Introduction
The Coping Cat Program (CCP) is an interventionist program that was established to treat children with anxiety disorders. The program is managed under the Children, Youth and Family Mental Health Evidence-Based Practice Project under the collaborative partnership between the New York State Office of Mental Health and the University at Buffalo School of Social Work.
The project began in the year 2002 to assist in assessment, training and consultation to over 400 affiliate agencies across nineteen countries in western region. Its main goal is to, through the agencies, provide guidelines in increasing awareness, establish plans and institute widely recognizable evidenced –based practices aimed at improving the mental status of children and families at large. (Promising Practices Network, 2006).
Project description
The program is established under a joint partnership between the school of social work and New York State Office of Mental Health to assess and implement the following:
- Staff training in countries of western region and agencies to the Office of Mental Health in regard to evidence based practices to assist children, adolescents and families.
- A project website that provides Western New York mental health practitioners with access to current evidence- based practice information and resources for children, adolescents and their families (Promising Practices Network, 2006).
This program is administered to children aged between eight and thirteen years under the coping Cat plan and also adolescents aged between fourteen and seventeen years through the CAT plan. This program is established on the premise that children under this age bracket encounter challenges of coping with their anxieties in their prime age of learning. On the other hand, adolescents are also a vulnerable group of children who are undergoing challenges during developmental changes which immensely contribute to anxiety disorders.
It is within this context that anxiety therapies are necessary so as to assist children and youth in overcoming their anxiety problems while turning these challenges into learning experiences. Families are also another facet that must not be left out. Since they are the primary host of children, they are the immediate consumers of the impacts of anxiety in children. The program thus seeks to engage families in understanding and helping children to cope with their anxiety complexes through parent involvement.
Validity and Fidelity of Data
Studies conducted by Kendall and Hedtke (2007), have widely been employed in an attempt to showcase the validity of the empirically supported treatment (EST) as applied by the coping Cat program. This is used as supportive evidence to demonstrate the flexibility concept in the context of fidelity. Since flexibility under fidelity focuses on the use of ESTs as well as considering the individual participant presentation, Kendall proposes the use of the Coping Cat with younger children and adolescents who exhibit both mild and acute signs of anxiety.
Coping Cat is a purely evidence -based strategy that makes use of empirical clinical tests to establish validity of treatment advances, with the aim of assessing viability of the treatment. Studies however reveal that about 47% of the clinicians do not use treatment manuals in their practice as professionals. This approach may render results invalid due to lack of evidence as relates to the improvement in the child subjected to the treatment.
Since the research has shown much objectivity and focus on a number of items, proponents have suggested that it embarks on the concern for fidelity of its operations (California Evidence-Based Clearinghouse (CEBC), 2006). It suggests that assessment procedures should either be contracted with the primary developer of Coping Cat program or simply to have its staff trained so as to ensure that specific expert individuals act in the capacity of the facilitators in quest for quality delivery of program objectives. One of the fidelity requirements is that all the assessment processes be taped during the evaluation treatment procedures so as to assist in rating all the sessions based on the set requirements to ascertain consistency in the practice.
Secondly, an assessment that is exclusively rigorous should be substituted instead by developing a less demanding, yet acceptable plan that would offer itself as the best alternative. Recording and sampling of the tapes should be carried out and then subjected to critical review by an expert in treatment plans. These suggestions are intended to culminate into a more reliable, more efficacious and conclusive assessment of the deliverability of the program requirements.
Fidelity assessment may also be undertaken through making printouts for the session goals from the treatment manuals and training manuals. This would still be managed by a treatment expert with a clear view to determine whether goals were adequately addressed. Evaluation of fidelity may also be done through the printouts gotten from the manuals adopted by the treatment plan. This measure is intended to establish whether or not the primary goals are exclusively addressed by the therapist.
For any research to be reliable, it should be based on quantifiable evidence of its efficacy. The use of such techniques that render themselves ineffective may not deliver the program to its immediate objectives for which it was founded. The manual of workbooks implemented by the program offers the best methodology of maintaining trends in behavior change among children that were subjected to treatment. These manuals come inform of parent reports, self- reports and teacher- reports.
