Wellbeing recovery: what should summer support programmes look like for schoolchildren this year?
This is a rapid, evidence-based response to the policy need that was identified at IPPO’s roundtable discussion on the mental health and wellbeing of young people. It has been written by a team of 13 academic specialists led by Dr Maria Loades from the University of Bath
This paper offers a rapid, evidence-based answer to the question: how should this summer’s holiday support programmes for school-age children in the UK be designed and structured?
A particularly strong theme emerging from the International Public Policy Observatory roundtable on 11 February 2021 was the need to use the 2021 summer holiday not simply for children to catch up academically, but to give them a chance to recover in other ways: emotionally, physically and socially.
The evidence presented in this paper underscores that message: its authors conclude that this summer should not be filled with extra lessons. Rather, children, parents and teachers need time and space to recover, reconnect, and re-build confidence following the complex challenges of the past year.
While there is understandable concern about catching up academically, children will not learn effectively if their mental health and wellbeing is poor. Adequate nutrition, social interaction, play, physical activity, and good mental and physical health need to come first to enable academic catch-up and learning going forwards.
This paper presents five key considerations to underpin the design of any recovery plan for children during the summer holidays:
- Nutrition/diet: including provision of high-quality and varied food, plus opportunities to eat in social contexts and for hands-on involvement with preparing food.
- Sleep: sleeping well benefits children’s mental and physical health, and having a good sleep routine will help their transition back to school after the summer.
- Physical activity: the evidence suggests a clear association between physical exercise and good physical and mental health outcomes for children.
- Valued activity: social (re)connection, play, spending time outdoors and in nature, and creative arts can all help to overcome loneliness, promote wellbeing and inspire hope.
- Family support: parents can be empowered to help themselves and their children to recover, and to manage emergent emotional and behavioural difficulties.
This paper also offers suggestions for what this could mean in practice, in terms of designing:
- Structured summer programmes based on existing evidence-based approaches and community needs (a key recommendation is that these programmes should avoid looking or feeling like term-time school, with time allotted for free play every day).
- Community-based initiatives.
- Parental support programmes.
- Tailored support for children who need more individualised help, for example with their mental health (a summary of the groups of children who have been disproportionately affected by COVID-19 is included at the end of this paper).
Author’s note: throughout this paper, the term ‘children’ is used to refer to those of school-going age (i.e., 5-18 years old). ‘Parents’ is used to refer to parents or primary caregivers.
Part 1: Key negative impacts of COVID-19 for children
The past year of lockdowns and other virus containment measures have had a substantial impact on children. There have been marked individual differences in responses1: while a minority of children have experienced benefits2-6, there is growing evidence that the overall and longer-term impact has been detrimental:
- Physical health. Food security has been profoundly affected, which has had a negative impact on diet quality and quantity, and reduced food variety. Increased levels of food insecurity have affected vulnerable groups such as families with children who normally receive free school meals, and families where parents’ income has suddenly reduced due to being unable to continue with their jobs in lockdown conditions.7,8 Furthermore, lockdown/restrictions have changed the experience of food and eating as a social activity. Sleep patterns and quality have altered in children9 who are, on average, having more difficulties initiating and maintaining sleep, as well as delayed bedtimes and wake times.10 Many children are less physically active and more sedentary than they were prior to the pandemic.9,11,12
- Mental health and wellbeing. During the pandemic, there has been an increase in mental health issues among children. For example, in England, one in six (16%) 5–16-year-olds was identified as having a probable mental disorder in July 2020, an increase from one in nine (10.8%) in 2017.4 Difficulties have been heightened as restrictions have persisted.13 The pandemic and associated lockdown restrictions have brought a range of concerns and challenges for children and families including: worries about catching coronavirus14, the health/health of their family and friends15, food shortages/money worries16, worries about education and longer-term opportunities, school closures5,17, school work and learning from home18,19, exams and academic pressures20, educational opportunities, the economy, and jobs15,20, stresses around not seeing friends and restricted social interaction21,22, feeling isolated and disconnected23, managing boredom and not able to do enjoyable things 5,14,15,24, managing ongoing uncertainty25,26, a lack of opportunities to play27, increased family stress and conflict28, and increased child sexual abuse.29 This has been compounded by decreased access to support, reflected in, for example, a decrease in referrals to mental health services30,31 and for child protection32 although the use of helplines has increased.33 Many children have not felt confident about knowing how to access support.5
- Developmental progression. Childhood is a life stage of dramatic growth and development. Primary school leaders in the UK reported relative weaknesses in several developmental domains on the return to school in autumn 2020, including communication and language development, and fine and gross motor skills.34 Some also reported decrements in social skills.34 For teens, ongoing home confinement and lack of opportunities to explore, develop skills and gain confidence in their abilities separately from their family has had a likely impact on their sense of independence and on their development of key life skills, such as using public transport independently to get to school. Those who are at key transition points have missed out on activities that are symbolic rites of passage, such as proms and graduations.35
Part 2: Why is this summer so important for children?
There is substantial evidence that good mental health and wellbeing are critical precursors to satisfactory learning and academic progress.36-39 Furthermore, children who experience psychological distress are more likely to be excluded from school.40 Therefore, if children are to achieve rapid, long-lasting and effective learning, we must first make sure that they are in a psychologically fit state to be taught.
The summer holidays are the mental health ‘reset button’ on the school year; there is evidence pre-pandemic that during this period of the year, adolescents’ symptoms of anxiety and depression and their reports of daily hassles are lower than during term-time.41 Suicide propensity is also known to decrease.42
This summer, the ‘reset’ is even more important than usual as an opportunity to promote children’s social and emotional wellbeing, crucial to thriving at school and in post-lockdown life. Many children will already have gone back to school before the summer break, but this is unlikely to have been enough to remediate for the impacts of the pandemic. Therefore, the holiday period represents a key time to recover, develop, (re)build confidence, (re)establish friendships, and foster emotional health. Even though this may happen to some extent with summer holidays ‘as usual’, the evidence is that, alongside the benefits of weekends and summer holidays, children are usually less physically active during these times, and spend more time on screens, have more irregular sleep patterns, and eat less healthily – all of which might compound the negative impacts we have seen in children during lockdown.
Maximising the opportunity for physical and mental health recovery will require investment in a dedicated programme of support. To help children be physically and emotionally ready for academic learning in the next academic year, the key goals for the summer recovery programme are to remediate both the losses in physical health that have arisen, and the developmental, psychological, and social losses that children have experienced during the pandemic.
Part 3: Five key considerations to underpin this summer’s recovery strategy
Based on the evidence, the following key principles should be considered in planning for recovery in children during the summer holidays:
Children are particularly vulnerable to poor nutrition and this can have a detrimental effect on their learning capabilities, mood, and physical health3,43,44, with long-term consequences for their life chances. Children’s confidence in social interactions may have been reduced through lack of shared eating opportunities. The aim during recovery should be to ensure that children have access to high-quality nutrition with improved food security and food-related social interaction. Specifically, recovery will require:
(i) The provision of high quality and varied food, in appropriate quantities throughout the summer. On days when activities are provided, meals should be integrated into the plan and could include breakfast, hot meals, packed meals and/or healthy snacks. The importance of eating together for re-socialising children after lockdown should not be underestimated.
(ii) Opportunities for hands-on involvement with food. This could include engaging children in meal-planning, preparation, and cooking. Cookery classes have been shown to be effective in familiarising children with new foods.45 They are often enjoyed by children and are likely to increase skills and confidence in teamwork, verbal communication, following instructions and making meals from fresh unprocessed ingredients.46
(iii) Learning about healthy nutrition as a foundation for play activities. For example, gardening and growing edible items provide opportunities for children to make the connection between ‘farm’ and ‘fork’, as well as fostering other skills including social skills. The fruits and vegetables harvested can be prepared and consumed, adding to dietary variety.
