Community violence is a major public health problem most visible in low-income, inner-city, predominantly ethnic minority communities. The public mental health impact of living in violent communities is significant, particularly for children. Most of the extant treatment and preventive interventions focus on the perpetrators of the violence, not on the youth who are its direct or indirect victims. Among the psychological correlates of community violence exposure are anxiety symptoms (e.g., fears, social withdrawal, intrusive thoughts, poor concentration, worry) and disorders (e.g., post-traumatic stress disorder, separation anxiety disorder). This is a request for a NIMH Pilot Effectiveness Trial for Mental Disorders Grant (R21) to support a 3- year pilot study of a school-based prevention and early intervention program with inner-city, primarily African American children at risk for anxiety disorders. This cognitive-behavioral intervention is based on the FRIENDS Anxiety Prevention Program that has demonstrated efficacy in reducing the rate of anxiety disorders and preventing the onset of new disorders in school samples of Australian children. Maintaining therapeutic integrity, the proposed project will broaden the FRIENDS target population by modifying the intervention to be culturally and contextually appropriate for inner-city ethnic minority youth exposed to community violence. Four-hundred 3rd-5th graders will be screened to identify those at risk for anxiety symptoms and disorders. 180 elementary school students from low-SES, high crime communities will be randomly assigned to either an anxiety prevention and early intervention group or a non-intervention comparison group. Child, parent and teacher assessments will be made at pre- and post- intervention, and 6-month follow-up. This project will contribute to the applicant's goal of studying and preventing the mental health effects of community violence by achieving the following aims: 1) To broaden the target population of an existing efficacious preventive and early intervention program from Australian children to inner-city, low-SES primarily African American children; and 2) To maintain the therapeutic integrity of the modified FRIENDS preventive and early intervention program among children from schools located in inner- city, high crime, low-SES communities. The results of this R21 project will facilitate the design and later implementation of a full-scale NIMH R01 preventive intervention effectiveness trial.
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