These implementation documents have proven to be of significant importance in pursuit for assessment and evaluation criteria by both parties of the treatment process. To stress on their importance, Kendall studies showed that post-treatment reports according to follow-up plans conducted indicated great improvements in the anxiety levels. Self reports as requisite data are maintained by the subject under study and treatment so as to solely evaluate themselves in relation to individual progress.
Since aspects of confidentiality are pertinent in therapy and especially in the adolescents, coping Cat therapeutic services take into account the need to have such private matters during parent- child and therapist discussion meetings. This practice is aimed at ensuring that confidential aspects are kept as private as possible while using it to influence treatment.
Fidelity is paramount on the side of a clinician who shares such private information with an adolescent undergoing therapy for anxiety treatment. For instance if he or she shares that he has experimented with thing s such as alcohol, drugs and sex, it should not be shared together with parents. The subject therefore bestows his or her trust in the psychotherapist who in turn should be able to practice fidelity as much as possible. The program however suggests that if the teen shared that he or she once drove while under the influence of alcohol, then such information is of safety interest and as such, may be shared by parents. Therefore addressing aspects of fidelity and flexibility in a way to gaining confidence of an adolescent is critical in ensuring that they are psychologically safe in the clinical treatment.
Justification and Application of the Coping Cat Manual as an EST for the Program
Anxiety challenge in children and adolescents presents a huge challenge to families, schools, and other social institutions that find children as their partner in the course of their establishments. Studies reveal that anxiety disorders are among the most common types of psychopathology that exhibits chronic tendencies when not properly treated and attended to (Achenbach, Howell, McConnaughy, & Stanger, 1995).
Based on this empirical study among others, Kendall in his quest for a mentally upright child under the influence of anxiety, established the program that heavily borrows from empirical approach for treatment of psychological disorders of anxiety. The Coping Cat strategy provides this multifaceted approach to treatment of psychopathology with the aid of practical based scientific clinical treatment. Studies conducted by Kendall indicate that far reaching positive outcomes abound from the use of the Cognitive Based Treatment (CBT), which is the primary recipe for the success of the Coping Cat program of anxiety treatment.
The analysis of the program shows that it has succeeded in delivering its goals through the use of its evidence- based approach. This evaluation is in accordance with the CEBC report on scientific rating scale of 1 to 5 where it was rated as 1 because of its well established and evidence-based used by the Coping Cat (CEBC, 2003)
The project uses a four tire approach to treatment of the anxiety problems in children. Use of the acronym FEAR employs the strategy of dealing with the complex in children. Since fear is one of the main components that accompany anxiety, Coping Cat draws its strategy from this to realize its objective.
Research outlining the effectiveness of the program
Numerous researches have been conducted to ascertain the effectiveness of the Coping Cat program of treating anxiety disorders through its practical- based approach. The California Evidence-Based Clearing house (CEBC) through its analysis found out that Coping Cat program was on of the most successful programs that ridden on the principles of empirical scientific studies. (CEBC, 2006). Due to its efficiency in application of evidence-based practices in the treatment plans for anxiety, it has recorded significant progress hence rated 1 on the scale of 1 to 5. This scaling indicates, according to CEBC, as a program it has implemented its studies and treatment with well- evidenced research that is empirically proven.
In a research conducted (McNally, 2011), it was noted that Kendall and Hedtke’s Coping Cat CBT approach treatment of anxiety among children was among the most empirically supported and widely disseminated treatment programs for anxiety disorders in youth. A wide range of literature has supported and demonstrated an advancing support for cognitive based treatment in treating anxiety based disorders in children.
McNally observed that the use of CBT in children has shown significant impact on treatment of children suffering from autism spectrum disorder (ASD), however no concrete studies have expounded on its efficacy on reducing anxious symptoms associated with ASD. Application of Cognitive based treatment in children with ASD indicated that in spite of the high rates of re-occurring anxiety and other associated psychiatric disorders, ASD associated children who accomplished 16- weeks under Coping Cat CBT program of intervention evidenced significant reductions in anxiety more than those who were on a waitlist condition. This resounding evidence asserts that children who were not subjected to the therapy could not record improvement in reduction of anxiety disorders.
