CRITIQUE OF RESEARCH ARTICLE

Critique of Research Article

Alicia Marchini
University of Calgary

CRITIQUE OF RESEARCH ARTICLE

Critique of Research Article

Introduction
The article, Anxiety in Children: Remote Area Sensitivities and Considered
Changes in Structuring a Cool Kids Approach, by Michael Davies (2011), examined the
practicality of adapting Cool Kids, a mainstream anxiety treatment program, for
Aboriginal children in a remote location.
Methodology
Cool Kids was selected because of its strong research foundation and its
flexibility to be adapted to different settings and formats. A systematic literature review
was conducted through Scopus, PEP, and PubMed using the search words, anxiety,
depression, Indigenous, and Aboriginal Australian. The search results accumulated
253 articles and eight books; however, only 20 of these sources offered direction for this
project. Only factors that were regarded as phenomenological differences to the
mainstream were considered in the article.
Literary Review and Results
The phenomenological difference of helplessness was a mainstream difference;
however, due to the cultural history of colonization for the Indigenous people,
helplessness is a prominent issue. According to Davies, literature suggested that anxiety
in the Aboriginal population is typically presented in externalized projections, instead of
internalized. As such, external symptoms and behaviours, such as somatization, may be
overt displays of anxiety, and this should be considered in the development of
interventions. This was evident in the Longitudinal Aboriginal Birth Cohort Study, as it
examined somatic symptoms, including dizziness, indigestion, and trouble breathing.

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Sadness was strongly correlated with anxiety in the sample of this study, which is a
finding that was not reproduced in mainstream populations. Another study indicated that
mood and external projects are not consistently related to feelings in the mainstream
population; however, in Aboriginal peoples, they are more closely linked to feelings.
According to this study, appropriate intervention strategies include cultural approaches
through activity challenges that are culturally sensitive and involve a connection to the
land, art, and play. Other literary works offer similar suggestions, such as cultural
narrative, establishing a sense of purpose, reestablishing ancestral memory, and
restorative education. According to the article, Davies asserts that these literary findings
and considerations are evident in the interactive sections of the adapted Cool Kids
program. The consideration of the issue of helplessness, as well as the inclusion of
culturally sensitive approaches, activities, and narratives, contribute to the strength of the
program for use in remote, Indigenous areas.
In regard to process of interventions in remote areas with populations that
emphasize traditions, like the Aboriginal peoples, it is important to establish relationships
and trust because this will adhere to cultural protocol and respect traditions. The literature
indicates that narrative approaches are accepted more in yarning circles and mens and
womens groups in Indigenous communities because these groups offer a familiar space
to share knowledge. According to Davies, Cool Kids is flexible enough to be adapted to
settings such as these, while adhering to its core structure and targets. Ultimately, the
extensive literary research illuminated necessary components of intervention plans in
Indigenous communities, which were identified in the Cool Kids program. In this regard,

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Cool Kids is a suitable program for such settings and cultures because of its flexibility
and adaptability to Aboriginal communities and activities.
Suggestions for Improvement
Despite the programs strengths, there are challenges that accompany the
implementation of Cool Kids in Indigenous settings. For instance, it is difficult to
effectively manage and address the externalization of blame. As well, literature also
revealed that it is important to understand how a sense of self differs in Aboriginal
populations in that it is socially expressed differently than in European cultures. This is
likely the case because Aboriginal peoples engrain dreamtime stories about plants,
animals, the land, and all other things in the sensory world in the children of their
population. As such, everything has its own story, from the Indigenous perspective, and
therefore, Aboriginal children form different thought processes that are more external,
compared to children in mainstream society. This provides evidence for the influences of
tradition on Aboriginal children and the importance of considering this in the adaptation
of Cool Kids, which is a valuable suggestion for improvement. Also, the influence of
modernity on Aboriginal children is another issue that must be taken into account in its
adaptation and implementation. For example, the importance of the extended family is a
factor that may need to be considered. Ultimately, the need to consider these complexities
provides reason to embark on extensive consultation of cultures and remote settings in
which any standard program will be implemented. As a result, time extensions in the
implementation of the program may be required. Moreover, further research is necessary
to evaluate the effectiveness of the adapted program as it is implemented in Aboriginal
communities.

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Conclusions
The findings of the theoretical exploration of anxiety in remote and Indigenous
communities have been applied to the Cool Kids program to evaluate its suitability for
such areas. As a result, Cool Kids can be deemed an appropriate program because the
fundamental considerations of cultural sensitivity and trust are included in the adapted
Cool Kids program or can be incorporated due to its flexibility. However, further research
is necessary to explore its effectiveness in remote, Aboriginal communities.

