School-Based CBT for Anxious African-American Children

描述（由申请人提供）：本R34提案是根据PAR-03-078（服务干预发展/探索性研究资助）提交的，旨在解决美国最脆弱和服务不足的人群之一-低收入的非洲裔美国儿童的需求。本研究的主要目的是确定基于学校的认知行为治疗（CBT）的可行性和有效性，由基于学校的临床医生提供，旨在降低焦虑症状和障碍的水平。焦虑症是最普遍的儿童精神疾病之一，有2%至19%的儿童受到影响。这些疾病的高发病率表明，儿童的过度恐惧、担心和焦虑是一个新出现的公共卫生问题，需要有效和可获得的治疗方法来减轻这些儿童的痛苦。在过去的十年里，关于认知行为疗法对患有焦虑症的儿童的疗效的证据越来越多。必须的是，现在的注意力已经转向检查这些治疗的“可移植性”，通过评估其在不同背景的年轻人（例如，学校，社区精神卫生中心）的有效性，并由非cbt专家临床医生提供。本提案解决了这些关键问题。本研究采用多阶段方法来吸引社区利益相关者，完善研究方法（如评估、干预）以确保其文化相关性，培训校本临床医生，并评估招聘的可行性。该研究的最终结果是一项试点随机对照试验（RCT），比较了六所小学60名非裔美国儿童使用2（干预：CBT与ASC） × 4（评估期：干预前和干预后以及治疗后6周和12周）设计的手动CBT治疗与手动注意支持控制（ASC）治疗的有效性。蒙面独立评估人员（IE）将对结果进行评估（连同儿童、家长和教师的报告）。干预措施的依从性和质量保证将通过结构化手册、lEs审查的录音会议和持续的每周监督来评估。这些干预措施将由约翰霍普金斯大学学校心理健康项目的员工进行，该项目位于儿童精神病学部门。如果本研究的结果是积极的，干预措施将在大量城市学校的更大研究中进行评估（R01）。

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.