According to Remschmidt (2003), Psychotherapeutic intervention methods in depression rely heavily on the cognitive behavior therapy (CBT) and the combination of this method with family education interventions, group approaches and interpersonal therapy (IPT). This literature ventures to establish the effectiveness of CBT on youth who undergo therapeutic procedures under the program of CBT.
However studies suggest that this treatment may, according to Remschmidt be employed either singly or in combination with other medication for maximum results. CBT has shown significant positive impact on families as regard to satisfaction after the therapy was administered. After treatment, CBT indicated to have specifically impacted cognitively on the side of patients and a much more on two family variables that included control behavior and marital satisfaction. (Remschmidt, 2003).
Further empirical studies by Remschmidt (2003) support the inclusion of parents in the therapy process as employed by the Coping cognitive treatment. Relying on the fact that parents play a significant role as identity and attention providers, children suffering from acute deficit of attention showed less improvement in hyperactivity disorder and disruptive behavior disorders were more likely to experience depression recurrence after treatment. It follows then that they should be engaged during the process so as to avoid post- treatment disorders.
CBT as described by kendall et al, “has shown to be an effective prevention and early intervention approach for children who exhibit mild to moderate problems in anxiety (Dadds,et al quoted in Schroeder, & Gordon, 2002). Massive support that has been marshaled by numerous psychology studies in therapeutic anxiety treatment continues to give credit to studies conducted by Kendall and its application in Coping Cat Treatment. Post- treatment follow-ups on two year successive plan showed that approximately 20% of children exhibited improvement in anxiety as compared to those under no treatment at all. This comparative study is a clear confirmation that Kendall’s CBT approach was a sure way of treating youth with undesired anxiety complexes.
Many researchers have recommended the therapy that utilizes the CBT in treatment of the anxiety disorders as applied by Kendall in the Coping Cat treatment. Appreciating the importance of parents in the development of children, their inclusion in the therapy together with children has been proven much success in treatment of anxiety problems. Gordon (2002) commends on the significance of parents in modeling of solutions to children with personality challenges and as such, he suggests that they should be included in the struggle to treat youth who exhibit anxiety disorders. To assert its successes, when used in combination with other treatment strategies yields a milestone treatment according to many who have sort to assess its effectiveness in treatment of anxiety.
The Program as research and evidence based treatment
The Coping Cat program has been rated and commended as one of the approaches of treating anxiety disorders based on the principles of practicality and research. Extensive research conducted by Kendall with regard to the application of CBT is an indicator that the program does not run short of the requirements of an empirical study.
Results according to clinical trials conducted by Kendall showed much efficacy for parent involvement in the therapy exercise alongside children who exhibited identity and withdrawal symptoms. This studies have since been cited by many other subsequent researches by scholars who have investigated to find out the effectiveness of the program. The rating by the California evidence based center was a clear indicator that Coping Cat relied on the empirical studies and scientifically proven data in establishing its treatment plans for the anxiety affected children and youth.
According to Remschmidt (2003), CBT provides an independent, reliable and most efficient practical study and evidence based approach that many other researches have for so long been able to apply. Many organizations for instance acknowledged the use of the scientific clinical approach in dealing with acute anxiety complexes that were observable in children of the age between 6 and 12. This among many other researches and institutions have echoed Coping Cat program plan and have subsequently applied it in a more rigorous manner for instance “Coping Koala” which has heavily borrowed from the plan by Kendall. This new plan was a remodel of the Coping Cat which successfully applied the approaches alongside other medical treatments in solving anxiety problems in children and youth.
