Lawrence Scahill

Anxiety Disorders in Primary Care: Needs Assessment and Feasibility of Brief CBT

Anxiety problems are frequent in children and adolescents affecting as many as 20% in this age group. Undetected, anxiety disorders can be the source of considerable morbidity. Although there are effective psychosocial interventions, dissemination of appropriate treatment for youth with anxiety disorders is less than adequate. Barriers to obtaining appropriate treatment include lack of recognition in primary care settings and poor access to specialty mental health services. For these reasons, many experts call for improved routine mental health screening and treatment in primary care. Given the relatively high frequency of anxiety disorders in children and adolescents and the associated morbidity, anxiety disorders are a critical target for improving case identification and treatment in primary care. In addition, a specific psychosocial intervention called cognitive-behavior therapy (CBT) has been shown to be effective in reducing anxiety in children and improving adaptive functioning in the short- and the long-term. Despite the evidence showing the efficacy of CBT for the treatment of anxiety disorders in children, it has not been systematically implemented in primary care settings. This pilot project includes experts in child CBT from the Yale School of Nursing and Child Study Center in close collaboration with a large group pediatric practice (ChildrenÕs Medical Group in Hamden, CT). The aims of this one year project are to gather preliminary information on a systematic method of screening approximately 200 children for anxiety disorders in primary care and to evaluate the feasibility of delivering a brief, structured (CBT) program in 16 anxious youths (age 9-17) ascertained from this practice.

During the first six months children seen in the ChildrenÕs Medical Group (CMG) will be screened with a brief valid and reliable anxiety measure. Children who score above the established cut-off will be offered a more detailed evaluation for anxiety disorders. Children with clinically significant anxiety problems will be referred for treatment. Initially, children with clinically significant anxiety problems will be referred to collaborating clinicians in the community. Beginning at Month Three, however, children with clinically significant anxiety problems will be offered a brief, structured CBT program by a specially trained child psychiatric nurse practitioner. We expect to screen 200 children during the first six months. Fifteen to 20 subjects will be ascertained during Months Three to Six for the CBT pilot study. The final three months of the one-year project will be used to complete the follow up of children in the CBT and data analysis.

Funded by the Beatrice Renfield-Yale School of Nursing Clinical Research Initiatives Fund

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