Treatment Study for Rural Latino Youth With Anxiety
Condition: Anxiety Disorders; Separation Anxiety Disorder; Social Anxiety Disorder; Specific Phobia; Generalized Anxiety Disorder
MeSH terms: Anxiety Disorders; Phobia, Social; Anxiety, Separation
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      This pilot study will examine the feasibility of two modes of service delivery (e.g., a
      minimal therapist contact, self-help program, and a more intensive therapist supported,
      telephone-based approach) in a rural, primarily Latino, population. These modes of delivery
      may ultimately improve access to evidence based treatments and mental health outcomes among
      underserved groups.
    

Detailed description: 
      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.

      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 bibliotherapy 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.
    

Intervention name(s): Therapist-Assisted by Telephone; Self-Help
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Parents will receive educational workbooks and ongoing support over the phone from a child anxiety specialist to learn how to use cognitive behavioral therapy skills to manage their children's fears and worries.; Parents will receive educational workbooks to learn how to use cognitive behavioral therapy skills to manage their children's fears and worries independently. Parents will have the option to access support over the phone from a child anxiety specialist.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: cognitive behavior therapy; telemedicine; rural; Latinos; children