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ACTION

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The ACTION program has been rated by the CEBC in the area of: Depression Treatment (Child & Adolescent).

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • Target Population: 9 to 14-year olds who are depressed.

ACTION is a developmentally sensitive group treatment program for depressed youth that follows a structured therapist's manual and workbook. Each of the 20 group and 2 individual meetings lasts approximately 60 minutes. The child treatment is designed to be fun and engaging while teaching the youngsters a variety of skills and therapeutic concepts that are applied to their depressive symptoms, interpersonal difficulties, and other stressors. Skills are taught to the children through didactic presentations and experiential activities. The skills are rehearsed during in-session activities and are applied through therapeutic homework. Skills application is monitored and recorded through completion of workbook activities, and completion of the therapeutic homework is encouraged through an in-session reward system. In general, the first nine sessions focus primarily on affective education and teaching coping and problem-solving skills. Sessions 10–19 focus primarily on learning and applying cognitive restructuring as well as continued use of previously learned strategies. Beginning with the 11th meeting and continuing through the 20th meeting, children work to improve their sense of self.

Essential Components

  • Psycho-education
  • Goal setting
  • Behavioral activation
  • Coping skills and emotion regulation skills training
  • Problem solving skills
  • Cognitive restructuring
  • Improvement in self-schema
  • Self-monitoring
  • Self-evaluation
  • Self-reinforcement
  • Social reinforcement
  • Interpersonal skills

Child Component

ACTION was designed with a child component that addresses the following presenting problems and symptoms:

  • Depression.

Age range: 9 – 14

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Parent / Caregiver Component

ACTION was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • Parents of adolescents with depressive disorders.

Group Format

ACTION was designed to be conducted in a group setting, and has been tested for use in a group setting.

Recommended group size:

4 to 6 children

Testing References:

Stark, K. D., Reynolds, W. M., & Kaslow, N. J. (1987). A comparison of the relative efficacy of Self-Control Therapy and a behavioral problem-solving therapy for depression in children. Journal of Abnormal Child Psychology, 15, 91-113.

Stark, K. D., Arora, P., & Funk, C. (in press). CBT for youth depression: Implications for training school psychologists. Psychology In The Schools.

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • School

Homework

ACTION includes a homework component:

Structured workbook that facilitates application of the therapeutic skills to daily life.

Languages

ACTION has materials available in languages other than English:

Dutch, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Therapist
  • Manuals
  • Workbooks
  • Meeting space
  • Space to get up, and complete therapeutic activities

Minimum Provider Qualifications

Completion of training workshop is required. Additional supervision while implementing the program for 6 months is ideal. No minimum educational requirement is necessary.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

On-site or regional

Number of days/hours:

Two days

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Stark, K. D., Reynolds, W. M., & Kaslow, N. J. (1987). A comparison of the relative efficacy of Self-Control Therapy and a behavioral problem-solving therapy for depression in children. Journal of Abnormal Child Psychology, 15, 91-113.

Type of Study: Randomized controlled trial
Number of Participants: 29

Population:

  • Age range — 9 to 12 years old
  • Race/Ethnicity — Not Specified
  • Gender — 57% Male
  • Status — Children in the fourth, fifth, and sixth grades of a semirural elementary school

Location / Institution: Semirural elementary school

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children who were identified as moderately to severely depressed using the Children’s Depression Inventory (CDI) were randomly assigned to either a self-control (an early version of the ACTION treatment program), behavioral problem-solving, or waiting list condition. The self-control treatment focused on teaching children self-management skills. The behavioral problem-solving therapy consisted of education, self-monitoring of pleasant events, and group problem solving directed toward improving social behavior. Subjects were assessed pre- and post treatment and at 8-week follow-up with the CDI, Child Depression Scale, Child Behavior Checklist (CBCL), Coopersmith Self-Esteem Inventory, and the Revised Children's Manifest Anxiety Scale. At post-treatment, subjects in both active treatments reported significant improvement on self-report and interview measures of depression while subjects in the waiting list condition reported minimal change. Results were maintained at follow-up.

Length of post-intervention follow-up: 8 weeks

Stark, K. D., Arora, P., & Funk, C. L. (2011). Training school psychologists to conduct evidence-based treatments for depression. Psychology In The Schools, 48(3), 272-282.

Type of Study: Randomized controlled trial
Number of Participants: 158

Population:

  • Age range — 9 to 13 years old
  • Race/Ethnicity — Not Specified
  • Gender — 100% Female
  • Status — Identified in the schools using a multiple gate identification and assessment procedure

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
One hundred and fifty eight girls between the ages of 9 and 13 years old who were experiencing a diagnosable depressive disorder were randomly assigned to either CBT with or without parent training, or a minimal contact control condition (MCC). The majority of participants (64%) were experiencing at least one comorbid condition while 30% were experiencing two or more comorbid disorders. They were similar in this respect and in terms of the disruption that they experienced in their global functioning index to participants in the NIMH-funded Treatment for Adolescents with Depression Study (TADS) that was conducted in university hospitals across the country. Depression was assessed with the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), Beck Depression Inventory for Youth (BDI-Y), and Children’s Depression Inventory (CDI) at pretreatment, post-treatment and annual follow-up assessments. Girls in the two active treatments reported significantly less depression on the K-SADS and the BDI-Y relative to those in the MCC condition. In addition, they reported a significantly more positive view of the self and the future on the Cognitive Triad Inventory for Children (CTIC). There was no difference between the two active treatment conditions on any of the measures. Results also indicated that 84% and 81% of the girls that participated in CBT or CBT plus parent training respectively no longer reported a diagnosable depressive disorder following treatment. In addition, the majority of these youngsters were symptom free. In contrast, 46% of the girls in the MCC condition were no longer experiencing a depressive disorder following treatment. The primary limitations of this article are the limited detail on the study methods and analyses, which make it unclear whether statistical differences were seen at the follow-up time points.

Length of post-intervention follow-up: Annual follow-ups for 4 years

References

Stark, K. D., Herren, J., & Fisher, M. (2009). Treatment of childhood depression. In M. J. Mayer, R. Van Acker, J. Lochman & F. M. Gresham (Eds.), Cognitive behavioral interventions for students with emotional/behavioral disorders (pp. 266–294). New York: Guilford Press.

Stark, K. D., Streusand, W., Arora, P., & Patel, P. (in press). Depressive disorders. In P. C. Kendall (Ed.), Child and adolescent therapy (4th ed.). New York: Guilford Press.

Stark, K. D., Streusand, W., Krumholz, L. S., & Patel, P. (2010). Cognitive-behavioral therapy for depression: The ACTION treatment program for girls. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 93–109). New York: Guilford Press.

Contact Information

Name: Kevin D. Stark, PhD
Agency/Affiliation: University of Texas, Dell Children’s Medical Center
Email:
Phone: (512) 471-4407

Date Reviewed: September 2010