Good sleep is critical to physical and mental health, enabling physical recovery and repair as well as normal cognitive and emotional functioning.47 Difficulties initiating and maintaining sleep are typically caused by stress, or poor bedtime routines. Persistent problems with sleep quality can lead to both immediate and longer-term difficulties across daily functioning such as concentration, attention, anxiety and low mood.48 Since the beginning of the pandemic, children have shown greater difficulties initiating and maintaining sleep compared to pre-COVID, as well as delayed bedtimes and wake times.9,10
This may also be a challenge when children return to school, and their sleep patterns do not suit their daily schedule. Although teenagers may be getting more sleep on school nights, compared to pre-pandemic, likely due to being able to wake up later as they do not have to travel to school, this increase in sleep time does not appear to reflect improvements in sleep quality.10
Various aspects of ‘lockdown life’ are likely to be unhelpful for sleep, such as home-schooling, particularly where schoolwork is done in the bedroom as this can break the body’s association between bedroom and sleep and recreate an association between bedroom and stimulation. As other aspects of life begin to return to normal, and children are encouraged to engage in a wider range of activities, it is important that sleep routines are prioritised including through the summer holidays. This will enable their physical and mental health recovery and their ability to engage in a range of different summer activities.
3. Physical activity
There is evidence that physical inactivity in children has increased since the start of the pandemic9,11,49, and this may be particularly true of those living in urban areas.50 Physical activity is linked to good physical health. Additionally, the evidence suggests a clear positive association between physical exercise and mental health, good cognitive (thinking) functioning, lower levels of psychological difficulties (e.g., depression, stress, negative affect, distress), and greater psychological wellbeing (i.e., self-image, satisfaction with life and happiness).51-53 Activity selection and matching individual preferences are important so children need access to a range of options; inappropriate provision (e.g. of a sport that a child does not enjoy) may have negative impacts on their wellbeing.54
4. Valued activity
Doing more of what matters (i.e., things that we value) is an important way to increase feelings of achievement, closeness, and enjoyment55-57, all of which, ultimately, underpin good mental health. During the pandemic it has been difficult for children to engage in many of their normal valued activities, and this is likely to have contributed to feelings of disengagement, hopelessness, lack of motivation, boredom, and loneliness.5,6,58 The summer holidays, therefore, provide a crucial opportunity for children and families to re-engage in these activities. Many valued activities will involve spending time with other people outside of the home. Depending on age and individual preferences, valued activities may include playing, being outdoors and in nature, and engaging in any form of creativity (see below). After a long time away from valued activities, children might find it hard to re-engage and therefore support and encouragement is likely to be helpful. Children need to have opportunities provided for them, to be inspired and to regain a sense of hopefulness about their futures.
(i) Social (re)connection. Children need time to (re-)connect with one another socially: a lack of social interaction with peers has substantial impacts on the development of social skills and self-identity, and on mood.59-62 Loneliness is associated with poor mental health, both depression and anxiety, both concurrently, and prospectively, up to nine years later.63 There is evidence that loneliness has increased in schoolchildren during the pandemic.5,6,64,65 Children need the time and opportunity to play and spend time with peers to socially (re)connect. Children need to (re)build their social networks, both in quality and quantity, to experience social rewards, to feel part of a group, and to know that there are others they can look to for support. They may need specific support to overcome loneliness.66
(ii) Play. Although some children will have spent more time playing than usual during lockdown, either alone or with parents and siblings, many will have played less than usual. For example, there is evidence that Welsh children were playing less during the third lockdown compared to the first lockdown.5 Moreover, most children have missed out on seeing and playing with their peers.5,21 This is worrying for two key reasons:
(a) Children’s social interaction with their peers happens primarily via play. Play with peers is unique because peer relationships are voluntary and egalitarian; they require negotiation and compromise in a way that sibling relationships do not.67 Because of this, play with peers provides vital learning experiences that support healthy social, cognitive and literacy development.37,68 Play is so essential to children’s wellbeing that The United Nations Convention on the Rights of the Child, Article 3169, defines play as a fundamental right. It has substantial benefits for children’s holistic development and emotional wellbeing.70