Easiness of use of the Coping Cat strategies
The program is user-friendly and easy to apply solely or in partnership. This is possible since parents are also taken as partners in the therapy plan and as such get first hand knowledge and skills in dealing with anxiety of their children and themselves. The use of manuals for both therapists, parents, and the subjects under treatment goes along way in ensuring that one can easily use it. To expound on this, teacher- reports, self- reports and parent- reports provides a comfortable and enabling conditions in which all participants can assess and evaluate their progress as relates to improving scores on anxiety rating scale.
On the other hand, the use of a practical approach in treatment of children makes it much easier for children to employ day to day activities in the treatment plans. Through this practical usage of its strategy, its use becomes increasingly cheap and easy to apply.
Application of the program and application in public schools
The CBT has widely been acknowledged by many as an applicable methodology in numerous ways in institutions of learning. Cognitive approach in the treatment of anxiety related complexes is applied based on the first principles of cognitive behavior among growing children. Since this treatment approach makes use of this indicator, it will be sufficiently important that it be applied in schools so as to aid in dealing with the challenges faced by school going children, teachers, parents and other educational stakeholders.
The CBT program is a sixteen stage session treatment applied to youth in schools from the age of seven to thirteen tears. The program suggests that the first eight stages can adequately be used to help them identify the cues that will help them identify anxiety and subsequently applying the same to cope with those anxiety related complexes or disorders. Kendall suggests that subsequent eight sessions are rather behavioral and as such may be used to shape their personality as they approach puberty.
In schools, play is taken as a usual activity to be undertaken by children and as such it should be modeled according to the manual, to meet the requirements of the treatment process. Teachers and therapists are cautioned by the developer that though the program has shown extensive benefits when applied, some children may encounter challenges during this implementation due to varied developmental processes and abilities. The manual suggests that its application should then be used with regard to the prevailing circumstances under which the child may be exhibiting.
The application of play remains a significant application of the treatment plan suggested by Kendall with the view of developing rapport between the therapist, child, and the youth who is undergoing clinical anxiety treatment therapy. Reinforcement in a positive way as used by B.F Skinner in influencing positive behavior and acquisition of learning habits is primary in this application. Therefore play modeled in a proper way in schools is bound to yield numerous benefits concerning the treatment of anxiety disorders as observed in children and youth. For example, Kendall notes that a therapist in schools may engage the subject under treatment in what he calls a “personal facts” game where they try to remember some facts about the other as learned, and upon winning, gifts or rewards are given.
The use of coping thoughts as a component in psycho-education is applicable in schools. Here the method can be applied where the children are allowed to challenge their anxious thoughts and cognitions. This is important in developing coping feelings and thoughts that will help them deal with their fears. Since therapy is applicable to youth of different developmental stages and ages, use of one general thought such as “Yes you can do it” may be a better way in ensuring that they always can refer to it in case of challenges or difficulties. An example of how such may be smoothly enabled is by ensuring that such coping thoughts are placed or written on school bags, shoes or a places where they can easily access in case of and during a situation that is provoking.
Tasks that will bring about exposure to youth are a welcome application of the cognitive- based treatment plan which can be utilized in schools today. Children who have challenges with their memory may be assisted to remember about those improvements that they have made in as far as treatment tasks are concerned. Therefore teachers through a practical approach may record the treatment task accomplishment exercises carried out by children who are having anxiety problems. This will help them to appreciate their ability to perform certain tasks and in so doing, they will be able to overcome their fears.
In adolescents, play may not be a best for them and as such there is a suggested CAT program for them which may be used in the manner to accomplish the desired goal of managing the fears of the teenage youth in schools. Strategies such as logical thinking in this type of group may be successfully employed to help them cope with anxiety and related challenges.
According to Macklem (2011), schools dealing with a wide range of children may identify some of the strategies advanced in the manualized CBT approach by Kendall and see which ones in particular apply to their situation. This may be applied through grouping students with similar or homogeneous anxiety exhibitions and then planning on what strategy they can apply with the view of solving anxiety related disorders.
