Feasible Delivery of CBT for Rural Latino Youth with Anxiety

描述（由申请人提供）：患有焦虑症的儿童的特点往往是未满足的治疗需求，然而，在拉丁美洲和农村青年等特殊人群中，文化和地理隔离的影响加剧了这种差异。更具体地说，与语言、耻辱和获得有关的障碍往往导致需要心理健康服务的儿童的利用率较低，结果较差（Alvidrez和Azocar，1999年; McCabe等人，2002; Myers等人，2008; Vega等人，2001年）。这些发现是令人失望的，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; Beidel等人，2007; Kendall & Southam-Gerow，1996; Walkup等人，2008年）。努力研究可行的方法，为焦虑症儿童提供循证治疗是至关重要的，以便将优质护理扩展到服务不足的群体。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（酷孩子外展计划;莱纳姆和Rapee，2006年），以适应讲西班牙语的农村家庭的需求，并检查使用不同的交付模式实施这种干预的可行性，可接受性，耐受性和安全性。定性方法，其中包括重点小组与双文化和双语心理健康服务提供者和个别访谈与农村拉丁裔父母将被用来检查干预的可接受性和文化的适当性。利用这些研究结果和其他现存的文献，一个由文化适应框架（刘，2006年）指导的专家小组将确定酷孩子外展计划的必要性。接下来，对患有焦虑症的儿童（8-13岁）进行了一项试点研究（即，分离焦虑症、广泛性焦虑症、社交焦虑症和特定恐惧症），40名儿童将被随机分配到两种服务提供模式，这两种服务提供模式代表了不同程度的治疗师接触：1）20个家庭将被随机分配到基于电话的、治疗师支持的CBT计划; 2）20个家庭将被随机分配到一个更小的接触bilbiotherapy条件（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机构招募。将在基线、治疗中期和治疗后测量可行性和临床结局。此外，在离职面谈期间，参与者（以及那些可能已经退出该计划的人）将被要求讨论干预措施的感知有用性，可接受性和影响。这项试点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，以及试点程序的机会，这些程序将用于农村拉丁美洲青年的更大有效性试验。 公共卫生相关性：这一R34提案将纳入家庭和社区精神卫生服务提供者的观点，以根据需要量身定制儿童焦虑症的循证治疗，以满足难以接触的群体（即，拉丁美洲青年）。试验研究将探讨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，和一个更密集的治疗师支持，基于电话的方法），最终可能会改善获得证据为基础的治疗和心理健康结果的服务不足的群体。这些发现最终将为一个更大的研究项目提供信息，该项目将重点关注焦虑症儿童的有效性和传播工作，使用允许心理健康护理个性化的服务提供方法。

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.