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Teaching Kids to Cope (TKC)

Teaching Kids to Cope (TKC) is a cognitive-behavioral health education program, based on stress and coping theory, for adolescents ages 12-18 with depressive symptomatology and/or suicidal ideation. This group treatment program teaches adolescents a range of skills designed to improve their coping with stressful life events and decrease their depressive symptoms. Participants are guided through a process to discover their distorted thinking patterns and to test their thinking against reality using suggested approaches. They also explore and practice problem identification, alternate ways of viewing a situation, and alternate ways of reacting. During each group session, adolescents are first provided with information on topics such as common teen stressors, self-image, coping, family relationships, and communication. In the second portion of each session, they participate in experiential learning, identifying their problems and engaging in concrete problem-solving tasks. Activities also include group discussion, role-play, group projects, and the use of worksheets, handouts, films, and audiotapes. Homework assignments provide an opportunity for the adolescents to practice using new skills.

Ten 1-hour group sessions are delivered weekly by a professional with a bachelor's degree in education, social work, child development, nursing, psychology, or other health-related field, and 1 year of experience working with children or adolescents. TKC can be implemented in schools, hospitals, outpatient clinics, churches, summer camps, or other community-based settings.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: February 2010
1: Depressive symptomatology
2: Coping skills
Outcome Categories Mental health
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations Rural and/or frontier
Implementation History Since its development in the early 1990s, TKC has been delivered to an estimated 2,000 adolescents in 10 schools in Pennsylvania and other States. Outside the United States, TKC has been implemented in Jordan with university students.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations TKC has been adapted to teach skills for coping with anger in rural schools serving predominately White students and in urban schools serving predominately African American students. It also has been adapted to help adolescents deal with the stress associated with their illness (diabetes, cystic fibrosis, or cancer) and with geographic mobility and relocation to a new school.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Indicated

Quality of Research
Review Date: February 2010

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Lamb, J. M., Puskar, K. R., Sereika, S. M., & Corcoran, M. (1998). School-based intervention to promote coping in rural teens. American Journal of Maternal Child Nursing, 23(4), 187-194.  Pub Med icon

Study 2

Puskar, K., Sereika, S., & Tusaie-Mumford, K. (2003). Effect of the Teaching Kids to Cope (TKC) program on outcomes of depression and coping among rural adolescents. Journal of Child and Adolescent Psychiatric Nursing, 16(2), 71-80.  Pub Med icon

Outcomes

Outcome 1: Depressive symptomatology
Description of Measures Depressive symptomatology was measured using the Reynolds Adolescent Depression Scale (RADS), a 30-item self-report instrument specifically developed for use with adolescents. For each item, the adolescent selects from four responses (rated 1 to 4) the one that best matches how he or she usually feels. The scale measures cognitive, motor, somatic, and interpersonal symptoms commonly associated with depression.
Key Findings In a randomized controlled trial, from pre- to posttest, self-reported depressive symptomatology decreased for female adolescents who received TKC and increased for female adolescents who did not receive the intervention (p = .032). There was no significant change in RADS scores for males in either the intervention or control group.

In another randomized controlled trial, mean depressive symptomatology scores improved from pre- to posttest (p = .026) and from pretest to the 6-month follow-up (p = .027) for adolescents who received TKC, while scores showed no change for adolescents who did not receive the intervention. No significant differences were found between the intervention and control group at 12-month follow-up.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)
Outcome 2: Coping skills
Description of Measures In one study, coping skills were measured with the Jalowiec Coping Scale (JCS). With this 60-item scale, students choose a stressful life event that occurred in the preceding week, select their style of coping with that event, and evaluate the degree to which they believe that coping method is helpful (ranging from not helpful to very helpful). Eight different styles of coping are offered as choices: confrontive, evasive, optimistic, fatalistic, emotive, palliative, supportant (using personal, professional, and/or spiritual support systems), and self-reliant.

In another study, coping skills were measured using the Coping Responses Inventory Youth Form (CRI-Y), a 48-item self-report instrument designed to assess how adolescents between the ages of 12 and 18 cope with a wide variety of stressful life events. With four approach scales (Logical Analysis, Positive Reappraisal, Seeking Guidance and Support, and Problem Solving) and four coping avoidance scales (Cognitive Avoidance, Resignation or Acceptance, Seeking Alternative Rewards, and Emotional Discharge), the CRI-Y measures cognitive and behavioral efforts directed at managing a stressful situation.
Key Findings In a randomized controlled trial, adolescents who received TKC reported significantly greater use of a supportant coping style at posttest than control group adolescents who did not receive the intervention (p = .001).

