Cool Kids Outreach Program

About This Program

Target Population: Children and young adolescents suffering anxiety disorders who are unable to attend standard clinical practice

For children/adolescents ages: 7 – 12

Program Overview

Cool Kids Outreach Program is a version of Cool Kids, a program that teaches children and their parents how to better manage the child's anxiety. The program aims to teach clear and practical skills to both the child and parents. The program is supported by manuals. The outreach version is designed to be conducted without any face-to-face contact between client and therapist. For younger children, parents act as the “therapist” and receive detailed instructions to help their child.

Program Goals

The goals of the Cool Kids Outreach Program are:

  • Reduce the symptoms and amount of life interference caused by anxiety
  • Reduce avoidance
  • Reduce family distress
  • Increase confidence
  • Improve peer relationships
  • Increase engagement in extra-curricular activities

Essential Components

The essential components of the Cool Kids Outreach Program include:

  • Psychoeducation: Understanding of the components, presentation, and nature of anxiety as well as factors involved in its development; understanding of the relevant components to treatment and their purpose
  • Cognitive restructuring: Learning to act like a detective and gather evidence about whether feared events are really highly likely
  • Parent skills: Helping parents to manage their anxious child better and reducing their urge to control and overprotect; also teaching parents strategies to help manage their own anxious feelings
  • In-vivo exposure:The development of stepladders for the child that allows them to gradually face their fears and learn that feared events are unlikely to happen and that they can cope
  • Social skills: How to act in a more skilled manner and engage better with people and to act more assertively with peers
  • Improved coping strategies: Dealing more effectively with teasing and bullying, developing a range of coping strategies such as relaxation and reducing poor coping such as drug-taking, and problem solving

Program Delivery

Child/Adolescent Services

Cool Kids Outreach Program directly provides services to children/adolescents and addresses the following:

  • Anxiety disorders of any type - including separation anxiety, social anxiety, generalized anxiety, and obsessive compulsive disorder; coexisting disorders are acceptable as long as anxiety is the primary problem
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Primary materials are aimed at helping the parent/ caregiver run the program with the child (i.e., the parent becomes the therapist). 

Recommended Intensity:

Weekly 30-minute sessions by telephone are recommended, however, the program can be done with as few as four 30-minute calls over 12 weeks.

Recommended Duration:

It is an individual program and so length is personal. However, standard is 12 weeks with phone contact during the first 10.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster/Kinship Care
  • School

Homework

Cool Kids Outreach Program includes a homework component:

Skills learned in the program are implemented and practiced for homework. This includes monitoring of symptoms, cognitive restructuring practice, in-vivo exposure practice, and practice of relevant skills. Parents also practice child management and anxiety management.

Languages

Cool Kids Outreach Program has materials available in languages other than English:

Danish, Finnish, Icelandic, Korean, Polish, Spanish, Turkish

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:

  • Helping Your Anxious Child: A Step-by-Step Guide for Parents (go to https://www.newharbinger.com/helping-your-anxious-child-second-edition for more information).
  • The child manual for this program, which is freely downloadable from a website that can be accessed through a password that is available in Helping Your Anxious Child: A Step-by-Step Guide for Parents.
  • Therapist manual
  • 1 therapist
  • Access to computer (for Skype interaction) and/or telephone

Education and Training

Prerequisite/Minimum Provider Qualifications

  • 4-year undergraduate or 2-year postgraduate degree in health (psychology, counselling, social work, occupational therapy) or education

  • and

  • Additional training in cognitive-behavioural therapy (dedicated postgraduate subject, introductory workshop or online training from recognised provider)

Preferable to have a degree in clinical psychology – the equivalent of a PhD in Clinical Psychology. Practitioners need to be well-trained in standard cognitive behavioral techniques and understanding of psychopathology - ideally clinical psychology training. Experience working with children and families is preferable.

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:

Training and accreditation is obtained online via the Centre for Emotional Health, Sydney. Onsite training can be arranged.

