ACQ_Vol_11_no_3_2009

Mental health

Clinical insights Kool Kids Positive Parents: A school-based early intervention and prevention program for children with challenging behaviour and emerging conduct disorder Suzanne Lim

In this paper, the Kool Kids, Positive Parents (KKPP) program, which provides school-based consultation and programs for young children with behavioural problems, is described. The rationale, background and development, levels of intervention and outcomes are outlined. Rationale Childhood behavioural problems such as defiance, tantrums and arguing with adults are fairly common especially when children are hungry, tired, upset or stressed. Sometimes these behaviours can be a temporary reaction to stress, such as a family crisis or an important transition, such as going from kindergarten to school. However, when these problems are chronic and impact on the child’s social, emotional or academic development, these children may be at risk of developing more persistent or serious behavioural problems, such as oppositional defiant disorder (ODD), or conduct disorder (CD) (American Academy of Child and Adolescent Psychiatry [AACAP], 2009; for definitions of these disorders visit http://www.mentalhealth.com/p20-grp.html). Research has shown that approximately 67% of children diagnosed with ODD who receive treatment are symptom free after three years, yet approximately one-third go on to develop CD. Adolescents with CD have significantly higher rates of comorbid psychiatric conditions, such as anxiety and depressive disorders and are more likely to engage in concurrent substance abuse. Thus, the long-term outcomes for children with persistent behavioural difficulties can be poor, and even less optimistic if there is an early onset of symptoms, or if those symptoms are severe such as persistent aggression towards others (AACAP, 2007). It is therefore not surprising that a key approach to working with children with behavioural problems is prevention and early intervention. Schools are an ideal place to deliver programs to groups of children, to their parents and to provide support to school staff. The Incredible Years program, for example, provides parents of young children with conduct problems support and education, while the children receive group training in social skills, emotional regulation and conflict resolution skills (Webster-Stratton & Reid, 2003). Background and development KKPP, based at Eastern Health Child and Adolescent Mental Health Service (CAMHS), Melbourne, started in May 2004 as

one of two 3-year pilot projects. It was initially funded by the Victorian Department of Human Services, Mental Health Branch (DHS MHB) and aimed to provide early intervention and prevention of conduct disorder. 1 There was great excitement when this pilot project was announced, as it was one of the first of its kind in mental health to provide a school-based early intervention approach. The project brief described a multi-level, multi-pronged approach to be implemented at schools together with school staff, thus providing a vehicle for collaboration between the health and education sectors. While the project brief provided the overall guidance and framework, it was up to the KKPP team leader and multidisciplinary staff to develop and implement the project. The first KKPP groups for children and parents targeting problematic behaviour were implemented in six pilot schools in second semester of 2004. During 2005, further components such as teacher training and classroom programs were developed while running the program in more schools. At the end of that year, KKPP was the recipient of the Victorian Healthcare Award for Innovations in Models of Care. By mid-2006, when the combined CAST and KKPP project evaluation had been completed (Brann, Corboy, Costin, McDonald, Hayes, & Turner, 2007), the Vic DHS MHB awarded recurrent funding to both projects. Levels of Intervention There are three main components: 1) universal prevention : school-based professional development and building of social emotional skills for all children, 2) targeted early intervention : parent groups and child groups aimed to support children already showing signs of challenging behavior, and 3) indicated early intervention: for those children who require additional or a more individualised focused approach (see table 1). Universal prevention The KKPP’s aims at the universal prevention level are to build awareness and knowledge in schools and communities about severe behavioural disorders, such as ODD and CD, and about the importance of early identification and intervention. At a broader level this includes links with community agencies, and presentation at conferences as well as linking in with the media. At the primary school level this includes professional development to all the school staff about behaviour disorders, associated behavioural and developmental problems and management strategies.

Suzanne Lim

1. The other project, Cool at School Together (CAST) is based in the Grampians (in rural western Victoria).

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ACQ Volume 11, Number 3 2009

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