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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
The Cool Kids Anxiety Program is a skills-based treatment programme designed to manage anxiety in children and young people (aged 7-17 years) who have anxiety as their primary disorder. The targeted programme applies cognitive behavioural approaches to teach anxiety management skills for all types of anxiety, including separation anxiety, social anxiety, general worries, specific fears and panic. The programme is therefore designed with the goal of reducing anxiety in children/ young people and improving their quality of life.
An initial assessment is carried out to determine programme suitability for the child (aged 7-12 years), or adolescent (aged 13-17). This assessment is conducted using online questionnaires, and/ or in-person or phone interview. Participants recommended for the programme then receive the intervention from accredited practitioners in an outpatient clinic setting, community setting, school setting or remotely over an online platform. The intervention can be delivered to individual families (child/young person and parents) in ten 1-hour sessions over 10-12 weeks, or to groups of families (about 5-7 families per group) in ten 2-hour sessions over 10-12 weeks. Parents’ attendance at all individual sessions is encouraged. Within schools, The Cool Kids Anxiety Program is delivered to high risk groups of children/ adolescents (up to 10 per group). Typically, eight 60-minute sessions are delivered outside of classes but during school time. However, delivery method is flexible and is dependent on school system structures. Parents do not attend school sessions, but attend two parent information sessions, and may be offered individualised phone consultations.
The Cool Kids Anxiety Program focuses on psychoeducation, cognitive restructuring, graded exposure, and parent management training. The taught topics include feelings and anxiety, realistic thoughts and expectations, facing fears, social skills training, problem solving, confidence building, and general coping strategies. Children, adolescent, and parent workbooks are used to deliver the programme. These workbooks have identical basic principles and teach identical fundamental skills. However, they differ in the examples used to demonstrate taught skills, and the extent of parental involvement (with less active parental role for adolescents). Programme activities conducted include discussions, games, role-play and practice of real-life situations. Homework exercises are a part of the intervention and are discussed with the therapist at each session.
The Cool Kids Anxiety Program is not recommended for children or adolescents who have suicidal ideation, who are self-harming, have autism or significant learning delays. It is also not recommended for young people with depression or oppositional defiant disorder that is more severe than the anxiety.
Fidelity
The Cool Kids Anxiety Program fidelity is evaluated using the following measures;
Use of fidelity monitoring checklist (made available on request)
Modifiable Components
The Cool Kids Anxiety Program is typically delivered in 10 sessions, over 12 weeks, however, there is flexibility in period of delivery, depending on participant progress and practical constraints. There is also flexibility in the way practitioners choose to deliver the programme to meet participant needs. However, it is important that programme principles are adhered to, and programme techniques/ strategies are taught.
The Cool Kids Anxiety program is also available online as the Chilled Out online program for young people aged 13-17 years, and the Cool Kids online program for children aged 7-12 years. Other programme variants are available to young persons for whom the standard programme may not be suitable. These include Cool Kids ASD for young people with Autism Spectrum Disorder, Cool Little Kids for young children aged 3-6 years, and Cool Kids anxiety / depression (Chilled) for teenagers with significant depression. Cool Kids Anxiety Program manuals are available in several languages including English, Chinese, Danish, Icelandic, Korean, Spanish, Swedish, Italian and Turkish.
Support for Organisation / Practice
Implementation support is provided by Centre for Emotional Health Clinic (CEHC), Australia.
Implementation Support
CEHC provide support with practitioner training, and accreditation. CEHC also provide online access to purchase therapist manuals, and participant workbooks.
Licence Requirements
A licence is not required to deliver Cool Kids Anxiety program.
Start-up Costs
Start-up costs for the Cool Kids Anxiety Program cover practitioner training, accreditation, and program materials.
eTraining & Accreditation course (all online) - $600 (AUD) - per person.
Program Materials - Cool Kids Anxiety Program 2nd Edition Therapist Kit - $99.95 plus postage - per person. The program materials (kit) includes 1 x therapist manual, 1 x child workbook, 1 x teen workbook and 1 x parent workbook
Each family requires a copy of the workbook set - either the child/parent workbook set or the teen/parent workbook set. Each workbook set is $49.95 plus postage.
Building Staff Competency
Qualifications Required
The Cool Kids anxiety program is typically delivered by practitioners who have 4 years undergraduate or 2 years postgraduate degree in mental health-related professions such as psychology, counselling, social work, occupational therapy or education. Practitioners should have a background in cognitive-behavioural therapy (CBT) or attend training in CBT. They should also have experience working with young people with mental health problems. One practitioner delivers the programme to individual families, while two practitioners deliver the programme to family groups.