Number of days/hours:

Online training consists of 12 video modules and practice activities that you can start, pause, or stop at any time. It takes approximately six hours to complete training.

Accreditation requires professionals to demonstrate their ability and skill through a series of assessment tasks. Accreditation takes approximately three hours to complete.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Cool Kids Outreach Program.

Formal Support for Implementation

There is no formal support available for implementation of Cool Kids Outreach Program.

Fidelity Measures

There are no fidelity measures for Cool Kids Outreach Program.

Implementation Guides or Manuals

There are no implementation guides or manuals for Cool Kids Outreach Program.

Research on How to Implement the Program

Research has not been conducted on how to implement Cool Kids Outreach Program.

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

Rapee, R. M., Abbott, M. J., & Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436-444. doi:10.1037/0022-006X.74.3.436 

Type of Study: Randomized controlled trial
Number of Participants: 267

Population:

  • Age — 6-12 years
  • Race/Ethnicity — Not specified
  • Gender — Group Treatment: 53.3% Female, Bibliotherapy Group: 35.6% Female, and Waitlist Group: 29.9% Female
  • Status — Participants were children diagnosed with anxiety disorders who were referred by school counselors, general practitioners, or mental health professionals.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the impact of a 12-week trial of bibliotherapy materials based on the Cool Kids anxiety program for parents of children with anxiety disorders. Participants were randomized to one of three groups: group treatment (Cool Kids), bibliotherapy [now called Cool Kids Outreach], and to waitlist. Children completed the following measures at baseline, posttreatment, and 3-month follow-up: the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-CP), Spence Children’s Anxiety Scale (SCAS), Children’s Automatic Thoughts Scale (CATS), and parents completed the parent version of the SCAS and the Child Behavior Checklist (CBCL). Results indicated that the bibliotherapy demonstrated benefit for children relative to waitlist but was not as efficacious as the standard Cool Kids group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. Children in all three groups reported significant and marked change over time, but differences between groups were not significant. Limitations included reliance on semistructured interviews and parent-completed questionnaires as outcome measures and length of follow-up.

Length of postintervention follow-up: 3 months.

Lyneham, H. J., & Rapee, R. M. (2006). Evaluation of therapist supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Research and Therapy, 44, 1287-1300. doi:10.1016/j.brat.2005.09.009 

Type of Study: Randomized controlled trial
Number of Participants: 100

Population:

  • Age — 6-12 years
  • Race/Ethnicity — 96% Caucasian, 1% Asian, and 3% Other
  • Gender — 51% Male and 49% Female
  • Status — Participants were self-referred parents and children with anxiety disorders from rural communities.

Location/Institution: Macquarie University Anxiety Research Unit

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the efficacy of bibliotherapy, where a program [now called Cool Kids Outreach] is implemented solely through the use of written or computerized materials with little or no therapist contact, in a rural population. It investigated the impact of facilitating therapist-family contact using 1) scheduled telephone sessions, 2) scheduled emails, or 3) as-needed client initiated contact, as compared to a wait-list control group. Measures used included the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV) and the self-reported Spence Children’s Anxiety Scale (SCAS), Revised Children’s Manifest Anxiety Scale (RCMAS), Children’s Depression Inventory (CDI), Children’s Automatic Thoughts Scale (CATS), Child Behavior Checklist (CBCL), Parenting Stress Index (PSI), and the Depression Anxiety Stress Scale (DASS). The Cool Kids Outreach treatment protocol was adapted from the standard cognitive behavioral group treatment program based on the Cool Kids anxiety program. The treatment conditions and waitlist lasted for a 12-week period, at which time the post-treatment assessment was conducted.  A long-term follow up was conducted 12 months after the post-treatment assessment with a subset of families. Results indicated that bibliotherapy with any form of contact produced superior outcomes in comparison to no treatment on self-report measures and the clinician rated severity and diagnostic profile. Additionally, supplementing bibliotherapy with scheduled telephone sessions produced superior diagnostic outcomes and lower clinician-rated severity at post-treatment in comparison to email and client-initiated contact. Limitations included the lack of a ‘‘pure’’ bibliotherapy condition, the low number of families who satisfactorily implemented the program in the email and client-initiated conditions, and lack of control/comparison groups able to be evaluated at follow-up.

Length of postintervention follow-up: None.

Chavira, D. A., Bustos, C., Garcia, M., Reinosa Segovia, F., Baig, A., …Camacho, A. (2018). Telephone-assisted, parent-mediated CBT for rural Latino youth with anxiety: A feasibility trial. Cultural Diversity and Ethnic Minority Psychology, 24(3), 429-441. doi:10.1037/cdp0000186

Type of Study: Randomized controlled trial
Number of Participants: 31

Population:

  • Age — 8-13 years
  • Race/Ethnicity — 100% Latino/Latina
  • Gender — 29 Female
  • Status — Participants were children with anxiety disorders recruited from primary care settings.

Location/Institution: Rural county of California by the United States Mexico Border

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the feasibility of the Cool Kids Outreach Program modified for use with rural Latino/as. Participants were randomly 1 of 2 modes of parent-mediated CBT bibliotherapy: (1) telephone-delivered, therapist-assisted bibliotherapy (TTB; n =15), and (2) a more minimal contact, self-directed, bibliotherapy condition (SB; n =16). Modifications were mostly focused on improving the acceptability of the intervention and included mostly surface-level modifications such as translation of study materials, tailoring of examples to be culturally appropriate to Latino/a families and to the rural context, simplifying workbook materials, and addressing issues of literacy. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Spence Children’s Anxiety Scale (SCAS), Adolescent Life Interference Scale (ALIS), Preferences and Attitudes Questionnaire, and Children’s Automatic Thoughts Scale (CATS). Results indicated in the TTB group, 10 of 15 parents (66.7%) completed the requisite number of therapist-assisted bibliotherapy sessions, and in the SB group, 4 of 16 parents (25%) completed the requisite number of self-directed bibliotherapy modules; this comparison was significant. In the TTB condition, treatment length and session duration were longer than reported in previous studies. Barriers that were most strongly endorsed were stressors and obstacles competing with treatment, as well as treatment demandingness. Findings revealed good satisfaction across the conditions, although ratings were significantly higher in the TTB group. Remission rates (i.e., no anxiety disorder) for those that provided posttreatment data (N= 25) were 50% and 36% for the TTB and SB groups, respectively. Limitations include small sample size, lack of control group, generalizability to other populations due to ethnicity and gender, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Lyneham, H. J., & Rapee, R. M. (2005). Evaluation and treatment of anxiety disorders in the general pediatric population: A clinician's guide. Child and Adolescent Psychiatric Clinics of North America, 14(4), 845-862.

McLellan, L., Fitzpatrick, S., Schniering, C. A., & Rapee, R. M. (in press). Self-help treatment of childhood anxiety disorders. In T. Ollendick, L. Farrell, and P. Muris. (Eds.), Innovations in CBT for childhood anxiety, OCD, and PTSD: Improving access and outcomes. Oxford: Cambridge University Press.

Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M.-L., Hudson, J. L., Kangas, M., & Mihalopoulos, C. (2017). Comparison of stepped care delivery against a single, empirically validated CBT program for anxious youth: A randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 841-848. doi:10.1016/j.jaac.2017.08.001

Contact Information

Ronald M. Rapee, PhD
Agency/Affiliation: Macquarie University
Department: Centre for Emotional Health
Website: www.mq.edu.au/coolkids
Email:

Date Research Evidence Last Reviewed by CEBC: September 2018

Date Program Content Last Reviewed by Program Staff: December 2018

Date Program Originally Loaded onto CEBC: April 2011