Children with anxiety disorders are often characterized by an unmet need for treatment however, in special populations such as Latino and rural youth, such disparities are compounded by the effects of culture and geographic isolation. More specifically, barriers related to language, stigma, and access often lead to lower rates of utilization and poorer outcomes among children in need of mental health services (Alvidrez and Azocar, 1999;McCabe et al., 2002;Myers et al., 2008;Vega et al., 2001). These findings are disappointing given abundant data supporting the effectiveness of cognitive behavior and behavior therapies for children with anxiety disorders (Barrett et al., 1996;Beidel et al., 2007;Kendall &Southam-Gerow, 1996;Walkup et al., 2008). Efforts to examine feasible methods to deliver evidence-based treatments to children with anxiety disorders are critical in order to extend quality care to underserved groups. The goal of this R34 is to address these disparities, by translating and tailoring an existing child anxiety cognitive behavior therapy program (The Cool Kids Outreach Program;Lyneham and Rapee, 2006), to fit the needs of Spanish-speaking rural families and examining the feasibility, acceptability, tolerability and safety of implementing this intervention using varying modes of delivery. Qualitative methodologies which include focus groups with bicultural and bilingual mental health providers and individual interviews with rural Latino parents will be used to examine the acceptability and cultural appropriateness of the intervention. Using these findings and other extant literature, an expert panel guided by a cultural adaptation framework (Lau, 2006), will determine the extent to which tailoring of the Cool Kids Outreach Program is necessary. Next, a pilot study for children (age 8-13) with anxiety disorders (i.e., separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, and specific phobias) will be conducted and 40 children will be randomized to two service delivery modes which represent varying levels of therapist contact: 1) 20 families will be randomized to a telephone-based, therapist- supported CBT program, and;2) 20 families will be randomized to a more minimal contact bilbiotherapy condition (primarily CBT self-help materials). All families will be recruited from primary care settings, given its defacto mental health service status. Feasibility and clinical outcomes will be measured at baseline, midtreatment and post-treatment. Additionally, during exit interviews, participants (as well as those who may have dropped out of the program) will be asked to discuss the perceived usefulness, acceptability, and impact of the intervention. This pilot study will provide important data regarding the feasibility, acceptability, tolerability and safety of the intervention conditions as well as the opportunity to pilot procedures that will be used in a larger effectiveness trial with rural Latino youth.
This R34 proposal will incorporate the perspectives of family and community mental health providers, to tailor, as necessary, an evidence based treatment for child anxiety disorders, in order to meet the needs of a hard-to- reach group (i.e., rural Latino youth). The pilot study will examine the feasibility of new modes of service delivery (e.g., a minimal therapist contact, self-help program, and a more intensive therapist supported, telephone-based approach) that may ultimately improve access to evidence based treatments and mental health outcomes among underserved groups. These findings will ultimately inform a larger program of research focusing on effectiveness and dissemination efforts for children with anxiety disorders, using service delivery approaches that allow for the personalization of mental health care.
|Camacho, Alvaro; Ng, Bernardo; Bejarano, Anabel et al. (2012) Crisis visits and psychiatric hospitalizations among patients attending a community clinic in rural Southern California. Community Ment Health J 48:133-7|
|Ramsawh, Holly J; Chavira, Denise A; Stein, Murray B (2010) Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. Arch Pediatr Adolesc Med 164:965-72|