(b) Play can help children to recover from difficult experiences and support their physical and mental health. Peer Play is beneficial during times of anxiety, stress and adversity71: it provides a sense of control and independence, it helps children make sense of things they find hard to understand72, and it supports their coping and resilience.73 Importantly, in highly stressful situations (e.g. war zones, hospitals, orphanages), research has shown that playing with other children is therapeutic.74,75
(iii) Being outdoors and in nature benefits wellbeing. Regular access to green space is beneficial to mental health and wellbeing in children.76 Outdoor play has been linked to increased physical health as well as social and emotional health77,78, and there is robust evidence that time spent outdoors and in nature is associated with stress recovery and decreases in anxiety.79-81
(iv) Creative arts. Engagement with projects and initiatives in creative arts can have a positive impact on children’s wellbeing, confidence, social skills, academic achievement, and attitude towards learning.82-84 Research also suggests that participation in creative arts can be especially important in re-engaging disengaged pupils with education and narrowing the gaps associated with disadvantage. Students who are highly engaged with creative arts, in comparison with those who are not, are more likely to graduate, enrol at university, participate in extra-curricular activities, and display civic engagement (e.g., community volunteering).85,86 There is a gap in our understanding of the differences between curricular and extra-curricular creative arts programmes. However, ongoing work during the pandemic suggests that voluntary engagement with creative arts projects, as well as supportive and inclusive environments, appear to be beneficial for the development of positive psychological outcomes identified above.87
5. Supporting families
Children are part of family systems in which adult caregivers play a pivotal role in promoting and maintaining their health and wellbeing. Parents of children in the UK have faced enormous demands and appear to have experienced an increase in mental ill-health during the pandemic28,88-90, and parents in Europe have reported the negative effects of home-schooling, with increased stress, worry, social isolation and domestic conflict.91 There is extensive research that highlights the potential reciprocal relationship between child and parent distress, with recent evidence of this within the pandemic context92; furthermore, there is clear evidence that parents can be supported and empowered to help their children manage emotional and behavioural difficulties, and that this brings benefits to both children and parents.93,94
Part 4: What this means in practice – summer support programme design
This year, the summer holidays present an opportunity to promote children’s social, emotional, and physical recovery from the impacts of the pandemic and to deliver them to school in the new academic year in optimal readiness for learning. To maximise returns on this opportunity, we recommend the following:
1. Structured summer programmes
For the reasons outlined above, we recommend that summer programmes should not focus on direct academic instruction with formal classroom-based teaching, but on supporting psychosocial wellbeing. In other words, programmes should avoid looking or feeling like term-time school.
To be clear, this does not mean that very real academic concerns should be left unaddressed: on the contrary, there is much evidence that well-planned summer programmes can have significant impacts on children’s academic outcomes even if not directly focused on these.95 For example, it has been shown that programmes focused on engagement with nature have concomitant effects on children’s academic performance, as well as the self-esteem, resilience, social skills, and physical development that they were primarily aiming for.96 Programmes focused primarily on sports and physical activity have also been shown to have positive secondary impacts on children’s executive functioning (thinking, planning, and organising skills)97 and other academic outcomes.98
As well as the incidental learning that arises as part of such activities, skilled educationalists should be employed to devise activities that will not be perceived as formal learning, but which will bolster academic development. For example, a well-planned treasure hunt could integrate stealth literacy and numeracy activities while children have fun developing their softer skills of teamwork, negotiation, planning, and so on.
Summer programmes should be carefully planned, based on the existing evidence, and considering the needs of the specific population and community the programme is intended to serve. Involving families, children and community groups in the planning will be important for ensuring that what is provided is a good match to the needs of the community it serves. Furthermore, there are substantial developmental differences over the course of childhood, and it is important that planning takes account of the specific needs of both younger and older children. For example, as lockdown restrictions ease, adolescents may (in general) be more able to meet their own needs for social contact than younger children. Therefore, programmes will need to be tailored to meet the developmental needs of different age groups.
