School-Based CBT for Anxious African-American Children

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DESCRIPTION (provided by applicant): This R34 proposal, submitted in response to PAR-03-078 (Intervention Development to Services/Exploratory Research Grant), addresses the needs of one of the most vulnerable and underserved populations in the United States-low income, inner city African American children. The primary aim of this research is to determine the feasibility and effectiveness of a school-based cognitive behavioral treatment (CBT), delivered by school-based clinicians, aimed at reducing levels of anxiety symptoms and disorders. Anxiety disorders are among the most prevalent childhood psychiatric disorders, with 2% to 19% of children affected. The high rates of these disorders indicate that excessive fear, worry, and anxiety in children is an emerging public health issue and effective, accessible treatments to alleviate the suffering of these children are needed. Evidence has accumulated over the past decade for the efficacy of CBT for children with anxiety disorders. Necessarily, attention has now turned to examining the "transportability" of these treatments by assessing their effectiveness in diverse contexts (e.g., schools, community mental health centers) with youth of diverse backgrounds, and delivered by non-CBT expert clinicians. This proposal addresses these key issues. This study uses a multi-stage approach to engage community stakeholders, refine research methods (e.g., assessments, intervention) to ensure their cultural relevance, train school-based clinicians, and assess feasibility of recruitment. The study culminates in a pilot randomized controlled trial (RCT) comparing the effectiveness of the manualized CBT treatment to a manualized attention support control (ASC) for 60 African American children in six elementary schools using a 2 (interventions: CBT versus ASC) x 4 (assessment period: pre and post-intervention and 6 and 12 weeks post treatment) design. Masked independent evaluators (IE) will conduct assessments of outcomes (along with child, parent, and teacher reports). Intervention adherence and quality assurance will be assessed via structured manuals, audiotaped sessions reviewed by lEs, and ongoing weekly supervision. The interventions will be conducted by employees the Johns Hopkins School-based Mental Health program which is housed within the Division of Child Psychiatry. If findings from the present study are positive, the intervention will be evaluated in a larger study (R01) across a large number of city schools.