Core Components

The C.A.T Project is a targeted intervention designed to treat anxiety and anxiety disorders in adolescents aged 12-18 years. The manualised programme applies cognitive behavioural approaches to teach skills for managing general anxiety disorder, social phobia, and/or separation anxiety. The programmes’ overall goal is to help adolescents recognise signs of anxiety, and to apply the strategies taught in this programme to manage anxiety. It also teaches skills to enhance emotional management, and boost understanding of social influences. The meaning of the acronym C.A.T is decided by the participants in order to enhance their involvement in the programme. The content of the C.A.T. Project is the same as Coping Cat (for children 7-13 years old) but has been adapted to be developmentally appropriate for adolescents. 

The C.A.T Project comprises of two sections, which contain sixteen sessions in total. These sessions are delivered over 16-20 weeks, in one-hour weekly sessions. The first section is delivered in eight sessions (sessions 1-8) and focuses on psychoeducation as well as skills needed to identify and manage anxiety. Within this section, participants are exposed to four key concepts delivered in a “FEAR” plan:

• “F” (Feeling frightened?)- Recognition of body response to anxiety
• “E” (Expecting bad things to happen) - Identification of anxious thoughts
• “A” (Attitudes and Actions) - Strategies to manage anxiety (e.g. problem solving, coping skills, relaxation)
• “R” (Results and Rewards) - Self-rating of anxiety management, and self-rewards for efforts made

The FEAR acronym helps participants learn and remember the strategies to apply when facing anxiety. After learning the concepts within the first section, programme participants proceed to the second section. This latter section also consists of eight sessions (9-16), and involves exposing participants to anxiety provoking scenarios, while encouraging them to draw on skills taught in the first section. The exposure tasks that participants embark on depend on the specific anxieties they present with. Two of the sixteen sessions (i.e. sessions four and nine) are delivered to parents. These parents-only sessions enhance parental knowledge of the programme, promote parental co-operation, and gather parental input.

The C.A.T Project is delivered in outpatient clinics, inpatient settings, schools, and community centres, typically as an individualised intervention. In outpatient clinics and community centres, the weekly individualised sessions last about one hour, but are usually shorter (lasting about 30 minutes) when delivered in the school setting. C.A.T Project can also be delivered in group format, with one practitioner delivering the programme to groups of about six participants. Group sessions are only delivered after three to four initial individualised sessions have been completed. These initial individualised sessions prepare participants for group sessions. Group sessions are delivered over 50-90 minutes, depending on the setting of delivery, number of adolescents in the group, participants’ progress and practical constraints. Activities conducted during programme sessions include coping modelling, role-plays, exposure tasks, and weekly homework assignments (to reinforce taught skills). Participant recruitment can be via advertisements, or referrals from paediatricians, school counsellors, and mental health professionals.

Fidelity

Programme fidelity is ensured by implementation of the following measures;

1. Use of therapist manual that contains detailed session-by-session programme content and specific goals
2. Ensuring completion of session goals using monitoring checklist. This can be assessed by practitioners within the implementing organisation
3. Programme developer review of video-recorded sessions, and provision of feedback on these sessions

Modifiable Components

The C.A.T Project is a version of Coping Cat (for children aged 7-13 years), with programme content modified to suit adolescents. The manualised programme can be adapted to meet the individual needs of participants. This includes, delivering the intervention remotely online and, among other features, selection of exposure tasks that are specifically individualised based on participants’ anxieties. A family therapy manual is available for use if parents are included as co-clients, and a group treatment manual is available for programme delivery to children in group format. C.A.T Project is available in English, Norwegian, Portuguese and Spanish.

Support for Organisation / Practice

Implementation support is provided by Professor Philip C. Kendall and the Child and Adolescent Anxiety Disorders Clinic (CAADC) team at Temple University, USA.

Implementation Support

Supports provided include practitioner training, supervision, and data analysis on collated data. Programme resources (including treatment manual and participant workbooks) can be accessed online via the Workbook Publishing, Inc. webpage.

Licence Requirements

There are no licence requirements for programme delivery

Start-up Costs

Start-up costs required for programme delivery include costs of therapist manual at $24.00, and participant workbook at $26.95 (per participant). Highly recommended costs include one-day (virtual or face-to-face) practitioner training at $4500 (for 40-80 practitioners), or a more intense two-day (virtual or face-to-face) training at $9000 (also for 40-80 practitioners). The two-day training provides opportunities for practitioners to try several treatment strategies and get feedback from programme trainers. The training costs do not include travel. Other highly recommended costs include training DVD at $55.95; session-by-session DVD guide at $85.95; and parent companion at $19.00. Optional programme implementation costs include cost of practitioner supervision charged at $240 per hour; as well as cost of review of video-recorded sessions and feedback on the sessions charged at $240 per hour. Trainer training is available on request. 

Building Staff Competency

Qualifications Required

The C.A.T Project can be delivered by social workers, teachers, psychologists, counsellors, graduate students, and doctoral students. Other professionals can also deliver this programme, and an educational degree is not a requirement. Experience working with youth is preferable. 

