School-Based CBT for Anxious African-American Children

描述(由申请人提供)：这份R34提案是根据PAR-03-078(干预发展对服务/探索性研究拨款)提交的，旨在满足美国最脆弱和服务最少的人群之一--低收入、市中心的非洲裔美国儿童的需求。这项研究的主要目的是确定由学校临床医生提供的以学校为基础的认知行为治疗(CBT)的可行性和有效性，旨在降低焦虑症状和障碍的水平。焦虑症是最常见的儿童精神障碍之一，2%至19%的儿童受到影响。这些疾病的高发生率表明，儿童中过度的恐惧、担忧和焦虑是一个新出现的公共卫生问题，需要有效、可获得的治疗来减轻这些儿童的痛苦。在过去的十年里，关于CBT治疗焦虑症儿童的有效性的证据已经积累起来。现在，人们的注意力转向通过评估这些治疗在不同背景下(例如，学校、社区精神卫生中心)对不同背景的年轻人的有效性，并由非CBT专家临床医生提供，来检查这些治疗的“可传递性”。这项提案解决了这些关键问题。这项研究使用多阶段方法来吸引社区利益相关者，改进研究方法(例如，评估、干预)以确保其文化相关性，培训以学校为基础的临床医生，并评估招募的可行性。这项研究的最终结果是一项试验性随机对照试验(RCT)，采用2(干预：CBT与ASC)×4(评估期：干预前、干预后以及治疗后6周和12周)设计，对6所小学的60名非洲裔美国儿童进行了手动CBT治疗和手动注意支持控制(ASC)的有效性比较。蒙面独立评估员(IE)将对结果进行评估(以及儿童、家长和教师报告)。将通过结构化手册、LES审查的录音会议和持续的每周监督来评估干预遵守情况和质量保证。干预措施将由约翰·霍普金斯大学心理健康项目的员工进行，该项目设在儿童精神病学部。如果本研究的结果是肯定的，将在一项更大的研究(R01)中对大量城市学校的干预措施进行评估。

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.