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160 ACQ Volume 11, Number 3 2009 ACQuiring knowledge in speech, language and hearing
Mental health
Suzanne Lim
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.
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 ).
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
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
1. The other project, Cool at School Together (CAST) is based in the
Grampians (in rural western Victoria).