Cool Kiwi kids - a pilot group Cognitive-Behavioural Therapy programme for anxiety in primary-aged children

The Cool Kids programme is a highly effective cognitive behavioural therapy (CBT) protocol for childhood anxiety, which can be administered by psychologists to groups in school settings. Group therapy is efficient, with up to 10 children provided with treatment in the time usually required for one, it is cost-effective, and confers additional benefits such as role modelling and social skill support. A pilot intervention trial will be implemented in primary schools in Auckland, to test the efficacy, feasibility and acceptability of the Cool Kids programme.Trained Ministry of Education psychologists will deliver the groups within schools. In addition, the intervention will be delivered through Marinoto Child and Adolescent Mental Health (CAMHS) services, to groups of primary-aged children. With parent consent, 8–11-year-old children will complete anxiety assessments. Eligible children with moderate anxiety symptoms will be invited to participate in the intervention. Two trained clinicians will then provide the Cool Kids intervention for groups of approximately ten children, with additional sessions for parents (after child sessions 1 and 5). Two clinicians offer additional support for children, while ensuring fidelity to the structured initiative, and are best practice for trial purposes – though one alone can deliver the programme when needed. Clinical assessments will be repeated post-intervention, and after three months. Evaluation of efficacy and acceptability will incorporate input from children and parents, as well as clinicians and school leaders. Clinicians were trained in late 2025, by Distinguished Professor Ron Rapee, who developed the Cool Kids programme. D/Prof Rapee visited Auckland to provide this training in person in a workshop format, of eight hours in one day. Cool Kids workbooks will be used by clinicians, parents and children. Fidelity checklists will be included for clinicians, to monitor adherence to the weekly session components. Sessions will be provided to groups of children in person, and separately the parent sessions will be conducted with groups of parents in person. Ten weekly sessions of approximately 90 minutes each will be provided to children, and two sessions for parents. School delivery will take place within the children's primary schools, and clinic delivery at the CAMHS clinic location. Children will be referred by their teachers and/or parents, or through the CAMHS intake process. Eligibility will be decided through psychometric assessment, with 12 with elevated anxiety scores selected for each group. Psychometric assessments will be repeated six weeks later to ensure that only children with chronic/continuous anxiety (rather than reactive/temporary distress) are included. This also allows a within-subject symptom change comparison between six weeks without treatment, and the treatment period. Ineligible children, such as those without a primary anxiety presentation, and those who decline to be involved in the pilot, will be referred to treatment as usual with the Ministry of Education psychologists or CAMHS clinicians. Assessment of symptoms and functioning will be completed through psychometric questionnaires. The Revised Child Anxiety and Depression Scale (RCADS; Chorpita et al., 2000; Ebesutani et al., 2011) and Child Anxiety Life Interference Scale (Lyneham et al., 2013) will be completed by parents and children. The Strengths and Difficulties Questionnaire Goodman & Goodman, 2011) will be completed by parents and teachers. Teachers will also complete the School Anxiety Scale - teacher report (Lyneham et al., 2008). These are all well-established measures, with strong psychometric properties (validity, reliability, ensitivity and specificity). Each can be repeated to reliably demonstrate change, before and after the intervention, and triangulates data through multiple informants. These assessment tools have been widely used in past evaluations of children's anxiety interventions including Cool Kids, and provide a strong platform of evidence to evaluate programme outcomes. Outcomes will include clinical data about the efficacy of Cool Kids when delivered in a group format in NZ schools and CYMHS services, feasibility and acceptability findings from children, parents and school leaders, and insights into cultural acceptability for NZ. This will inform the next planned phases of the study and further grant applications, including potential cultural adaptations following Ecological Validity Model process previously used to adapt CBT programmes for Aotearoa and for Maori participants, and investigations of adaptations to delivery options to improve outcomes and cost-effectiveness, and randomised control trial (RCT) evaluation.