Cool Kids Outreach Program

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

About This Program

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

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

For children/adolescents ages: 7 – 17

Brief Description

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 face-to-face 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.

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

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: 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.

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 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/

Implementation Information

Since Cool Kids Outreach Program is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show 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 implementation guides or manuals for Cool Kids Outreach Program as listed below:

The program is guided by a therapist manual that assists therapists in structuring the program. It is also a self- help program, so parents are supported by a detailed commercial book that describes step-by-step implementation and teenagers are supported by a CD that fulfills the same purpose. Available fromhttps://shop.centreforemotionalhealth.com.au/product/cool-kids-outreach-program-kit/

Research on How to Implement the Program

Research has been conducted on how to implement Cool Kids Outreach Program as listed below:

Lyneham & Rapee (2006) compared self-help for parents of anxious children supplemented with three forms of therapist assistance - email, telephone, or ad lib. See Relevant Published, Peer-Reviewed Research Section below for research summary.

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. 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.

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. doi:10.1007/s00787-008-0703-y 

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

Population:

  • Age — 14-16 years
  • Race/Ethnicity — Not specified
  • Gender — 4 Females and 1 Male
  • 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 [now called Cool Kids Outreach], 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. Pretreatment and posttreatment 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 posttreatment telephone ADIS interview and returned the 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. Limitations included small sample size, lack of a control or comparison group, and length of follow-up.

Length of postintervention follow-up: 3 months.

Wuthrich, V. M., Rapee, R. M., Cunningham, M. J., Lyneham, H. J., Hudson, J. L., & Schniering, C. A. (2012). A randomized controlled trial of the Cool Teens CD-ROM computerized program for adolescent anxiety. Journal of the American Academy of Child & Adolescent Psychiatry, 51(3), 261-270. doi:10.1016/j.jaac.2011.12.002

Type of Study: Randomized controlled trial
Number of Participants: 43

Population:

  • Age — 14-17 years (Mean=15.17 years)
  • Race/Ethnicity — 74.8% Australian, 5% Asian/Asian Australian, 15.2% European/European American, and 5% Other
  • Gender — 62.3% Female
  • Status — Participants were adolescents with a primary diagnosis of anxiety.

Location/Institution: New South Wales, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the use of the Cool Teens CD-ROM [now called Cool Kids Outreach], for adolescents with diagnosed anxiety disorders. Participants were randomly allocated to the Cool Teens program or a 12-week wait list. 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 at posttreatment and follow-up assessments that adolescents in the Cool Teens condition, compared with those on the wait list, were found to have significant reductions in the total number of anxiety disorders, the severity of the primary anxiety disorder, and the average severity for all disorders. These results were matched by significant reductions in mother and child questionnaire reports of anxiety, internalizing symptoms, automatic thoughts, and life interference. Limitations include small sample size, generalizability to other populations due to ethnicity and gender, and length of follow-up.

Length of postintervention 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: shop.centreforemotionalhealth.com.au/product/cool-kids-outreach-program-kit
Email:

Date Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: April 2011