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Cool Kids Outreach Program

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 Cool Kids Outreach Program has been rated by the CEBC in the area of: Anxiety Treatment (Child & Adolescent).

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • Target Population: Children and adolescents suffering anxiety disorders who are unable to attend standard clinical practice

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 and has slightly different versions for children (7-12) and teenagers (13-17). The outreach version is designed to be conducted without any personal contact between client and therapist. For younger children, parents act as the “therapist” and receive detailed instructions to help their child. For teenagers, the young person receives detailed instructions and parents are encouraged to participate as a support.

The goals of Cool Kids Outreach are to reduce the symptoms and amount of life interference caused by anxiety, including reducing avoidance and family distress and increasing confidence, peer relationships, and engagement in extra-curricular activities.

Essential Components

Cool Kids Outreach Program has the following essential components:

  • Psychoeducation: Including 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: Including learning to act like a detective and gather evidence about whether feared events are really highly likely.
  • Parent skills: Including 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: Including 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: Including how to act in a more skilled manner and engage better with people and to act more assertively with peers.
  • Improved coping strategies: Including 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.

Child Component

Cool Kids Outreach Program was designed with a child component that addresses the following presenting problems and symptoms:

  • Anxiety disorders of any type - including separation anxiety, social anxiety, generalized anxiety, and obsessive compulsive disorder. Co-existing disorders are acceptable as long as anxiety is the primary problem.

Age range: 7 – 17

Developmental Delays:

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

Treatment Involves Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: For children under 13, primary materials are aimed at helping the parent/ caregiver run the program with the child (i.e., the parent becomes the therapist). For adolescents, parents receive some information to enable them to assist and support the young person.

Parent / Caregiver Component

Cool Kids Outreach Program was not designed with a parent/caregiver component.

Group Format

Cool Kids Outreach Program was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster Home
  • 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 a language other than English:

Spanish

For information on which materials are available in this language, 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:

  • Program manuals for parents and children (CD-Rom for teenagers)
  • 1 therapist
  • Access to computer and/or telephone

Minimum Provider Qualifications

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 with 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:

Regular workshops are conducted at the Centre for Emotional Health, Sydney. Onsite training can be arranged if required.

Number of days/hours:

Typically 1-day workshop, but is occasionally delivered as 2-days.

Additional Resources:

There currently are additional qualified resources for training:

Very similar training workshops in a closely related program can be obtained in the US through The Reach Institute - http://www.thereachinstitute.org/

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...

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.

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

Population:

  • Age range — 6-12 years
  • Race/Ethnicity — Caucasian
  • Gender — 61% Male, 39% Female
  • Status — Participants were parents with 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 (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 Cool Kids Outreach 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. Major limitations included reliance on semi-structured interviews and parent-completed questionnaires as outcome measures.

Length of post-intervention 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.

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

Population:

  • Age range — 6 to 12 years
  • Race/Ethnicity — Caucasian (96%), Asian (1%), and Other (3%).
  • Gender — 51% Male, 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 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. Major limitations included the lack of a ‘‘pure’’ bibliotherapy condition and the low number of families who satisfactorily implemented the program in the email and client-initiated conditions.

Length of post-intervention follow-up: None. A 12-month post-intervention follow-up assessment was conducted; however, the control and comparison groups were no longer intact at that time as families were allowed to receive a different treatment type if they desired, after the initial 12-week

Cunningham, M. J., Wuthrich, V. M., Rapee, R. M., Lyneham, H. J., Schniering, C. A., & Hudson, J. L. (2009). The Cool Teens CD-ROM for anxiety disorders in adolescents: A pilot case series. European Child & Adolescent Psychiatry, 18, 125-129.

Type of Study: One-group pretest/posttest design
Number of Participants: 5

Population:

  • Age range — 14 to 16 years
  • Race/Ethnicity — Caucasian
  • Gender — 1 Male, 4 Females
  • Status — Participants were adolescents with an anxiety disorder recruited from successive parental referrals.

Location / Institution: Macquarie University Anxiety Research Unit

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the use of the Cool Teens CD-ROM, a home-based therapy option for adolescents with diagnosed anxiety disorders, based on the Cool Kids anxiety program. Subjects received a multimedia CD-ROM containing a self-help treatment program for young people with an anxiety disorder. Participants used the 8-module Cool Teens CD-ROM over a 12-week period on a home computer. Every 2 weeks, they received a brief telephone call from a clinical psychologist to monitor symptoms and progress and to discuss any problems with understanding content or implementing techniques. Pre- and post-treatment diagnoses and outcomes were clinically assessed using the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Spence Children’s Anxiety Scale (SCAS), and Children’s Automatic Thoughts Scale (CATS). After 12 weeks of treatment, each participant completed a post-treatment telephone ADIS interview and returned Barriers to Treatment Scale and User Preferences and Attitudes questionnaires. Results indicated a decrease in anxiety severity ratings for two participants who at 3-month follow-up no longer met diagnostic criteria for any clinical anxiety disorder. Major study limitations included small sample size and lack of a control or comparison group.

Length of post-intervention follow-up: 3 months.

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.

Wuthrich, V. M., Rapee, R. M., Cunningham, M., Lyneham, H., Schniering, C., & Hudson, J. L. (2009). Cool Teens computer-based CBT program for anxious adolescents. Australian Association for Cognitive Behaviour Therapy Annual Conference, Perth, September 7-9, 2009.

Contact Information

Name: Ronald M. Rapee, PhD
Agency/Affiliation: Macquarie University
Department: Centre for Emotional Health
Website: www.emotionalhealthclinic.com.au
Email:

Date Reviewed: April 2011