Transporting CBT for Childhood Anxiety Disorders into Inner-City School-Based Mental Health Clinics

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Abstract

The systematic expansion of evidence-based cognitive behavioral (CBT) protocols into the schools provides an opportunity for training front-line service providers in the early identification of anxious children and in the delivery of evidence-based treatments to children who might otherwise go without such treatment [Weist, M. D., & Evans, S. W. (2005). Expanded school mental health: Challenges and opportunities in an emerging field. Journal of Youth and Adolescence, 3, 3­6]. In this article, we discuss the progress of our ongoing study aimed at transporting manualized CBT for anxious youth into inner-city school-based clinics. In this context, we outline the rationale for the study and specific adaptations and obstacles encountered to date.

Section snippets

BCATSS: Study Description

The primary aim of BCATSS is to determine the feasibility and effectiveness of a school-based CBT, delivered by school-based clinicians, in reducing levels of anxiety symptoms among inner-city (predominantly African American) boys and girls (ages 7 to 12). More specifically, the study takes place in five public elementary schools in inner-city Baltimore, a low-income, high-crime, and predominantly African American community. The study is comprised of several stages. Stage 1 focuses on engaging

Rationale for Transporting CBT for Anxiety Disorders Into Schools

Several features unique to the school setting highlight the value of conducting treatment for anxious children in their schools. The school context is a primary setting in which anxiety-related problems occur. This is partly because school factors, such as teachers, peers, academic performance requirements, and school violence, contribute to and/or maintain anxiety symptoms. As a result, anxious youth may experience declines in their academic performance (Ialongo, Edelsohn, Werthamer-Larsson,

From Efficacy to Effectiveness: Strategies and Modifications

Successful treatment of childhood anxiety holds the hope of decreasing acute distress and altering the life trajectory of affected children. As noted, studies involving children and adolescents document the efficacy of CBT for children with GAD, SAD, SP, and SOP (e.g., Kendall et al., 1997, Pina et al., 2003). The next step is to evaluate the transportability of this treatment by assessing its effectiveness in community settings, with youth of diverse backgrounds, and delivered by non-CBT

Conclusion

The delivery of CBT to anxious youth in the school setting offers an opportunity to provide treatment to youth who may not otherwise receive services. The empirical literature provides preliminary evidence for the feasibility and effectiveness of school-based CBT interventions. The training of school-based clinicians to deliver CBT is a critical step toward the dissemination and sustainability of empirically supported treatments to community providers and the availability of such treatments to

References (49)

  • MasiaC.L. et al.

    School-based behavioral treatment for social anxiety disorder in adolescents: Results of a pilot study

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2001)
  • MifsudC. et al.

    Early intervention for childhood anxiety in a school setting: Outcomes for an economically disadvantaged population

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2005)
  • NealA.M. et al.

    What are African American children afraid of? A preliminary study

    Journal of Anxiety Disorders

    (1993)
  • OwensP.L. et al.

    Barriers to children's mental health services

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2002)
  • PinaA.A. et al.

    Exposure-based cognitive-behavioral treatment for phobic and anxiety disorders: Treatment effects and maintenance for Hispanic/Latino relative to European-American youths

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2003)
  • TreadwellK.R.H. et al.

    Ethnicity and gender in relation to adaptive functioning, diagnostic status, and treatment outcome in children from an anxiety clinic

    Journal of Anxiety Disorders

    (1995)
  • AddisM.E. et al.

    A national survey of practicing psychologists' attitudes toward psychotherapy treatment manuals

    Journal of Consulting and Clinical Psychology

    (2000)
  • AngoldA. et al.

    Psychiatric disorder, impairment, and service use in rural African American and white youth

    Archives of General Psychiatry

    (2002)
  • BarlowD.H.

    Evidence based practice: A world view

    Clinical Psychology: Science and Practice

    (2000)
  • BarrettP.M. et al.

    Family treatment of childhood anxiety: A controlled trial

    Journal of Consulting and Clinical Psychology

    (1996)
  • ChorpitaB.F.

    Modular cognitive-behavioral therapy for childhood anxiety disorders

    (2007)
  • CopelandV.C.

    African Americans: Disparities in health care access and utilization

    Health & Social Work

    (2005)
  • DaddsM.R. et al.

    Prevention and early intervention for anxiety disorders: A controlled trial

    Journal of Consulting and Clinical Psychology

    (1997)
  • FerrellC.B. et al.

    Assessment and treatment of socially phobic children: A cross cultural comparison

    Journal of Clinical Child and Adolescent Psychology

    (2004)
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    Preparation of this article was supported by a grant from the National Institute of Mental Health (R34 MH074552-01A2) awarded to the first author.

    1

    Now at Hobart and William Smith Colleges.

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