Training Requirements

Practitioners are required to read the C.A.T Project therapist manual before delivering the programme. In addition, it is very highly recommended that practitioners receive training prior to programme delivery. Training is delivered over six hours (one day) either remotely (via live Zoom training) or face-to-face. Practitioners who receive the C.A.T Project training can also deliver Coping Cat. Training facilitates practitioners’ application of programme strategies for managing youth anxiety. Trainer training is available on request.

Supervision Requirements

Supervision is available to practitioners after they complete practitioner training and are in the process of delivering the programme. Supervisory sessions are one-hour long, delivered remotely, and can be requested multiple times. 

Theory of Change

The C.A.T Project is centred on cognitive behavioural approaches, as it combines cognitive strategies (e.g. recognition of perceived threat, self-appraisal, problem solving, changing self-talk) to behavioural strategies (e.g. relaxation, exposure tasks, homework, rewards) for the purpose of addressing anxiety. This helps young people recognise signs of anxiety and apply the taught strategies to manage anxiety.

Values

The C.A.T Project is a targeted intervention designed to treat anxiety and anxiety disorders in adolescents aged 12-18 years. The programme is typically delivered as an individualised programme, and it applies cognitive behavioural approaches to teach skills for managing general anxiety disorder, social phobia, and/or separation anxiety.

• Does this approach align with the key values of your organisation?

Priorities

The C.A.T Projects’ overall goal is to help adolescents with anxiety and anxiety disorders (aged 12-18 years) to recognise signs of anxiety, and apply the strategies taught in this programme to manage their anxiety (including general anxiety disorder, social phobia, and/or separation anxiety).

• Is your service looking to deliver a targeted programme to treat general anxiety disorder, social phobia, and/or separation anxiety in adolescents aged 12-18 years?
• Is a programme that is designed to teach skills to recognise anxiety and manage anxiety a priority for your service?
• Would an intervention that also focuses on other mental health conditions be a better fit?

Existing Initiatives

• Does your organisation have existing programmes that aim to treat anxiety and anxiety disorders in adolescents?
• Are there components addressed by C.A.T Project that are not met by existing programmes?
• Are the existing initiatives effective?
• Do existing initiatives fit your current and anticipated future requirements?

Workforce

The C.A.T Project can be delivered by social workers, teachers, psychologists, counsellors, graduate students, and doctoral students. Other professionals can also deliver this programme, experience working with adolescents is preferable. Practitioner training is delivered over six hours either remotely (via live Zoom training) or face-to-face. Practitioner DVD training is also available. The C.A.T Project sessions are delivered to targeted adolescents over 16-20 weeks, in one hour weekly sessions.

• Does your organisation have practitioners who are available and interested in learning and delivering this programme?
• Can your organisation support the time commitment required for practitioner training and programme delivery?

Technology Support

Practitioner training is delivered remotely (via live Zoom training), face-to-face, or via DVD. As part of fidelity monitoring, the programme developer can review video-recorded sessions, and provide feedback on these sessions.

• Does your organisation have technology to support practitioner training (if training is to be delivered via Zoom or DVD)?
• Is there available technology to record and send video recordings for fidelity monitoring?

Administrative Support

The C.A.T Project is delivered in several settings including outpatient clinics, schools, and community centers. Participants can be recruited via advertisements, or referrals from paediatricians, school counsellors, and mental health professionals.

• In what setting will the programme be delivered? Does your organisation have a venue (within this setting) to run programme sessions?
• How will programme participants be recruited?
• Does your organisation have administrative capacity and systems to access available training, support participant recruitment, and deliver the programme in the chosen setting?

Financial Support

Start-up costs required for programme delivery include costs of therapist manual at $24.00, and participant workbook at $26.95. Highly recommended costs include one-day (virtual or face-to-face) practitioner training at $4500, or a more intense two-day (virtual or face-to-face) training at $9000. Other highly recommended costs include training DVD at $55.95; session-by-session DVD guide at $85.95; and parent companion at $19.00. Optional programme implementation costs include cost of practitioner supervision charged at $240 per hour; as well as cost of review of video-recorded sessions and feedback on the sessions charged at $240 per hour. Trainer training is available on request.

• Will your service train practitioners to deliver The C.A.T Project?
• Will your practitioners receive the one-day or two-day training?
• Will your service train trainers?
• Can training costs be financially supported?
• What type of training will your practitioners receive (Zoom, face-to-face, DVD)? Can this be financially supported?
• Can other implementation costs (including programme materials and fidelity monitoring) be financially supported?

Comparable Population

The C.A.T Project is a targeted intervention designed to treat general anxiety disorder, social phobia, and/or separation anxiety in adolescents aged 12-18 years. Evidence of effectiveness in persons aged 13-18 years comes from one RCT conducted in the USA. The study included youth from different ethnic groups (majority Caucasian 78.9%), aged 7-17 years. Participants met diagnostic criteria for separation anxiety disorder (SAD), social anxiety disorder (SOC), and/or generalized anxiety disorder.

• Is this comparable to the population your organisation would like to serve?

Desired Outcome

The C.A.T Project is designed to treat anxiety and anxiety disorders by helping adolescents to recognise signs of anxiety, and teaching them to apply taught strategies in managing their anxiety. Programme delivery is associated with significant reductions in anxiety disorders and anxiety severity.

• Is delivering a programme designed to treat anxiety and anxiety disorders in adolescents aged 12-18 years a priority for your organisation?
• Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes?