The scale of the challenge

Schools are working harder than ever to support children's wellbeing, participation and attendance — against a backdrop of need that has grown significantly since the pandemic.

Around one in five children in England are currently persistently absent from school, missing more than 10% of their sessions. Referrals for children where the primary concern is anxiety have more than doubled since before the pandemic, rising from Approx 99K to 204K in 2023-24. Emotionally based school avoidance affects an estimated 1% to 5% of the total school population, with a larger group still attending but experiencing significant distress.

The demand for support is not being met. In 2023-24, 78,577 young people waited over a year for CAMHS treatment — a 52% increase on the previous year — with anxiety the most commonly identified mental health condition among those referred. Referral thresholds are so high that many children who need specialist support are turned away before they can access it.

Schools are increasingly being asked to bridge that gap.

Why group work matters

For children experiencing anxiety, social withdrawal or difficulties with engagement, group-based intervention offers something that individual support cannot replicate — the experience of being with peers. Learning to take turns, read a room, contribute to a shared goal and recover from small social difficulties are skills that can only be practised in a group. Done well, group work reduces isolation, builds social confidence and creates a sense of belonging that directly supports re-engagement with school life.

The challenge has always been finding a group intervention that children will actually engage with. That is where tabletop roleplay may helpt.

The therapeutic model

Little Steps, Big Adventures uses a sensory behavioural approach, drawing on the Game to Grow framework — a recognised model of therapeutically applied roleplay developed specifically for use with children and young people experiencing social, emotional and mental health difficulties.

Sessions are structured, clinically held and purposefully designed. They are not a hobby club. Each session has a therapeutic arc — a check-in, a shared narrative, specific challenges designed to elicit collaboration, emotional regulation and communication, and a structured debrief. Every element of the game is a tool. The environment, the pacing, the challenges children face, the way success and difficulty are framed — all of it is intentional.

Safety is built into the structure. Clear group expectations are established and regularly revisited. Children have agency over their experience, including the ability to pause or redirect the story at any time if themes become overwhelming. This makes the approach accessible to children who have previously disengaged from support.

What this looks like in practice

Children arrive and the session begins socially — informally, with space to settle. The group checks in, the shared story is refreshed, and play begins. For roughly an hour children are engaged in collaborative decision-making, problem-solving and peer interaction — without any of it feeling like intervention. At the end of each session children are invited to notice and name something another character did well. Not their own contribution — someone else's. It is a small mechanism with a significant effect on empathy, observation and peer regard.

The engagement seen in children participating in this kind of therapy is consistently high. Research has recorded adherence rates of 80% over twelve months in comparable TTRPG therapeutic programmes — significantly above the 49% average for equivalent clinical interventions. Children come back because they want to. That sustained engagement is where the therapeutic change happens.

What Little Steps, Big Adventures can support in your setting

Sessions can contribute directly to the following outcomes schools are working towards: reduced dysregulation and behavioural incidents; improved social participation and peer relationships; progress against EHCP outcomes, particularly in communication, social interaction and emotional regulation; increased engagement and attendance; support for inclusion and reduced risk of escalation to alternative provision.

Who leads the sessions

Little Steps, Big Adventures is led by a paediatric occupational therapist registered with the HCPC, with eight years of clinical experience working with children and young people. Sessions draw on a sensory behavioural model and the Game to Grow therapeutic framework, and are adapted for each child's individual needs. Regular progress updates are provided to schools and contributions to EHCP reviews can be made where relevant.

How to refer and funding

Referrals can be made directly by the SENCO or pastoral lead following an initial conversation. Sessions are typically funded directly by the school through SEND or pastoral budgets. In some cases, where OT goals have been set around engagement, social participation and emotional regulation, sessions may be fundable through an individual EHCP.

References

Department for Education (2024/25). Pupil absence in schools in England, autumn and spring term. https://explore-education-statistics.service.gov.uk/find-statistics/pupil-absence-in-schools-in-england/2024-25-autumn-and-spring-term

Lester, K.J. & Michelson, D. (2024). Perfect storm: emotionally based school avoidance in the post-COVID-19 pandemic context. BMJ Mental Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC11021743/

YoungMinds (2024). Increase in youth waiting over a year for support. https://www.youngminds.org.uk/about-us/media-centre/press-releases/increase-in-young-people-waiting-over-a-year-for-mental-health-support/

Barriers to Education (2025). School attendance insights. https://barrierstoeducation.co.uk/what-do-we-know-about-school-attendance/BMA (2026). Children and young people's mental health services in England. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/children-and-young-people-s-mental-health-services-in-england

Frontiers in Psychiatry (2023). Social skills training with a tabletop role-playing game. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1276757/full