Training Requirements
Practitioner training and accreditation is required prior to programme delivery. E-Training (online training) consists of 12 modules, that can be started and stopped at any time, and can be completed in about five to six hours in total. After practitioner training, accreditation is achieved upon completion of assessment tasks. Assessment tasks can be completed in 3 hours and include answering multiple choice questions; reporting on two case studies; 30 minutes feedback session with programme supervisor; and reporting on another two case studies. The entire accreditation process may take up to six weeks to complete due to wait times for feedback on case studies, and availability of 30 minutes supervision appointments. Practitioner accreditation is valid for five years. Trainer training can be considered on request.
Supervision Requirements
Practitioner supervision is required during the accreditation process. The programme supervisor (from CEHC) provides remote feedback on the two sets of two case studies completed by the practitioner. The supervisor also provides a 30 minutes (remote) supervision session to the practitioner.
Theory of Change
The Cool Kids Anxiety program is based on cognitive behavioural approaches. Programme components (including cognitive restructuring, graded exposure, psychoeducation, and parent management training), and taught skills (including problem solving, assertiveness, and relaxation) help to address key factors that sustain anxiety. Hence programme delivery is expected to reduce anxiety.
Primary school: 6 to 12 years - Rating: 4+
Research Design & Number of Studies
The best evidence for Cool Kids Anxiety Program in children aged 6-12 years comes from two internal Randomised Control Trials (RCT) conducted in Australia, and one external RCT conducted in Denmark. The first internal study included 267 children aged 6-12 years (Rapee et al, 2006); the second internal study included 112 children/teens aged 7-16 years (Hudson et al, 2009); and the external study included 109 children/ teens aged 7-16 years (Arendt et al, 2016). All three studies only included children/ teens (male and female), with anxiety disorder as their principal disorder.
Outcomes Achieved
Compared to the control group who did not receive the Cool Kids Anxiety Program, the following outcomes were observed:
Child Outcomes
Significantly greater decrease in anxiety diagnosis at post-test (Rapee et al, 2006; Hudson et al, 2009; Arendt et al, 2016), maintained at 3 months (Hudson et al, 2009; Arendt et al, 2016), and 12 months follow-up (Arendt et al, 2016)
Significantly greater reduction in clinical severity rating of anxiety diagnosis at post-test and 3-month follow-up (Hudson et al, 2009)
Significantly greater reduction in parent report of child anxiety/ anxiety symptoms at post-test (Rapee et al, 2006; Hudson et al, 2009), and at 3-month follow-up (Hudson et al, 2009)
Significantly greater decreases in child internalising & externalising behaviours, at post-test (Rapee et al, 2006), and in emotional problems at post-test (Hudson et al, 2009)
Parent Outcomes
None
Key References
Arendt, K., Thastum, M., & Hougaard, E. (2016). Efficacy of a Danish version of the Cool Kids program: a randomized wait‐list controlled trial. Acta Psychiatrica Scandinavica, 133(2), 109-121
Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. J., & Bovopoulous, N. (2009). Cognitive behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 533-544
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
Adolescents: 13 to 18 years - Rating: 4+
Research Design & Number of Studies
The best evidence for the original Cool Kids Anxiety Program in children aged 13-18 years come from one internal RCTs conducted in Australia, and one external RCT conducted in Denmark. The internal study included 112 children/teens aged 7-16 years (Hudson et al, 2009); and the external study included 109 children/ teens aged 7-16 years (Arendt et al, 2016). All three studies only included children/ teens with anxiety disorder as their principal disorder. Separate data for children aged 13-18 was not reported.
Outcomes Achieved
Compared to the control group who did not receive the Cool Kids Anxiety Program, the following outcomes were observed:
Child Outcomes
Significantly greater reduction in principal anxiety diagnosis, and clinical severity rating of anxiety diagnosis at post-test and 3-month follow-up (Hudson et al, 2009)
Significantly greater reduction in parent report of child anxiety at post-test and 3-month follow-up, and significantly greater reduction in emotional problems at post-test (Hudson et al, 2009)
Significantly greater reduction in anxiety diagnosis at post-test, maintained at 3 months and 12 months follow-up (Arendt et al, 2016)
Parent Outcomes
None
Key References
Arendt, K., Thastum, M., & Hougaard, E. (2016). Efficacy of a Danish version of the Cool Kids program: a randomized wait‐list controlled trial. Acta Psychiatrica Scandinavica, 133(2), 109-121
Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. J., & Bovopoulous, N. (2009). Cognitive behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 533-544
Need
Comparable Population
The Cool Kids anxiety program is a skills-based treatment programme designed to manage anxiety in young people (aged 7-17 years) where anxiety is their primary disorder. The best evidence of effectiveness included in this summary comes from three randomised controlled trials that included male and female children/ young people aged 6-17 years. All participants included in the study were resident in Australia or Denmark, and had anxiety disorder as their principal disorder.
Is this comparable to the population your organisation would like to serve?
Desired Outcome
The Cool Kids Anxiety Program teaches anxiety management skills for all types of anxiety, with the aim of reducing anxiety in children/ young people, and improving quality of life. Programme delivery is associated with significant reduction across several outcomes including anxiety symptoms, anxiety diagnosis, internalising behaviours, externalising behaviours, and emotional problems.
Is delivering a programme designed to teach anxiety management skills for the purpose of treating anxiety in children and adolescents a priority for your service? Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes?
Need Score
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Fit
Values
The Cool Kids Anxiety program is a targeted skills based treatment programme designed to manage anxiety in young persons (aged 7-17 years) who have anxiety as their primary disorder. It applies cognitive behavioural approaches to teach anxiety management skills for all types of anxiety. The programme can be delivered to individual families, family groups, or separate children and parent groups.
Does this approach align with the key values of your organisation?
Priorities
The Cool Kids Anxiety program teaches anxiety management skills children and adolescents (aged 7-17 years) who have anxiety as their primary disorder. The programme aims to reduce anxiety in children/ young people and improve their quality of life. Cool Kids anxiety programme is delivered to children/ young people and their parents.
Is your service looking to deliver a targeted anxiety treatment programme to children and teenagers who have anxiety as their primary disorder? Is your organisation looking to deliver an intervention that requires parental involvement?
Existing Initiatives
Does your organisation have existing programmes designed to treat anxiety in children and teenagers? Are there components addressed by the Cool Kids anxiety programme that are not met by existing programmes? Are the existing initiatives effective? Do the existing initiatives fit your current and anticipated future requirements?
Fit Score
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Capacity
Workforce
The Cool Kids Anxiety Program is delivered by practitioners who have 4 years undergraduate or 2 years postgraduate degree in mental health-related professions such as psychology, counselling, social work, occupational therapy or education. Practitioners should preferably have a background in cognitive-behavioural therapy (CBT) or attend training in CBT.
Practitioner training and accreditation prior to programme delivery is mandatory. ETraining (online training) can be completed in about five to six hours. Accreditation tasks can be completed in 3 hours, but the entire accreditation process may take up to six weeks to complete.
The programme is delivered by one practitioner to individual families in ten 1-hour sessions, or by two practitioners to groups of families in ten 2-hour sessions. In schools, it is delivered to groups of children (up to 10 children per group), with separate parent information sessions.
Does your organisation have qualified practitioners who are available and interested in learning and delivering this programme? Can your organisation support the time commitment required for practitioner training, accreditation, and programme delivery?
Technology Support
Practitioner training is available online or face-to-face. Practitioner accreditation process requires completion of assessment tasks that require technological access.
Does your organisation have technology that will provide access to online training, and allow completion of assessment tasks for accreditation (computer, broadband, video recorder, phone)?
Administrative Support
The Cool Kids Anxiety Program can be delivered in an out-patient clinic, community setting, in schools or remotely online.
Does your organisation have administrative capacity and systems to support programme delivery in your chosen setting? Do you have a venue/ facility in your chosen setting to deliver the programme sessions?
Financial Support
Start-up costs for the The Cool Kids Anxiety Program includes practitioner training and accreditation costs, and material costs. Training and accreditation is delivered online for $600 (AUD) per practitioner.
Materials costs include The Cool Kids Anxiety Program 2nd Edition Therapist Kit - $99.95 plus postage. Each family requires a workbook set at the cost of $49.95 plus postage.
How many practitioners will receive training and accreditation to deliver the Cool Kids Anxiety Program? Will training be received face-to-face or online? Can the training, accreditation and programme material costs for this number of practitioners be financially supported? How many families will the programme be delivered to in the first year? Can the costs associated with delivery to this number of families be financially supported?
Capacity Score
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