Relaxation as an element in CBT may also find space in the application in schools. Since relaxation is closely related with the ability to conquer stress and fears, this elementary application may be a sure way of assisting them. Lessons on how to help children relax during situations of anxiety can be thought successfully in ensuring that children and youth adjust to fears and subsequently cope with them within time. For example, a therapist may employ the methodology of using such things as uncooked spaghetti to illustrate how our muscles strain when they are not relaxed. Such lessons applied to a group of youth in an anxiety situation may go along way in assisting them overcome their fears and stresses as a result of non- relaxation.
Schools can also employ the method of imagery through anxiety related pictures which are provocative to their thoughts so as to educate them about the need to overcome challenges of anxiety. This will borrow heavily from the element of cognitive recognition which suggests the practical use of cognitive practices in aiding children and youth in identifying and coping with anxiety related characteristics that they may be experiencing. Students may therefore be put to exercises like cutting out pictures that show anxiety and try explaining how they look like. This will automatically help them to dislike such character and as such overcome them.
Modeling can also smoothly apply the CBT treatment in children attending school. In this case, a person who is considered by a child as good may be used as a model of learning so as to instill the concept in him or her. This is to ensure that a child copes with his or her problems through the fact that he or she has copied from the model presented before him or her.
Limitations of Coping Cat Program
There are numerous criticisms that have been leveled against the CBT as used by the Coping Cat program in its delivery of anxiety treatment in children. Some researchers have opposed the approach’s use of a combination of various techniques where parents are engaged together with the children in assisting them cope with the disorders. Therefore this treatment approach fails to consider the ability of children themselves to independently move on with the treatment with the view of attaining normality in anxiety (Joughin, 2006 quoted in Macklem).
There has also been a concern for a growing loss of touch and connection between the therapist and the subjects under treatment with the introduction of computer based CBT in anxiety cases. This has significant impact on the progress of the children who have undergone such treatment procedure.
Criticisms as to the purpose of the CBT use have been leveled against the Coping Cat plan. This is based on the premise that it was used as a study as opposed to being applied for ongoing planning purposes (Joughin, 2006 quoted in Macklem). This should not be the case but rather should practically be employed in life cases in answering the question of anxiety problems in children.
The use of the limited data samples in the study that yielded CBT poses an inevitable setback since many have rejected its results not on principle but on the basis of weak samples that were used under the study.
Conclusion
The Coping Cat program that was initiated by partnership between York State Office of Mental Health and the University at Buffalo School of Social Work has since gained reputation since its establishment as a center for therapeutic treatment of anxiety disorders in children and teenage youth. The extensive research and studies that have been conducted have widely referred to the project as one of the most successful strategies that applied evidence based cognitive treatment in dealing with the anxiety challenges among the youth and children. Thought there are notable limitations associated with the program, its application remains abundantly efficacious in today’s situation.
The Coping Cat program as an avenue of hope to anxiety threatened families has been significantly applauded by the center for evidence based research based in California for its successful application of CBT which made use of the well researched empirical evidence to support its propositions.
Recommendations have however been given to participants who wish to use its strategies with caution. For example its application should not be taken as a package approach but rather applied in consideration of the relevant situation. This means that anxiety therapists, parents and teachers should trade carefully if excellent results have to be realized. It is also suggested that it can be applied in other institutions other than schools such as care centers and orphanages since they are organizations that encounter children who are prone to anxiety problems. This will yield multiple results when appropriately implemented under professional guidance.
References
Centre for Evidence-Based Conservation (CEBC). Coping Cat.
Kendall, C.P &Khanna. (2007). Computer –Assisted CBT for Child Anxiety: The Coping Cat CD-ROM. Web.
Macklem, G. L. (2011). Evidence-Based School Mental Health Services: Affect Education, Emotion Regulation Training, and Cognitive Behavioral Therapy. New York, NY: Springer.
Promising Practices Network. (2006). Coping Cat.
Remschmidt, H. (2003). Evidence Concerning the Effectiveness of Psychotherapies: Depression and Anxiety.
Schroeder, C. S. Gordon , B. N. (2002). Assessment and treatment of childhood problems: a clinician’s guide. New York, NY: Guilford Press.