An Evidence-Based Practice


Developed in Australia, the program FRIENDS sought to reduce anxiety in elementary school students through a cognitive-behavioral treatment (CBT) that taught students both to avoid situations that induce anxiety and to handle anxiety once it has been induced. Psychologists adapted the FRIENDS program to help anxious African American elementary school students in Baltimore moderate stress induced by urban violence in local neighborhoods. FRIENDS employed group-based discussions and student art sessions during the school day to teach students to predict, avoid, and process violent situations. FRIENDS is an acronym which spells out the skills the children have learned, for example, R=Relax and S=Stay calm.

Baltimore public school teachers recruited agitated and anxious students into the program. Parental consent and participation were a necessary condition for participation in the FRIENDS program. The students completed homework packets and participated in 13 biweekly hour-long, small group sessions, where they learned problem-solving and coping skills, reinforced through role-playing. The program was led by a Johns Hopkins psychologist and carried out by instructors trained in the FRIENDS program. NIH and the National Institute on Drug Abuse funded the study.

Goal / Mission

The goal of FRIENDS was to teach cognitive-behavioral skills to reduce anxiety in elementary school students who are exposed to violence.

Results / Accomplishments

Ninety-eight third through fifth grade students were recruited from two public schools in economically-disadvantaged and urban neighborhoods of Baltimore. The children were randomized into either the intervention or control group. Students in both groups took pre-post assessments measuring their exposure to community violence, academic performance, and victimization due to violence. Both the intervention and control groups saw a reduction in their exposure to community violence and an increase in their reading proficiency (p<.01). The intervention group saw significant reductions in their life stressors and in their victimization due to violence as well as significant gains in their mathematical aptitude (p<.01) while the control group exhibited no such change.

About this Promising Practice

Primary Contact
Michele R. Cooley-Strickland
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
The Candler Building
111 Market Place, Suite 850
Baltimore, Maryland 21202
(410) 347-3203
Health / Children's Health
Health / Mental Health & Mental Disorders
Health / Prevention & Safety
Baltimore City Public School System, Johns Hopkins Bloomberg School of Public Health
Journal of Prevention and Intervention in the Community
Date of publication
Aug 2011
Geographic Type
Baltimore, MD
For more details
Target Audience
Children, Families, Racial/Ethnic Minorities