Program Profile: Keep Cool...Start at School

This is a social, cognitive–behavioral treatment program that targeted children ages 8 to 12 who exhibited disruptive or aggressive behavior and conduct disorder. The program is rated Ineffective. Overall, the evidence from the evaluation found that students who participated in the intervention did not statistically significantly differ from those students in the waitlist control group on measures of conduct disorder, oppositional defiant disorder, and externalization of behaviors.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

Keep Cool...Start at School is a cognitive–behavioral treatment (CBT) program that focused on the processing of social information in children. The intervention targeted children ages 8 to 12, who exhibited disruptive or aggressive behavior and conduct disorder in a school setting. Overall, the Keep Cool...Start at School intervention sought to reduce the occurrence of disruptive behaviors in a difficult-to-reach population.

Program Theory

Keep Cool...Start at School used the social information processing (SIP) framework developed by Crick and Dodge (1994) as the foundation of the intervention, which states that social information is processed in six steps (Step 1: encoding cues; Step 2: interpretation of cues; Step 3: clarification of goals; Step 4: response access or construction; Step 5: response decision; Step 6: behavior enactment). The steps include cues to identify behavior, ways to respond to decisions, and how to enact certain behavior (Liber et al. 2013; Crick and Dodge 1994). It is believed that aggression results from a deficit in one of these steps.

Program Activities

Keep Cool...Start at School was adapted from van Manen’s (2001) Self-Control Manual. The developers modified the protocol to reflect the population targeted (i.e., individuals from low-socioeconomic-status (SES) backgrounds, deprived neighborhoods, and ethnically diverse neighborhoods). Participation in the program was voluntary for families, and parents were required to give consent for children to participate.

The Keep Cool...Start at School intervention included 10 sessions. The first was an individual session and focused specifically on setting individual goals. The remaining 9 were group sessions and focused on the children’s social information processes and social skills that were targeted through CBT techniques, such as cognitive reconstruction, emotional education, role playing, positive reinforcement, and modeling. The CBT techniques were expressed through specific exercises that directly related to the needs of the families, including the use of characters that represented both types of behaviors exhibited by the targeted children. 

There were four characters included in the intervention exercises: Hot Harry, Hot Hester, Cool Kevin, and Cool Kim. These characters were designed as representatives of the youth culture in low-SES areas. Parents were also invited to attend a one-session parent meeting mid-intervention.

Study

Liber and colleagues (2013) studied the intervention effects of a cognitive behavioral treatment (CBT) program, using a school-based, randomized controlled trial method. The Keep Cool...Start at School program was administered during 3 consecutive school years at 17 different middle schools in low-to-middle socioeconomic status (SES) urban areas in the Netherlands. Students were randomly placed into the intervention or waitlist control group based on grade level; both groups comprised participants from grades 5–8. To be eligible for inclusion, students were screened by two teachers independently using the List Global Screening (LSG), a 6-item questionnaire that seeks to identify children that display symptoms of antisocial behavior. The scores from each teacher were combined to identify at-risk students, and these students were then selected to participate in the study. Of the students selected to participate (n = 280), parental consent was required and obtained for 224 students. The sample was further confined to include only students whose IQ was greater than 85, resulting in a final sample of 171 students. Students with an IQ below 85 were excluded from the study sample, as they were not expected to understand the cognitive content of the training administered.  The majority of the students were male (n = 136), low SES (n = 96), and self-identified as non-Western immigrants (n = 109), including those who identified as Turkish, Moroccan, and Afghan.

Students were randomly assigned to the intervention group (n = 70) or waitlist control group (n = 103).Students were assessed in time waves, ranging from wave 1(T1) to wave 4(T3). T1 included the screening, assessment, and selection to participate in the study, as described above. The intervention group received the treatment between time periods T2 and T3. The waitlist control group did not receive the treatment during this time. Data on pre–post changes between the intervention and waitlist control groups was collected at T3 (1 to 2 weeks after the intervention concluded).

The study focused on four outcomes: (1) conduct disorder; (2) oppositional defiant disorder; (3) externalization of behaviors; and (4) parent-report measurements. Four specific scales were used to collect data on the outcomes. The Teacher Report Form (TRF), a 113-item Likert scale used to assess behavior problems, focused on conduct disorder and oppositional defiant disorder in students. The Disruptive Behavior Disorders Rating Scale (DBDRS) assessed symptoms on a 4-point Likert scale, which focused on conduct disorder and oppositional defiant disorder. The Peer Measurement of Internalizing and Externalizing Behavior (PMIEB), a 22-item peer-nomination scale evaluating psychopathology in children, was used to analyze external behavior and body language. Finally, the Strengths and Difficulties Questionnaire (SDQ), which focuses on the parent’s perception of strengths and difficulties their children express, was measured through a rating of 25 items on a 3-point Likert scale. Parents rated children’s attributes such as emotional symptoms, conduct problems, peer relationships, and inattention problems (Goodman, 2001). No subgroup analyses were conducted.

All teachers were required to participate in five training sessions, either in Active Teacher Support (ATS) or Educational Teacher Support (ETS). Each session included information on social- information processing; the content of upcoming child-treatment sessions; and the role of parents and peers in the development, maintenance, and remission of disruptive behavior. In addition to the information included above, the ATS sessions also included instructions on contingency management; how to assist with the completion of workbook exercises; and classroom modeling of positive behavior.

Researchers analyzed the impact of both training sessions on the teachers’ ability to interact with their students, to see if one training approach would enhance the impact that the Keep Cool...Start at School program had on the students’ social adjustment. Both teacher measures were collected preintervention and postintervention, after the inclusion of the ATS and ETS to examine whether the differences between the two types of treatment were more effective after the intervention. Results showed there were no significant effects found in posttreatment for either group.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: