Background and Significance: Cognitive behavioral therapy (CBT) is a type of therapy that is very effective for anxiety in children. It is a short-term therapy that involves learning about anxiety and then engaging in exposure practice, which means helping youth confront anxiety-provoking themes or situations in order to overcome fears. However, most children with anxiety do not receive treatment, for many reasons, including lack of therapists, stigma, difficulty getting to appointments, and time commitment. Online delivery of CBT using a program called Cool Kids leads to improvement in research settings, and could make CBT available for more families. Providing these treatments in community pediatrics practices could help even more children, particularly in lower-income and minority families that may not seek care elsewhere. No one has tested whether both in-person and online delivery methods of CBT in primary care pediatrics could work equally well with low-income and minority families, nor whether each of these formats may work better for certain patients or scenarios. We also don’t know whether children in primary care pediatrics who do not initially respond to one format might actually do better with the other.
Study Aims: We will test two different methods of delivering CBT for anxiety in kids—face-to-face versus online—in health centers and pediatric practices, both urban and semirural, that serve primarily racial/ethnic minority children. We will test different sequences of care for kids who do not get better with the first treatment, as well as whether one format or sequence is better for certain families or in certain contexts. Parents, patients, and providers will be actively engaged to help support the successful implementation of CBT in pediatrics and to ensure that the intervention includes patient-centered outcomes and decision making.
Study Description: English- and Spanish-speaking children ages 3–17 with mild to moderate anxiety symptoms who see their pediatrician in participating clinics (a combination of community sites and larger hospital systems) will be invited to participate. A therapist connected with the child’s pediatrician will either deliver face-to-face CBT using the Cool Kids manual, or facilitate use of the Cool Kids Online CBT program, in English or Spanish. This program is completed by parents for preschool-age kids, by parents and kids together for grade school kids, and primarily by adolescents in the 13–17 age range. After Phase 1 (five therapy sessions or eight weeks, whichever comes first) children will be evaluated again, and if their symptoms are not improving, they will be offered the other treatment instead or an enhanced version of the format they have already been receiving. We will determine if one format works best for delivering CBT in the community and if certain characteristics about patients, families, therapists, and healthcare systems may influence the effectiveness of each CBT format (e.g., comfort with technology, internet access, distance to clinic, other mental health problems). Outcome measures include parent and patient reports of anxiety symptoms, functioning and family stress, and feedback on the intervention. We will disseminate our findings immediately and widely to transform best practices for the treatment of childhood anxiety in the community.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.