pupil- and programme-level characteristics. The evaluation used a non-random control group design, involving a total sample of 384 children, aged 5–6 years, from 30 Nurture Group schools and a further 14 matched schools with no Nurture Group provision in Northern Ireland. The trial found effect sizes ranging in magnitude from g = 0.528 to 1.352 for a range of social, emotional and behavioural outcomes, using the Boxall Profile and the Strengths and Difficulties Questionnaire. However, no evidence of effects was found for academic outcomes. The article discusses the implications for policy and practice of the findings.

Leading the change to establish a whole-school nurturing culture

ABSTRACTThis paper presents findings from a year-long qualitative study of three primary schools in South-East England, focussing on the importance of leadership in changing the culture of a school. In each school, the aim was to embed nurturing principles across the whole school, not just run a nurture group as a specialist intervention. The underlying research question is: how did the head teacher and the Senior Leadership Team (SLT) embed the decision to apply a nurturing culture to the whole school? Findings relate to the style of leadership and particularly the process by which the leaders set about introducing and embedding the change in culture. The impact on the schools was positive, with clear examples of the change in culture. However, the vital role played by the head and the SLT in bringing about a change in culture raises the question of whether such a change could survive the departure from the school of senior leaders who are personally committed to nurture.

A language focused approach to supporting children with social, emotional and behavioural difficulties (SEBD)

ABSTRACTChildren with Social, Emotional and Behavioural Difficulties have been shown to constitute a unique class of Special Educational Need, where their ‘challenging’ behaviour can often result in a disproportionately punitive response, rather than one characterised by a needs-based understanding of behaviour as communication. Such an understanding underpins relational approaches to behaviour management in school where a will to develop, maintain, repair and sustain attachments is key. In addition, the centrality of language to the success of such approaches has also been identified. This paper explores a relational approach in school within the context of Nurture Groups, Restorative Practice and positive language and communication. It concludes that to enact a principle of inclusion for troubled children, we need to create facilitating environments in school that are consistent, equitable and that promote trust, through naturalistic opportunities for positive language and communication.

Exploring the impact of Nurture Groups on children’s social skills: a mixed-methods approach

ABSTRACTNurture Groups (NGs) are a short term, psychotherapeutic intervention aiming to provide reparative attachment experiences for children within an educational setting. The social skills of 16 children (aged between 6.0 and 9.75 years) were assessed through teacher ratings and children’s self-report to hypothetical and challenging social situations. Thematic analysis was also used to explore six children’s experiences and perceptions of NG intervention on their social skills. Over time, children attending NGs used significantly more socially appropriate responses. Teachers’ ratings of children’s social skills also improved, although did not reach statistical significance. In their interviews, children suggested that they enjoyed attending NGs and that this had helped them improve their social skills. However, they reported challenges engaging with peers outside of the NG, particularly in the playground. Implications for practice include the need to identify how practitioners can help to facilitate the generalisation of children’s developing social skills beyond the NG context.

Critical realism with a ‘small-c’: using domain theory to conceptualize therapeutic education

ABSTRACTThe recent rise in popularity of nurture groups in British schools appears to be aligned with a broader shift towards therapeutic education. With initial origins in attachment theory, nurture group practice has more recently embraced Social and Emotional Learning (SEL) as a way of enhancing children’s emotional wellbeing. Research into school-based SEL initiatives has, however, been caught in a crossfire between positivist and interpretivist traditions. The focus of this paper is to steer a middle course by developing a critical realist account which, in applying domain theory, elaborates on the generative mechanisms at work in nurture group practice. This article is based on ethnographic research conducted within one English school which sought to explore qualitatively how SEL was constructed in text, talk and practice. Additionally, this paper illustrates the benefits of ‘small-c’ critical realism as a way of overcoming certain dichotomies and dualisms inherent in social theory.

A model for personal and professional support for nurture group staff: to what extent can group process consultation be used as a resource to meet the challenges of running a nurture group?

This article details a mixed methods study designed to examine the impact of a group process consultation model in helping staff manage challenging behaviour in the nurture group setting. It relates to two geographical clusters of staff, including teachers and teaching assistants, running 11 nurture groups in a major metropolitan area in the UK, facilitated by an educational psychologist (EP). For 32 consultation referrals, teacher-rated levels of concern were compared before and after each session revealing a consistent drop, which was maintained throughout the intervention (p < 0.001). Measures of self-confidence and self-efficacy collected at the beginning of the group process consultation programme, and at the end of the first year of operation, revealed that teacher and teaching assistant self-confidence had improved significantly (p < 0.001) along with aspects of teacher self-efficacy (p = 0.023). A focus group, comprising eight teachers and teaching assistants, identified several themes and provided further elaboration on the outcomes of involvement.

The differentiated impact of Kangaroo Class programmes in Quebec primary schools: examining behavioural improvements in relation to student characteristics

ABSTRACTInspired by Nurture Groups, Kangaroo Class (KC) programmes have been gradually expanding in francophone schools throughout the Canadian Province of Quebec. These classes are designed for primary students with social, emotional and behavioural difficulties (SEBDs) and aim to provide children with a nurturing and predictable environment. To date, KC research data show only moderate improvements in attendees’ behaviour. The aim of this study is to differentiate the characteristics of children with a positive behavioural trajectory from those with a negative behavioural trajectory after 2 years of attending KC by examining the sample group in light of their prior educational history, family-specific factors and types of SEBDs. Results indicate that the primary school children whose behaviour improved after 2 years attending KC had entered the programme displaying higher levels of adjustment difficulties and a greater incidence of internalising behaviours in contrast to those whose behaviour deteriorated. These preliminary results, although obtained through a very small sample size, might warily suggest that when a KC admission choice must be made between a range of potential programme candidates, selecting children with internalising behaviours over those with externalising behaviours would likely lead to more effective outcomes.