For further advice on developing high quality, evidence-based programmes, please see the RAND Corporation review. A good example of a well-evaluated, successful summer programme based on therapeutic principles is Over the Wall for children with chronic illnesses and their families. This programme pivoted their approach successfully and ran virtual summer camps in the summer of 2020, with evidence of wide-ranging benefits including increased self-confidence, increased positive feelings about the future, decreased worries and loneliness, feeling happier and improved ability to make friends99. Another longstanding example is the Tower Hamlets Summer University (a.k.a. Futureversity), which provides independent learning programmes for young people aged 11 to 25.
However, it should also be noted that whilst structured activities are of enormous value, the opportunity for children to engage in free play should not be overlooked. The importance of free play to children’s development cannot be overstated, and we should not assume that high-quality free play opportunities with peers are available to all children equally; many children from disadvantaged backgrounds will have limited access to safe outdoor spaces and to high-quality green spaces where they can play with friends.100
Even where structured programmes are available, it is important to ensure that children are not ‘over-scheduled’ with too many highly structured, adult-directed activities. There should be time for free play every day. For adolescents, ‘play’ may be less applicable than other self-directed and self-selected valued activities, which become an increasingly important source of identity and self-esteem with age.101 Adults can help independent free-play by giving children time, space, and resources to be creative. Children need to be offered choices to empower them to engage in valued activities of their choosing.
Given the evidence that mental health and safeguarding concerns may have increased during the pandemic, and the fact that there have been fewer opportunities for these to be identified, we suggest that any structured summer programmes are particularly alert to these issues. We recommend that all frontline summer programme staff receive high-quality training in identifying and responding to mental health and safeguarding concerns. Managers of summer programmes must establish strong links with local safeguarding and mental health services at an early stage, and ensure that a clear plan for responding to concerns is in place from the outset.
No child will thrive if they are hungry. It is essential that we set up systems to ensure that children receive healthy, filling meals during the summer. Some families will have adequate resources for this, but it is important that those with financial difficulties are supported in feeding their children. Food provision must be planned and tested to make sure it is fit for purpose. It is not enough to rely on charities such as food banks to supply food without support and funding. Different areas may have different solutions, but they should be in place before children finish school at the end of the summer term. Some meal provision should occur as an integral part of any structured summer activity provision. This could usefully include hands-on involvement from children.
Maintaining a consistent routine, being physically active and getting out of their bedrooms through the summer will be likely to promote children’s sleep and to help them to re-establish a sleep pattern that is more conducive to that required by attending school in the next academic year.
2. Community-based initiatives
Structured summer programmes are unlikely to be appropriate, available, or wanted in all contexts. To meet the needs of children in these environments, community-based initiatives become increasingly important. Examples of community based initiatives include the playstreets initiative102,103, playwork practice in outdoor adventure playgrounds (e.g. thebigswing.org), large-scale loose parts play provision in school playgrounds104, and organised trips to local nature reserves/country parks that include time for independent play such as following a nature trail in a small group. Summer projects in creative arts, particularly where they employ creative practitioners from diverse demographic and professional backgrounds trained in community arts project delivery, have strong potential to nourish the supportive and inclusive benefits described above.
3. Supporting parents
Parents need to be enabled, empowered, and supported to help their children to recover and thrive. In order to do this the basics needed to be covered, for example, food and access to activities (particularly for disadvantaged families), along with access to: (a) information to promote understanding of their child’s difficulties, (b) clear guidance on how best to support their child, (c) support to develop confidence and be empowered to support their child, (d) opportunities to gain understanding and support from others who have had similar experiences, along with (e) direct practical, social and psychological support for parents themselves.
