Research and Development

Evaluation of the Efficacy of BUSS®

All BUSS® clinical work uses before and after measures to review efficacy. These include the BUSS® screening tool, Strength and Difficulties Questionnaires, Kidscreen Health Questionnaire, Goal Based Outcomes and children’s human figure drawings.

In addition to these, several qualitative evaluations of the model have been undertaken in the last few years. It is our intention to publish these, either together or individually.

Outlined below is a brief summary of these evaluations:

1) Work with Individual Children / Young people and their Foster Carers

2018/2019, Katherine Grindheim, Second Year Clinical Psychologist in Training at Leeds University – Service Evaluation Project entitled: ‘The BUSS Programme – an evaluation of the experience of foster carers and social workers.’

The full evaluation project is available at:

In this project, Kat used a qualitative methodology to explore the participants’ experiences of the BUSS® programme. These were face-to-face interviews with 5 foster carers and 5 Social Workers working in the Therapeutic Social Work team in Leeds where the intervention was being delivered.

Key themes that emerged from the project were:

  1. You can’t build a house on wobbly foundations – BUSS® was like the missing piece of the jigsaw, the chance to go back and build foundations again to give a firm foundation for possible psychological work.
  2. These children’s needs are multi-faceted – this was a recurring theme amongst foster carers, who could see that the child’s physical difficulties (e.g. not being able to stand without support) made ordinary activities like sitting at the table using cutlery or drinking from a bottle, or making and keeping friends, all led to a sense of hopelessness. They felt that the very practical emphasis of BUSS® gave them a place to start and hope.
  3. Lots of ingredients make it work – this really reflected the hard work that this intervention involves for foster carers, i.e. the repetition, making it fun, and also for Social Workers; the idea that it looks simple but actually it’s quite complicated.
  4. Gains are wide ranging and match the needs – improvements were wide ranging and mapped onto the multifaceted needs described earlier – bodily awareness and regulation, self-esteem and friendships.
  5. It’s not the answer to everything – the needs of the children are complex and while for some children, BUSS® was enough for them to make good progress, for others it was helpful to consider a psychological intervention following this.

2) Interviews with Foster Carers Post-intervention

2020, Harriet Haslam, Senior Practitioner, Social Work, as part of a Masters at University of Huddersfield – Innovations in Professional Practice, understood a study entitled: ‘An exploratory study of the impact of the BUSS model on the therapeutic skills set of carers.’

In this study, 4 foster carers who had completed the BUSS® intervention with the children they were caring for were interviewed. The findings of this research were that participation in BUSS® enabled the carers to better understand the neurosequential impact of trauma, which in turn improved their ability to interpret the physical and emotional presentation of the children, leading to more attuned caregiving. A key component in this was the carers role as the main agents of change in the intervention, which strengthened the carer–child relationship and increased the foster carers’ feelings of self-esteem, because they could see tangible changes and link these to the work that they’d been doing.

Introductory Webinar

3) Interviews with Adoptive Parents Post-intervention

2021, Chloe Robinson – Third Year Clinical Psychologist in Training, at the University of Hull undertook her doctoral thesis entitled: ‘Learning from adoptive families: What are their experiences of children’s development and the support they receive?’

Working with 10 adoptive families who had been through the BUSS® programme. The full dissertation is available at:

Results were divided into 4 key themes:

  1. Cognitive abilities – 8/10 parents described a marked increase in their child’s memory and attention. Parents felt that by building underdeveloped systems, children developed their skills and capacity to engage with cognitive tasks.
  2. Emotional, social, and behavioural development – Parents felt that improved bodily regulation led to increased emotional regulation. Parents talked about their child’s increased self-esteem and confidence, some suggesting this was because the child was able to attend to the whole picture – parents talked about their children being increasingly able to reason and think things through.
  3. 5/10 parents reported improvements in their child’s language and expressive skills. All parents reported improvement in their child’s flexibility of thought and imagination, an area that the majority of parents had felt their child really struggled with.
  4. Understanding of development – 9/10 parents talked about their greater level of understanding of their child’s development.

4) BUS as an Early Years Groupwork Programme for Preschool children and their Foster Carers

2021, Natalie Jones, Second Year Clinical Psychologist in Training at the University of Leeds, undertook a Service Evaluation Project (SEP) over one year, entitled: ‘An evaluation of the LEAPlets programme an interagency school readiness programme for children who are looked after based on the BUSS® model.’

In this project, Nat interviewed 8 foster carers, all of whom were carers for children aged between 3 and 5 years old. Nat used a qualitative methodology, and grouped findings into 3 themes:

  1. Changes for the child – themes that emerged here were a range of social (being part of something, being able to build relationships, increasing curiosity about the world), relational (greater enjoyment and participation in family life, confidence, self-belief, nurturing, regulating) and physical (filling in gaps, strengthening body, catching up with peers).
  2. Changes for carer – the recurring theme here was pride, that it had been a rewarding experience for carers who really valued the support of other foster carers and the specialist support of BUSS®. Carers talked openly about their scepticism about the programme when it was presented to them and said that they wouldn’t have believed the kinds of changes were possible if they hadn’t seen it with their own eyes.
  3. Characteristics of the group – carers experience was positive, feeling that the group was run according to the individual needs of the children. They felt it was a unique programme, where staff go the extra mile to support them and the children. Carers also valued the fact that the group ran every week, and the routine and structure of the group was the same each week.


Another theme that emerged from this SEP was carers wanting to know more and wanting to be able to carry on the work at home in a way that was more targeted to their individual child. Therefore, as a result of this SEP, we arranged to write programmes for carers and children to carry on at home.

5) BUSS® as an Early Years Groupwork Programme for newly adopted Preschool children and their new Adoptive Parents

2022, Danielle Smith, Second Year Clinical Psychologist in Training at the University of Leeds, is just beginning a one-year Service Evaluation Project (SEP) on the BUSS® group for new adopters and their children. Results from this will be available from September 2022.

To view a PDF version of the information on this page  click here

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