Feasible Delivery of CBT for Rural Latino Youth with Anxiety

描述（由申请人提供）：患有焦虑症的儿童通常以治疗需求未得到满足为特征，然而，在拉丁裔和农村青年等特殊人群中，由于文化和地理隔离的影响，这种差异更加严重。更具体地说，与语言、耻辱和获取相关的障碍往往导致需要心理健康服务的儿童的使用率较低和结果较差（Alvidrez和Azocar, 1999； McCabe等人，2002；Myers等人，2008；Vega等人，2001）。鉴于大量数据支持认知行为和行为疗法对焦虑症儿童的有效性，这些发现令人失望（Barrett et al., 1996; Beidel et al., 2007; Kendall & Southam-Gerow, 1996; Walkup et al., 2008）。努力研究为焦虑症儿童提供循证治疗的可行方法至关重要，以便向服务不足的群体提供高质量的护理。本R34的目标是通过翻译和调整现有的儿童焦虑认知行为治疗方案（The Cool Kids Outreach program; Lyneham and Rapee, 2006）来解决这些差异，以适应讲西班牙语的农村家庭的需求，并检查使用不同交付模式实施这种干预的可行性、可接受性、可容忍性和安全性。定性方法包括与双文化和双语精神卫生提供者的焦点小组以及与农村拉丁裔父母的个别访谈，将用于检查干预措施的可接受性和文化适宜性。利用这些发现和其他现存文献，一个由文化适应框架（Lau, 2006）指导的专家小组将确定酷孩子推广计划的定制程度。接下来，将对患有焦虑症（即分离性焦虑症、广泛性焦虑症、社交焦虑症和特定恐惧症）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模式，代表不同程度的治疗师接触：1)20个家庭将被随机分为以电话为基础、治疗师支持的CBT项目；2) 20个家庭将随机分配到最小接触bilbitherapy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，将从初级保健机构招募所有家庭。可行性和临床结果将在基线、治疗中和治疗后进行测量。此外，在退出面谈期间，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，并为试点程序提供机会，这些程序将用于对农村拉丁裔青年进行更大规模的有效性试验。

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.