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Teaching Kids to Cope

Blueprints Program Rating: Promising

A classroom-based intervention designed to reduce depression and stress by enhancing coping skills in late adolescence and early adulthood.

Program Outcomes

  • Depression

Program Type

  • Cognitive-Behavioral Training
  • School - Individual Strategies
  • Skills Training

Program Setting

  • School

Continuum of Intervention

  • Selective Prevention (Elevated Risk)
  • Indicated Prevention (Early Symptoms of Problem)


  • Late Adolescence (15-18) - High School
  • Early Adulthood (19-22)


  • Male and Female


  • All Race/Ethnicity


  • Blueprints: Promising
  • SAMHSA: 3.7

Program Information Contact

Kathryn Puskar, Ph.D.
415 Victoria Building
3500 Victoria St.
Pittsburgh, PA 15261
Phone: (412) 624-6933

Program Developer/Owner

  • Kathryn R. Puskar
  • University of Pittsburgh

Brief Description of the Program

Teaching Kids to Cope (TKC) is a 10-session psychoeducational group intervention designed to reduce depressive symptomatology and stress by enhancing the coping skills of adolescents. Each session lasts 45 minutes. 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. The TKC program focuses on behavioral techniques but also incorporates cognitive components. The behavioral techniques aim to improve coping skills, which include activity planning, social skills training, assertiveness training, bibliotherapy, role-playing, conflict resolution, and relaxation training. The TKC incorporates experiential exercises such as trust-fall, buddy assignments, and role-playing situations from school and home. Art is incorporated into the sessions through drawing exercises. The cognitive components employ techniques such as externalization of negative voices, reframing, establishing idiosyncratic meaning, and cognitive rehearsal.

To improve access to the treatment for high school students seeking help, this intervention is offered during regular school days. Eligible students should score in the mid-range (at least 60) on the Reynolds Adolescent Depression Scale (RADS). The intervention is implemented by a psychiatric nurse in collaboration with the school nurse or guidance counselor.

See: Full Description


The evaluations of Teaching Kids to Cope demonstrated the following significant program effects, comparing the intervention to the control group:

  • Short-term decrease in depressive symptoms (Puskar et al., 2003; Hamdan-Mansour et al., 2009) and stress levels (Hamdan-Mansour et al., 2009).
  • Decrease in depressive symptoms for female intervention participants (Lamb et al., 1998).

Significant risk and protective factors include:

  • Increase in the use of beneficial coping strategies (seeking guidance and support, Puskar et al., 2003; seeking social support, planful problem solving, positive reappraisal, Hamdan-Mansour et al., 2009; supportant coping style, Lamb et al., 1998) and decrease in avoidance coping behavior (escape-avoidance, Hamdan-Mansour et al., 2009).

Race/Ethnicity/Gender Details

The first two studies and the adaptation study (Puskar et al., 2003; Hamdan-Mansour et al., 2009; Puskar, Ren, & McFadden, 2015) conducted no subgroup analysis. Puskar et al. (2003) evaluated the program with a sample of predominantly white (99%), female (82%) adolescents. However, similar program effects were observed by Hamdan-Mansour et al. (2009) with a gender-balanced sample (55% males; 45% females) of Jordanian college students. In the Lamb et al. (1998) study, female intervention participants had a significant decrease in depressive symptoms compared to female control participants at posttest. No effect of the program was found for male students.

Risk and Protective Factors

Risk Factors
  • Individual: Stress*
Protective Factors
  • Individual: Coping Skills*, Problem solving skills*, Skills for social interaction

*Risk/Protective Factor was significantly impacted by the program.

See also: Teaching Kids to Cope Logic Model (PDF)

Training and Technical Assistance

Group leaders of TKC (master's-level nurses with psychiatric mental health experience including group therapy and adolescent work) will be trained in group skills such as facilitating communication, adolescent behavior, and content of each TKC session. The training will consist of viewing videotapes on Conducting Groups with Adolescents, Yalom (Expert on Group Therapy) Principles of Group Therapy, Adolescent Development, and establishing rapport issues of working with adolescents. Several articles on facilitating adolescent groups will be provided. Training is one day (8 hours) at a cost of $1,000 plus travel expenses, for up to 16 participants.

Brief Evaluation Methodology

All three evaluations of Teaching Kids to Cope employed similar study designs (Puskar et al., 2003; Hamdan-Mansour et al., 2009; Lamb et al., 1998). The studies employed a randomized controlled trial design with subjects having high scores on depression measures. While Puskar et al. (2003) recruited study subjects from three rural high schools located in the southwestern region of Pennsylvania, Hamad-Mansour et al. (2009) recruited the study sample from the University of Jordan and Lamb et al. (1998) recruited study subjects from one rural high school. All three studies employed small sample sizes of n=89 (Puskar et al., 2003), n=84 (Hamdan-Mansour et al., 2009) and n=46 (Lamb et al., 1998). The consented subjects were randomly assigned to the intervention (n=46, Puskar et al.; n=44, Hamdan-Mansour et al.; n=27, Lamb et al.) or the control group (n=43, Puskar et al.; n=40, Hamdan-Mansour et al.; n=19, Lamb et al.). Nurses with psychiatric mental health experience administered the intervention in small groups with group sessions lasting about 45 minutes. Subjects were evaluated at baseline (during the screening procedure), and at posttest (approximately 10-12 weeks following screening). While Puskar et al. (2003) evaluated true long-term effects (6-month and 12-month follow-ups), Hamdan-Mansour et al. (2009) conducted a follow-up assessment only 3 months after posttest. Lamb et al. (1998) conducted no follow-up beyond posttest. In addition to the core intervention, Puskar et al. (2003) administered a booster session 9 months after posttest to a random sample of 20 (43%) intervention group subjects.

An evaluation of the aggression-focused adaptation of the program (Teaching Kids to Cope with Anger; Puskar, Ren & McFadden, 2015), not certified by Blueprints, also used a randomized controlled trial, with participants assessed at baseline, posttest, and at 6- and 12-month follow-up. Rather than selecting subjects with already high baseline scores on the outcome, all non-special education freshman and junior students demonstrating English competency at 3 participating rural Midwestern high schools were eligible. Of 179 youth consenting, 160 (89%) were retained through the 12-month follow-up.


Hamdan-Mansour, A. M., Puskar, K., & Bandak, A. G. (2009). Effectiveness of cognitive-behavioral therapy on depressive symptomology, stress and coping strategies among Jordanian university students. Issues in Mental Health Nursing, 30, 188-196.

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.

Puskar, K., Lamb, J., & Tusaie-Mumford, K. (1997). Teaching Kids to Cope: A preventive mental health nursing strategy for adolescents. Journal of Child and Adolescent Psychiatric Nursing, 10(3), 18-28.

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.

Puskar, K. R., Ren, D., & McFadden, T. (2015). Testing the ‘Teaching Kids to Cope with Anger’ youth anger intervention program in a rural school-based sample. Issues in Mental Health Nursing, 36, 200-208.