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Reference
Davies, M. (2011). Anxiety in children: remote area sensitivities and considered changes
in structuring a Cool Kids approach. Australasian Psychiatry, 19, S23-S25.
doi:10.3109/10398562.2011.583055

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Critique of Research Article

Introduction of Program and Literary Review
In Australia, about 2000 suicides occur each year. Research indicates that at least
six people will be impacted by each of those suicides; however, many more may be
affected. Suicide bereavement can be more complicated than the typical grief process, as
it can be prolonged (i.e., ranging from three to five years) and is accompanied by a
greater risk of suicide. Although there are many different types of interventions for
suicide bereaved people, including support groups, grief therapy, and crisis intervention
services, research support is limited. However, their effectiveness appears to be
dependant on the relationship to the departed and the time since the death.
StandBy Response Service is a suicide bereavement intervention program that
operates in nine locations across Australia. In this program, clients are given unlimited
face-to-face and telephone support by a team of crisis response professionals at any time
after the loss. A case management plan, referring clients to community programs that are
relevant to their needs, is also created. Overall, Standby is based on modern crisis
intervention theories and strategies, thus contributing to the strength of the program.
However, the services provided to each individual client can vary considerably,
depending on their specific needs and the availability of services in the surrounding area.
The current study evaluated the effectiveness of the StandBy program in terms of its
ability to improve the health and social situations for the suicide bereaved.
Methodology
The Griffith University Human Research Ethics Board approved this retrospective
cross-sectional study. It compared former participants of the StandBy program between

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June 2009 and March 2011 and suicide bereaved individuals who have not yet begun the
program. These control group participants were recruited from advertisements in national
newspapers and social media, and all participants were over 18 years of age. Moreover,
the cases of those from the intervention program were coordinated with those who had
not yet begun the program in terms of the time since the suicide and the relationship to
the departed person. Also, in terms of measurement tools, the demographics and outcome
instruments included questionnaires and scales to measure quality of life, psychological
distress, suicidality, and work performance. In addition to these measures, health care
usage was measured by noting the number of medical visits participants made over the
previous four weeks.
Due to the lack of randomization for control groups and the observational,
subjective nature of the study, bias may be reflected in the results. As such, the results
may not be generalizable to all those who are bereaved by suicide. However, due to the
risk factors for detrimental health outcomes and suicide, an observational design was
most appropriate because it ensured the safety and wellbeing of participants.
Additionally, it is important to note that the use of external bereavement support was not
measured in this study, which indicates that results may be influenced by confounding
variables (e.g., participant use of other support or treatment programs).
Results
The results indicated that the StandBy program participants scored slightly higher
and consistently better than the control group in terms of psychological distress,
suicidality, and quality of life. However, suicidality was the only difference of statistical
significance. Further statistical analysis showed that, although both the intervention and

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control groups showed high levels of suicidality, the StandBy participants were
significantly less likely than the control group to be at high risk. Moreover, the StandBy
participants had a greater reduction in days that they were unable to perform their regular
duties (i.e., work and daily activities) as well as a greater reduction in visits to health care
professionals, compared to the control group.
Conclusions and Suggestions for Improvement
Ultimately, the results of the study indicate that the program effectively reduced
the risk level of suicide for those who are bereaved by suicide. This outcome is of
immeasurable value, as it suggests that program participants are less likely to end their
own lives. Moreover, this outcome supports previous literary research that suggests that
intervention support can be helpful in preventing additional suicides after enduring a loss.
Furthermore, the study results suggest that the StandBy program may lead to positive
results in terms of improving the ability to complete daily activities and reducing the need
to seek health care services. Due to the fact that these results are not statistically
significant, several areas of improvement can be suggested in regard to the improvement
of daily functioning for the suicide bereaved. For example, crisis response professionals
of StandBy should initiate personal contact (i.e., face-to-face- and telephone support)
with the bereaved client, rather than simply being available for the client to reach out for
support. Also, the crisis response professionals should follow up on the clients case
management plan to ensure that the client is seeking the necessary help and to make
appropriate adjustments in the plan to accommodate the changing needs of the client.
Overall, due to the limitations of the study, it can also be argued that further research on
the strength and effectiveness of StandBy is necessary to evaluate the program.

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Reference
Visser, V. S., Comans, T. A., & Scuffham, P. A. (2014). Evaluation of the effectiveness
of a community-based crisis intervention program for people bereaved by suicide.
Journal of Community Psychology, 42(1), 19-28. doi:10.1002/jcop.21586