A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness

Lawson, Gwendolyn M.; Jawad, Abbas F.; Comly, Rachel; Khanna, Muniya; Glick, Henry A.; Beidas, Rinad S.; Goldstein, Jessica; Brizzolara-Dove, Shelby; Wilson, Tara; Rabenau-McDonnell, Quinn; Eiraldi, Ricardo

doi:10.3389/fpsyt.2023.1105630

Cited by 4 publications

(1 citation statement)

References 41 publications

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“…For the current study, we compared implementation outcomes of TT vs. TT + and clinical effectiveness of the 8-session CATS manualized protocol under the two types of implementation support based on a sample of 22 schools (i.e., those receiving CATS with TT implementation support and those receiving CATS with TT + implementation support). Results pertaining to the effectiveness of FRIENDS vs. CATS using the TT strategy were presented elsewhere [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial

Eiraldi,

Lawson,

Glick

et al. 2024

Implementation Sci

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Background Little is known about the effectiveness and cost-effectiveness of train-the-trainer implementation strategies in supporting mental health evidence-based practices in schools, and about the optimal level of support needed for TT strategies. Methods The current study is part of a larger type 2 hybrid cluster randomized controlled trial. It compares two train-the-trainer strategies, Train-the-Trainer (TT) and Train-the-Trainer plus ongoing consultation for trainers (TT +) on the delivery of a group cognitive behavioral treatment protocol for anxiety disorders. Participants were 33 therapists, 29 supervisors, and 125 students who were at risk for anxiety disorders from 22 urban schools. Implementation outcomes were implementation fidelity and treatment dosage. Student outcomes were child- and parent-reported symptoms of anxiety, child-reported symptoms of depression, and teacher-reported academic engagement. We estimated the cost of implementing the intervention in each condition and examined the probability that a support strategy for supervisors (TT vs TT +) is a good value for varying values of willingness to pay. Results Therapists in the TT and TT + conditions obtained similarly high implementation fidelity and students in the conditions received similar treatment dosages. A mixed effects modeling approach for student outcomes revealed time effects for symptoms of anxiety and depression reported by students, and emotional disaffection reported by teachers. There were no condition or condition × times effects. For both conditions, the time effects indicated an improvement from pre-treatment to post-treatment in symptoms of anxiety and depression and academic emotional engagement. The average cost of therapist, supervisor, and consultant time required to implement the intervention in each condition was $1002 for TT and $1431 for TT + (p = 0.01). There was a greater than 80% chance that TT was a good value compared to TT + for all values of willingness to pay per one-point improvement in anxiety scores. Conclusions A TT implementation approach consisting of a thorough initial training workshop for therapists and supervisors as well as ongoing supervision for therapists resulted in adequate levels of fidelity and student outcomes but at a lower cost, compared to the TT + condition that also included ongoing external expert consultation for supervisors. Trial registration ClinicalTrials.gov identifier: NCT02651402.

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Section: Introductionmentioning

confidence: 99%

Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial

Eiraldi,

Lawson,

Glick

et al. 2024

Implementation Sci

Self Cite

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The FRIENDS preventive programme for reducing anxiety symptoms in children and adolescents: A systematic review and meta‐analysis

