This Mentored Research Scientist Development Award (K01) will provide the applicant with skills to pursue an independent program of research to ultimately improve treatment for children with anxiety disorders in primary care settings. This award will be pursued within the context of the San Diego Child and Adolescent Services Research Center and the University of California San Diego where the candidate's sponsor will be Dr. Ann Garland and co-sponsor, Dr. Murray Stein. This award will allow the applicant to build on strong existing training in child anxiety and treatment outcome research. The applicant is seeking new training and experience in mental health services research to address critical issues related to service engagement (e.g., initial uptake and ongoing use of services) in order to advance effectiveness studies for traditionally underserved populations, namely those with anxiety disorders and Latino youth. The proposed training plan includes coursework and mentoring in: 1) theoretical and empirical models of health services research, 2) service utilization in Latinos, 3) qualitative methodologies, 4) service engagement and effectiveness intervention strategies, and 5) multilevel and longitudinal data analysis. The primary goal of the proposed research is to identify child and parent factors that affect service engagement and to use this information to adapt and pilot test an evidence based child anxiety intervention in the primary care setting. A secondary goal is to examine factors that affect engagement for Latino families. The research plan relies on a mixed method approach including qualitative and quantitative strategies. Participants will be recruited from pediatric primary care settings. Qualitative interviews will be conducted with 30 parents of anxious youth with met and unmet treatment need. A quantitative study with 150 families of anxious youth will also be used to identify predisposing, enabling, and need characteristics that influence engagement. Equipped with parent perspectives about barriers to care, a child anxiety treatment will be adapted to include engagement strategies and to be feasible in primary care. Families of anxious youth (N= 26) will be randomized to receive an evidence based anxiety intervention with engagement strategies or supportive therapy (N = 26). Data regarding functional and symptom improvement, treatment acceptability, initial uptake and adherence will be used to design and parameterize a larger effectiveness trial for child anxiety disorders in primary care.
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