Treating Youth and Young Adults Diagnosed with Anxiety: Quality Improvement Assessment of Remotely Delivered Intensive Outpatient Programing (Preprint)
Authors: Evans-Chase Michelle , Berry Katie , Gliske Kate , Solomon Phyllis , Fenkel Caroline 
Published: June 2023

BACKGROUND

Clinical anxiety is the most common mental health disorder experienced by youth and young adults and one associated with poor physical, psychosocial, and educational outcomes. Those who seek treatment face multiple barriers to care, particularly youth under the age of 18 and those from minoritized gender and sexual orientation communities. Intensive Outpatient Programming (IOP) is one treatment model for youth with more complex mental health needs that may be well suited to treat clinical anxiety. Delivered remotely, it may also help to address barriers and enable programs to deliver treatment that is not limited by the clinical expertise of local populations.

OBJECTIVE

The objective of the quality improvement (QI) analysis reported here was to assess changes in anxiety among youth and young adults attending a remote intensive outpatient program. QI efforts are conducted as part of regular program procedures for monthly stakeholder reports and to inform clinical and programmatic decisions.

METHODS

The Generalized Anxiety Disorder (GAD-7) scale is used as part of ongoing QI efforts to assess changes in anxiety between intake and discharge. Repeated measures t-tests were used in this analysis to test changes in anxiety between intake and discharge and paired chi-square tests were used to test changes in clinical symptoms. One-way ANOVA and independent t-tests were employed to test differences among groups defined by age, gender, and sexual orientation. For the current analyses, N=516 cases were selected using criteria that included an age limit of 25 years, a diagnosis of anxiety and a minimum of 18 hours of treatment

RESULTS

Clients ranged in age from 11 to 25 (M=16 years, SD=3.64). Over a third were female (39%), 22% were male, 20% were gender expansive and 21% were transgender; 51% identified as a member of an LGBQ+ community and 28% identified as heterosexual or straight. Anxiety scores were, on average, 5½ points lower at discharge [t477=-19.69, P<.001], equating to a large effect (Cohen’s d = -0.90). Of the n=262 clients who reported moderate to severe symptoms at intake, 68% crossed the clinical threshold to minimal to mild symptoms at discharge [McNemar X2 (N=409), P<.001]. There were no significant differences among groups defined by age [F2,474=0.92, P=.40], gender [F7,377=0.76, P=.62] or sexual orientation [F7,366 =0.31, P=.95], nor was there a difference between transgender and cisgender clients [t382=-0.36, P=.72].

CONCLUSIONS

These findings suggest that IOP delivered remotely may be an effective way to treat clinical anxiety in youth and young adults presenting with complex mental health needs. Capitalizing on the opportunities offered by the remote platform to deliver treatment plans responsive to unique intersections of developmental, identity, and diagnostic needs may help to ensure equivalent treatment outcomes among youth with a variety of needs and from varied demographic groups.

CLINICALTRIAL

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