A psychological service contribution to nurture: Glasgow’s nurturing city

ABSTRACTThis article details the work undertaken in Glasgow to develop a range of nurturing approaches across establishments. Glasgow Psychological Service (GPS), in conjunction with Glasgow education colleagues, used the nurture group principles as developed by the Nurture Group Network, and extended and adapted these to give more detail and direction as to how establishments apply them. These, referred to as ‘Glasgow’s Extended Nurturing Principles’, were the basis from which GPS created a universal training framework to help develop awareness of the principles, their underpinning theory and their application, for 8000 staff in 313 education establishments. In addition to this, GPS contributed to Glasgow Education Service’s whole local authority strategy of using nurture principles to embed school improvement and self-evaluation by developing a tool called ‘How Nurturing is Our School?’. This tool offers a more targeted approach to support schools to self-evaluate their current practice in terms of a nurturing approach and to develop an action plan for improvement. The article reports on the positive impact of nurture within Glasgow. Nurture has been a substantial part of a success story in education in the city which can point to a clear reduction in pupil exclusions, an increase in attendance and a dramatic improvement in Glasgow establishments’ capacity to hold on to the most vulnerable young people.).

The attunement principles: a comparison of nurture group and mainstream settings

ABSTRACTTwo key areas identified for research are differences in practice between nurture groups and mainstream classrooms, and nurturing approaches in rural and low-density populations. This study compared classroom practice in a nurture group serving a wide rural area with the four mainstream classes to which the five children in the group belonged. The target behaviour was the frequency of use of the six principles for developing attunement – being attentive, encouraging initiatives, receiving initiatives, developing attuned interactions, guiding and deepening discussion. Two 1-h time samples were taken in the nurture group and each of the mainstream settings. The attunement principles, both collectively and for each of the six principles separately, were used significantly more frequently and more consistently in the nurture group than in each of the mainstream settings. The results suggest that teacher behaviour in nurture group and mainstream settings differs in terms of attunement. This study indicates the feasibility of conducting controlled research in small rural settings.

Setting up a primary school nurture group

Drawing on the work of South Rise Primary School, Jo Corrigan considers what makes nurture group provision successful, the impact it has on children and their families, and offers advice for schools

Investigating the fidelity and effectiveness of Nurture Groups in the secondary school context

ABSTRACTWhile there exists a sizeable evidence base suggesting nurture groups (NGs) in primary schools are effective in supporting children’s social, emotional and behavioural development, there is little exploration into their secondary context applicability, or their impact on our vulnerable youth. This study explores this area using a purposefully selected sample of seven secondary schools from Glasgow City Council (GCC). The impact and effectiveness of NGs in secondary schools was explored through analysis of pre- and post-Boxall Profile for Young People (BPYP) and contextual information for each young person (n = 24) who attended a NG during academic year 2014–2015. T-test results suggested a significant increase in all but one of the developmental strands of the BPYP following intervention. All diagnostic profile scores demonstrated a decrease; however, only one result was statistically significant. Qualitative information gathered was compared to GCC Education Services ‘Procedures for the Operation of Secondary Nurture Bases’, to investigate the fidelity of implementation of NGs. Analysis indicated that fidelity was achieved to some extent; however, there existed some notable differences between schools. Supporting factors and potential barriers to implementation are considered and discussed in the report, as are the implications of the quantitative BPYP data.

Creating a whole school ethos of care

ABSTRACTThis paper raises questions about schools as positive models of caring societies. Against a background of growing concern for the mental health of children it addresses the centrality of ‘nurture’ and its close cousin ‘care’ as a whole school value, theorised as both a means and an end of schooling. How might school leaders communicate a principle of mutual care and inspire whole school commitment from staff, pupils and parents? Discussion is informed by qualitative data (interviews, focus groups and observations) from a comparative study of seven schools in the NW of England which use the principles and practices of nurture groups. Three demonstrated strong leadership based on ‘deep care’ and an emphasis on ongoing relationships with children. The paper concludes that leadership, as evidenced in the good practice reported here, can go some way towards bringing about the ideal of a whole school ethos of care.

Setting up a nurture group

Garry Freeman presents a short guide to the practicalities and key challenges of setting up a secondary nurture group

‘It’s small steps, but that leads to bigger changes’: evaluation of a nurture group intervention

ABSTRACTThis article presents the results of a small-scale research project that aimed to evaluate the effectiveness of a part-time nurture group recently established in one primary school. Qualitative interviews were used to gather staff, pupil and parental perceptions about the nurture group. These focused not only on what difference the nurture group was making to the pupils concerned but also on views about what factors contributed to noted changes. All stakeholder groups identified areas of development for nurture group pupils. These included improved social skills, growth in personal confidence, greater engagement with academic tasks and fewer incidences of undesirable behaviour. The evidence suggests that the nurture group offered an effective way of supporting the social, emotional and behavioural skills of a group of ‘at-risk’ pupils. Nine practices thought to be important in achieving these outcomes are highlighted.