Filges,

Smedslund,

Eriksen

et al. 2024

Campbell Systematic Reviews

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BackgroundAnxiety and stress responses are often considered normative experiences, and children and adolescents may benefit from anxiety prevention programmes. One such programme is FRIENDS which is based on a firm theoretical model which addresses cognitive, physiological and behavioural processes. FRIENDS is manualised and can, thus, easily be integrated into school curriculums.ObjectivesWhat are the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents? Do the effects differ between participant age groups, participant socio‐economic status, type of prevention, type of provider, country of implementation and/or implementation issues in relation to the booster sessions and parent sessions?Search MethodsThe database searches were carried out in September 2023, and other sources were searched in October 2023. We searched to identify both published and unpublished literature. A date restriction from 1998 and onwards was applied.Selection CriteriaThe intervention was three age‐appropriate preventive anxiety programmes: Fun FRIENDS, FRIENDS for Life, and My FRIENDS Youth. Primary outcome was anxiety symptoms and secondary outcome was self‐esteem. Studies that used a control group were eligible, whereas qualitative approaches were not.Data Collection and AnalysisThe number of potentially relevant studies was 2865. Forty‐two studies met the inclusion criteria. Twenty‐eight studies were used in the data synthesis. Four studies had a critical risk of bias. Six studies did not report data that enabled calculation of effect sizes and standard errors. Two studies had partial overlap of data to other studies used, and two were written in Persian. Meta‐analyses were conducted on each outcome separately. All analyses were inverse variance weighted using random effects statistical models.Main ResultsStudies came from 15 different countries. Intervention start varied from 2001 to 2016. The average number of participants analysed was 240, and the average number of controls was 212. Twenty‐five comparisons reported on anxiety symptoms post‐intervention. The weighted average standardised mean difference (SMD) was 0.13 (95% CI 0.04 to 0.22). There was some heterogeneity. Twelve comparisons reported on anxiety symptoms at 12 months follow‐up. The weighted average SMD was 0.31 (95% CI 0.13 to 0.49). There was a large amount of heterogeneity. Five comparisons reported on self‐esteem post‐intervention with a weighted average SMD of 0.20 (95% CI −0.20 to 0.61) and a large amount of heterogeneity. At follow‐up, we found evidence that programmes implemented by mental health providers appears to perform better than programmes implemented by teachers. The evidence was inconclusive beyond 12 months follow‐up.Authors' ConclusionsOur results indicate that the FRIENDS intervention may reduce anxiety symptoms in children and adolescents when reported by children and adolescents themselves. The majority of trials employed a wait‐list design, implying only a few studies reported on the long‐term effects of the FRIENDS intervention. Our findings suggest that the FRIENDS intervention may increase the reduction in anxiety symptoms 12 months after the intervention. This emphasises the need for future research that apply designs that allows for long‐term follow‐up. We are uncertain about the effects on self‐esteem. The overall certainty of evidence varied from low to very low. There is a need for more rigorously conducted studies.

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A cluster randomized controlled trial comparing the effectiveness of two school-based interventions for autistic youth with anxiety

Pickard,

Maddox,

Boles

et al. 2024

BMC Psychiatry

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Background Recent systematic reviews have indicated that cognitive behavioral therapy (CBT) is effective in reducing anxiety symptoms for autistic and non-autistic children. However, the vast majority of CBT research for autistic youth has been implemented within university settings and primarily by mental health providers. Schools hold great promise to equitably manage the mental health symptoms of autistic youth. Although preliminary research evaluating CBT within schools has been promising, CBT has not yet been compared to another readily available school mental health program. The goal of this protocol paper is to describe a multi-site study comparing two school-based interventions, Facing Your Fears-School Based (FYF-SB) and Zones of Regulation (ZOR) via a cluster randomized controlled type 1 hybrid effectiveness-implementation trial to determine which of the two interventions will best support autistic youth with anxiety in schools. Methods Up to 100 elementary and middle schools will be randomized into FYF-SB or ZOR. Once schools are randomized, a minimum of two interdisciplinary school providers at each school will be trained to deliver either FYF-SB or ZOR over the course of 12 weeks to groups of 2–5 autistic students ages 8–14 years. Over the course of two years, a total of 200 autistic students will receive either ZOR or FYF-SB. The primary outcome of this trial is child anxiety, as rated by masked evaluators and via caregiver- and student-report, which will be measured at baseline, post-treatment, and 6-month follow-up. Semi-structured interviews will also be conducted with a purposive sample of students, caregivers, and school providers to understand the acceptability, appropriateness, and feasibility of either ZOR or FYF-SB. Stakeholder engagement is a central component of this project via two stakeholder advisory boards that will directly inform and oversee the project. Discussion Results of this study will provide evidence about the relative impact of two school-based mental health interventions on outcomes reported as meaningful by caregivers and school providers. The additional focus on evaluating factors that support the implementation of FYF-SB and ZOR will allow future studies to test targeted implementation strategies that support mental health programming uptake and implementation within public schools. Trial registration This trial is registered with clinicaltrials.gov (NCT05863520).

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A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness

Cited by 4 publications

References 41 publications

Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial

Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial

The FRIENDS preventive programme for reducing anxiety symptoms in children and adolescents: A systematic review and meta‐analysis

A cluster randomized controlled trial comparing the effectiveness of two school-based interventions for autistic youth with anxiety

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