Your Choice

What does this project involve?

Your Choice provides training for youth practitioners in cognitive behavioural therapy (CBT) techniques, who then aim to provide three sessions a week over 12-18 weeks to children at risk of involvement in crime and violence.  

Your Choice was developed by the London Innovation and Improvement Alliance (LIIA), acting for London Directors of Children’s Services (ALDCS), and supported by the London Violence Reduction Unit (VRU). Youth practitioners receive five days of training and a resource pack, followed by monthly supervision from a clinical lead.  

Sessions with children aim to build trusting relationships and support the child to better understand themselves, develop coping strategies, and disrupt unwanted patterns of behaviour. Youth practitioners are also provided with a budget for additional activities to support children to sustain engagement in activities that are meaningful to them, such as gym memberships. The project worked with 11 to 18-year-olds assessed by multi-agency risk panels as at risk of harm and exploitation. 

Why did YEF fund this project?

Cognitive Behavioural Therapy (CBT) is a type of talking therapy that has been used to address a range of psychological difficulties. When it is applied to violence prevention, it is based on the idea that negative or impulsive thoughts and behaviours might make someone more likely to lash out or act aggressively. As the YEF Toolkit explains, CBT is associated, on average, with a ‘High’ estimated impact on violent crime. 

However, we lack robust evidence of impact in an English and Welsh context. In addition, we recognise the current capacity challenges in the mental health system that may prevent enough clinicians being available to directly deliver CBT to vulnerable children. We also know that the most vulnerable children are currently least likely to access such support in a clinical setting. Your Choice aims to overcome these challenges, training youth practitioners – who may have more capacity and ability to engage with vulnerable children- to deliver CBT-techniques.  

YEF, therefore, funded an efficacy randomised controlled trial (RCT) of Your Choice.  Following a previously published pilot study, this evaluation aimed to establish whether Your Choice reduces conduct problems (as measured by the Strengths and Difficulties Questionnaire [SDQ]). This study also tested whether Your Choice improves wellbeing, hyperactivity, self-regulation, social connectedness, prosocial behaviours and identity.  

The evaluation used an RCT across 31 London local authorities (LAs). Each LA was asked to name at least two teams of youth practitioners. These two teams were randomised into treatment and control teams, with the treatment teams receiving Your Choice training and the control teams delivering business-as-usual (BAU) support. Once children were identified as requiring support, the intention was that they would be referred to the team with the most capacity at that time, recognising that this also depended on the team’s specialism and the type of needs presented. There were 968 children in the Your Choice intervention group (supported by 96 teams) and 690 children in the control group (supported by 69 teams).  

An implementation and process evaluation (IPE) also aimed to examine whether Your Choice was delivered as intended, how it differed from BAU support, barriers and facilitators to delivery and views of the programme. The IPE used 22 interviews with children, interviews or focus groups with 41 professionals, and an analysis of administrative and delivery data. The efficacy trial ran from September 2023 to June 2025. Of the 925 children included in the final analysis, 14% were Asian, 4% of Arab ethnicity, 22% were Black, 25% mixed or multiple group ethnicity, 19% White and 13% from another ethnic group.

Key conclusions

Your Choice demonstrated a small impact on reducing self-reported severe conduct problems amongst children. After the programme, children assigned to Your Choice practitioners were very slightly less likely to report severe conduct problems compared to their counterparts who were not assigned to Your Choice practitioners. There is uncertainty surrounding this estimate. This result has a very low security rating.

Your Choice showed a small impact on reducing children’s self-reported hyperactivity, emotional problems, and peer problems and on improving wellbeing and prosocial identity. It showed a moderate impact on improving children’s self-reported emotional self-regulation, social connectedness, and how safe they felt. It showed no impact on children’s self-reported prosocial behaviour. Your Choice practitioners perceived that children were less safe.  These findings are secondary outcomes that are uncertain and should be treated with more caution.

In the Your Choice group, fewer than 1% of children received 36 or more sessions (the expected number of sessions). 16% of children received no sessions, 47% received 1-9 sessions, and 26% received 10-19 sessions.

Low attendance was caused by a combination of practitioner capacity and the perceived preference of children. Your Choice practitioners reported difficulties fitting three sessions a week into their existing caseloads. Practitioners also questioned whether children needed, or wanted, three weekly sessions.

Children reported mixed reflections on the programme, with some commenting that it supported them to manage emotions, engage with education, and make better choices, while others questioned the impact.

How secure is the evidence?

These findings have a very low security rating (1/5 magnifying glasses). The trial was designed to be large enough to detect meaningful impacts on the primary outcome. However, 44% of children who started the trial were not included in the final analysis because they did not complete measures required for the primary outcome analysis. We do not know if the effect found for Your Choice would be the same if the children missing from the final analysis were included.  

Moreover, the trial relied on LAs always assigning children to the team with the most capacity at the time, recognising that this also depended on the team’s specialism and the type of needs presented. Important differences between the children in the intervention and control groups at baseline would indicate that LAs did not strictly adhere to this rule.  

Should you fund or deliver Your Choice?

The limitations of the evaluation (caused primarily by a high attrition rate) reduces the confidence we can have in the outcome findings and makes it difficult to offer a clear recommendation on whether Your Choice should be funded.  Given these limitations, Your Choice cannot be considered an evidence-based option at this stage, and any consideration of the programme would require material changes to the model, rather than minor adjustments. 

If considering the programme, or delivering any therapeutic intervention to vulnerable children, very careful thought is required on how to improve the attendance of children. The evaluation demonstrated that Your Choice struggled to retain the engagement of children, and significant thought is required on how engagement can be improved. Delivering the programme as it is currently designed is unlikely to lead to large reductions in children’s involvement in violence, and significant changes to the model would be required for YEF to have greater confidence in the programme.

The wider evidence base (as highlighted by the YEF’s Toolkit strands on CBT and trauma specific therapies) continues to support the use of therapy to support children at risk of involvement in crime and violence. YEF, therefore, continues to advocate for:  

• Investing in clinically-led CBT provision and increasing access for children at risk of, or already involved in, violence.  
• Ensuring referrals and assessments take place quickly.  
• Ensuring practitioners receive clinical supervision and have a clear referral pathway into specialist services.   
• Putting strategies in place to reach children from Black, Asian and minority ethnic communities, and implementing strategies to keep them engaged throughout the intervention.   
• Providing CBT interventions that offer more than one session per week.  
• Rigorously monitoring implementation. Good implementation is a key moderator of impact.     

What will YEF do next?

YEF has no current plans to invest in the scale up of Your Choice. We remain interested in innovative approaches that aim to provide evidence-based therapy to children who are particularly vulnerable to involvement in crime and violence. 

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