ACTION

9 to 14-year olds who are depressed.

For children/adolescents ages: 9 - 14

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.

Kevin D. Stark, PhD

• Agency/Affiliation: University of Texas, Dell Children's Medical Center
• Email: kstark@austin.utexas.edu
• Phone: (512) 471-4407

The goals of ACTION are:

• Learn five core coping skills and be able to independently apply the skills to improve their moods and maintain a pleasant mood
• Learn a five-step problem solving strategy and apply it to stressors in their everyday life
• Be able to identify their own depressive thoughts
• Learn three cognitive restructuring strategies and be able to independently apply the strategies to their depressive thinking
• Build a positive core belief that will replace existing depressive core beliefs
• Understand and apply the principles that:
• When you feel bad and you can change the situation, use problem solving.
• When you feel bad and you can't change the situation, use coping skills.
• When you feel bad and it is due to negative thoughts, change your thinking.

The essential components of ACTION include:

• 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/Adolescent Services

ACTION directly provides services to children and addresses the following:

• Depression.

Recommended Intensity

The ideal is 2 one-hour sessions a week, but one session will work if time/transportation is an issue.

Recommended Duration

20 group meetings and 2 individual meetings completed in 11 weeks

Delivery Settings

This program is typically conducted in a(n):

• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

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

Languages

ACTION has materials available in the following languages other than English:

• Dutch
• 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 in 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

Prerequisite/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.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

On-site or regional

Number of days/hours:

Two days

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for ACTION.

Formal Support for Implementation

There is no formal support available for implementation of ACTION.

Fidelity Measures

There are no fidelity measures for ACTION.

Established Psychometrics

There are no established psychometrics for ACTION.

Fidelity Measures Required

No fidelity measures are required for ACTION.

Implementation Guides or Manuals

There are no implementation guides or manuals for ACTION.

Implementation Cost

There are no studies of the costs of ACTION.

Research on How to Implement the Program

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. https://doi.org/10.1002/pits.20551

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• 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(1), 91–113. https://doi.org/10.1007/BF00916468

  Type of Study: Randomized controlled trial

  Number of participants: 29

  Population:

  • Age — 9–12 years
  • Race/Ethnicity — Not specified
  • Gender — 57% Male and 43% Female
  • Status — Participants were children in the fourth, fifth, and sixth grades of a semirural elementary school.

  Location/Institution: Semirural elementary school

  Summary:

  The purpose of the study was to evaluate the efficacy of two intervention programs for children who were identified as moderately to severely depressed. Participants were randomly assigned to either a self-control condition [now called ACTION], behavioral problem-solving condition, or waiting list condition. Measures utilized include the Children’s Depression Inventory (CDI), the Child Depression Scale, the Child Behavior Checklist (CBCL), the Coopersmith Self-Esteem Inventory, and the Revised Children's Manifest Anxiety Scale. Results indicate that at posttreatment, 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. Limitations include small sample size and length of follow-up.

  Length of controlled postintervention follow-up: 8 weeks.

• 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. (2011). Childhood depression: The ACTION treatment program. In P. C. Kendall (Ed.), Child and adolescent therapy (4th ed., pp. 190-233). 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.