Treatment Study for Rural Latino Youth With Anxiety

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.

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 bibliotherapy 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.

Inclusion Criteria:

- Child between ages of 8-13

- Meets DSM-IV criteria for one of the following disorders: separation anxiety
disorder, social phobia, generalized anxiety disorder, specific phobia, or
obsessive-compulsive disorder

- If takes a medication, has maintained a stable dose for 3 months before baseline
assessment

- Pediatric medical care is provided through one of the participating primary care
clinics

- Parent and child are fluent in English or Spanish

- Family has easy access to a telephone

Exclusion Criteria:

- Comorbid diagnosis, such as major depression, ADHD, or psychosis that is considered
clinically significant and the primary problem

- Life threatening conditions, active suicidality, psychotic disorders, bipolar
disorder or pervasive developmental disorders