Feasible Delivery of CBT for Rural Latino Youth with Anxiety

描述(申请人提供)：患有焦虑症的儿童的特点往往是治疗需求得不到满足，然而，在拉丁裔和农村青年等特殊人群中，这种差异因文化和地理隔离的影响而加剧。更具体地说，在需要心理健康服务的儿童中，与语言、污名和获取途径有关的障碍往往导致使用率较低和结果较差(Alvidrez和Azocar，1999年；McCabe等人，2002年；Myers等人，2008年；Vega等人，2001年)。这些发现令人失望，因为有大量数据支持认知行为和行为疗法对患有焦虑症的儿童的有效性(Barrett等人，1996；Bedel等人，2007；Kendall&Southam-Gerow，1996；Walkup等人，2008)。努力研究向焦虑症儿童提供循证治疗的可行方法，对于将高质量的护理扩展到服务不足的群体至关重要。R34的目标是解决这些差异，通过翻译和定制现有的儿童焦虑认知行为治疗计划(Cool儿童外展计划；Lyneham和Rapee，2006)，以适应说西班牙语的农村家庭的需求，并检查使用不同交付方式实施这种干预的可行性、可接受性、容忍性和安全性。将使用定性方法，包括与两种文化和双语精神保健提供者的焦点小组，以及对农村拉丁裔父母的个别访谈，以审查干预措施的可接受性和文化适当性。利用这些发现和其他现有文献，一个由文化适应框架(Lau，2006)指导的专家小组将确定在多大程度上有必要为酷孩子外联计划量身定做。接下来，将对患有焦虑症(即分离性焦虑症、广泛性焦虑症、社交焦虑症和特殊恐惧症)的儿童(8-13岁)进行一项试点研究，40名儿童将被随机分为两种服务提供模式，这两种模式代表了不同程度的治疗师接触：1)20个家庭将被随机分到基于电话的、治疗师支持的CBT计划；2)20个家庭将被随机分到更少的接触性双边治疗条件下(主要是CBT自助材料)。鉴于其事实上的精神卫生服务状况，所有家庭都将从初级保健环境中招募。可行性和临床结果将在基线、治疗中期和治疗后进行评估。此外，在离职面谈期间，参与者(以及那些可能已经退出项目的人)将被要求讨论干预措施的感知有用性、可接受性和影响。这项试验性研究将提供有关干预条件的可行性、可接受性、耐受性和安全性的重要数据，以及试验程序的机会，这些程序将用于在农村拉美裔青年中进行更大规模的有效性试验。 公共卫生相关性：R34提案将纳入家庭和社区精神卫生提供者的观点，根据需要量身定做儿童焦虑症的循证治疗，以满足难以接触到的群体(即拉美裔农村青年)的需求。试点研究将考察新的服务提供模式的可行性(例如，最少的治疗师接触，自助计划，以及更密集的治疗师支持的电话方法)，最终可能改善服务不足群体获得循证治疗和心理健康结果的机会。这些发现最终将为一个更大的研究项目提供信息，该项目的重点是焦虑症儿童的有效性和传播努力，使用允许个性化心理健康护理的服务交付方法。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.