Welcoming and parent-friendly Summer Activities could help re-establish a supportive community amongst parents, for example by inviting parents to interact at drop-off, or by holding formal or informal parent support sessions before pick-up. Summer programmes that establish links with local parent-support agencies could offer parents workshops on issues of known difficulty. Where parents are facing particular difficulties with child emotional or behavioural difficulties, support needs to be available that can be accessed rapidly and in ways that work for parents (who may be juggling work and childcare demands), including flexible digital options (see for example105,106). Given the mental health impacts of the pandemic on parents, rapid access to mental health support for parents of under-18s is needed.
4. Tailored support
Based on evidence from previous epidemics, some children will need more individualised help and support with their physical health (e.g. addressing sleep, diet), mental health (including social and emotional wellbeing) and developmental gaps, following exposure to virus containment measures.107 Structured summer activities will provide an opportunity to identify those in need and to signpost them to help and refer to support services. This will include those children with difficulties that have increased in frequency during the pandemic; e.g. eating disorders and tics.108,109
For some children, an individualised approach will be needed to ensure that emergent mental health problems do not continue to interfere with their functioning over the long-term. Therefore, we need to ensure that both safeguarding and mental health services are prepared to deal with an increase in demand and can provide assessments and evidence-based treatments in a timely and accessible manner, including remotely.
Part 5: Which groups of children have been disproportionately affected by COVID-19?
There is evidence that those living under more severe lockdown restrictions have been disproportionately impacted110; therefore, efforts should be directed to areas of the UK that have experienced the longest and most severe restrictions. Those children who are due to move schools (e.g., from primary to secondary school) have specific needs which may, in the pandemic context, also require particular consideration.111-113
Additionally, there is growing evidence that some groups of children are likely to have suffered disproportionately during the pandemic (see Table 1). Responses need to be co-developed with children and families from the communities that they will be supporting to ensure they are engaging, accessible, and meet their needs. Where resources are limited, efforts should be made to target those who have suffered most, or who are likely to experience the most disadvantage going forwards.
Table 1: Summary of evidence pertaining to specific groups which have been disproportionately affected during the pandemic
|Specific group||Evidence of how this group has been disproportionately affected|
|Children without siblings||
|Children who identify as LGBQT+||
|Pre-existing mental health problems or heightened risk for mental health problems||
|Children with SEN and/or developmental disorders (such as ASD and/or ADHD)||
|Children with chronic illnesses||
|Children of parents with mental health problems||
- There is understandable concern about catching up academically, but children will not learn effectively if their mental health and wellbeing is poor.
- Adequate nutrition, social interaction, play, physical activity, and good mental and physical health need to come first to enable academic catch-up and learning going forwards.
- Therefore, this summer should not be filled with extra lessons; children, parents and teachers need time and space to recover, reconnect, and (re)build confidence following the challenges of the past year.
Contributors to this IPPO paper:
|Name||Professional role||Organisational affiliation|
|Maria Loades||Senior Lecturer in Clinical Psychology||University of Bath|
|Ruth Sellers||Senior Lecturer in Child Development & Community Mental Health||University of Sussex|
|Jenny Gibson||Senior Lecturer in Psychology & Education||University of Cambridge|
|Helen Dodd||Professor of Child Psychology||University of Reading|
|Sam Cartwright-Hatton||Professor of Clinical Child Psychology||University of Sussex|
|Pauline Emmett||Senior Research Fellow, Centre for Academic Child Health||University of Bristol|
|Caroline Taylor||Senior Research Fellow, Centre for Academic Child Health||University of Bristol|
|Cathy Creswell||Professor of Developmental Clinical Psychology||University of Oxford|
|Maruša Levstek||PhD Student, School of Psychology||University of Sussex|
|Robin Banerjee||Professor of Developmental Psychology||University of Sussex|
|Faith Orchard||Lecturer in Psychology||University of Sussex|
|Shirley Reynolds||Visiting Professor||University of Reading|
|Polly Waite||Associate Professor of Clinical Psychology||Universities of Oxford and Reading|
|Roz Shafran||Professor of Translational Psychology||UCL Great Ormond Street Institute of Child Health|
With thanks to Rosie Hutson, placement student at the University of Sussex who supported the literature searches.
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