In another randomized controlled trial, adolescents who received TKC indicated greater use of the seeking guidance and support approach at posttest (p = .044) and at 12-month follow-up (p = .007) than control group adolescents who did not receive the intervention. In addition, adolescents who received TKC and a booster session 9 months later demonstrated a mean decrease in their reported use of cognitive avoidance strategies of coping compared with adolescents who received either TKC with no booster session or no intervention (p = .013).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 56.1% Female
43.9% Male 		95.1% White
4.9% Hispanic or Latino
Study 2 13-17 (Adolescent) 82% Female
18% Male 		98.9% White
1.1% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Depressive symptomatology 4.0 4.0 4.0 3.0 3.0 4.0 3.7
2: Coping skills 4.0 4.0 4.0 3.0 3.0 4.0 3.7

Study Strengths

The assessment tools used to measure both outcomes are well established in the research literature as being reliable and valid for use with the identified target population. Implementation fidelity was well documented and strongly supported through systematic training of personnel and review of audiotapes by an external expert in group therapy. Measures were used to avoid and/or address confounding variables (e.g., the study designs included random assignment to conditions). The analyses employed were appropriate for the type of data collected and sample sizes.

Study Weaknesses

Both studies had relatively high dropout rates (approximately 10% and 20%, respectively) given their small sample sizes. Researchers did not describe the methods used to address missing data. Baseline differences between treatment completers and dropouts and between the treatment group and control group also were not described.
Readiness for Dissemination
Review Date: February 2010

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Group Leader Checklist To Implement the TKC

Group Leader Roles: TKC [PowerPoint slides]

Program Web site, http://www.pitt.edu/~krp12/

Psychological Assessment Resources. (2005). Coping Responses Inventory Youth Form (CRI-Y), version 1.1.

Psychological Assessment Resources. (2005). Reynolds Adolescent Depression Scale (RADS) form, version 1.1.

Puskar, K. (1996). Individual therapy with adolescents. In S. Lego (Ed.), Psychiatric nursing: A comprehensive review (2nd ed.) (pp. 97-101). Philadelphia: Lippincott.

Puskar, K., Bernardo, L. M., Stark, K. H., & Frazier, L. (2008). Adolescent health promotion groups: A primer for milieu therapists. Residential Treatment for Children and Youth, 25(1), 39-53.

Puskar, K., & Tusaie-Mumford, K. (1996). Group therapy with adolescents. In S. Lego (Ed.), Psychiatric nursing: A comprehensive reference (2nd ed.) (pp. 102-108). Philadelphia: Lippincott.

Teaching Kids to Cope Implementation Manual

Yalom's therapeutic factors for group therapy. (2009).

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
1.8 2.0 1.8 1.8

Dissemination Strengths

The manual provides basic information on the content and flow of the group sessions, and selected readings convey general information about group therapy, such as the skills and competencies required by leaders, typical phases of treatment, and assessment and selection of participants. The required training covers the content in the readings and gives a good overview of group treatment. Telephone consultation and coaching also are available through the developer. Depression and coping measures are included to support outcome measurement. A group leader checklist provides tips about the group leader's roles during the sessions and can contribute to implementation fidelity.

Dissemination Weaknesses

The manual provides very little specific guidance for the implementation of the intervention, omitting essential information on preparing and facilitating this intervention in a group setting. The information in the selected readings is not specific to the intervention. The manual outlines the didactic presentations for each group session, but no script or further detail is included in the manual or the training. The training includes little information on the content and process of this intervention beyond the first session. There is no guidance for administering the quality assurance tools that are included or for using the information collected with them. No tool is provided to measure implementation fidelity, and there is little discussion about the role of supervision in promoting fidelity.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
1-day, on-site training (includes five implementation manuals, rights for use and duplication, and ongoing technical assistance) $1,000 plus travel expenses Yes
Additional implementation manuals $15 each Yes
Replications
Contact Information

To learn more about implementation or research, contact:
Kathy Puskar, Dr.P.H.
(412) 221-8331
Krp12@pitt.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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