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A Qualitative Examination of a School-Based Implementation of Computer-Assisted Cognitive-Behavioral Therapy for Child Anxiety

Crane, Margaret E; Phillips, Katherine E; Maxwell, Colleen A; Norris, Lesley A; Rifkin, Lara S; Blank, Jacob M; Sorid, Samantha D; Read, Kendra L; Swan, Anna J; Kendall, Philip C; Frank, Hannah E
Mental health treatment in schools has the potential to improve youth treatment access. However, school-specific barriers can make implementing evidence-based interventions difficult. Task-shifting (i.e., training lay staff to implement interventions) and computer-assisted interventions may mitigate these barriers. This paper reports on a qualitative examination of facilitators and barriers of a school-based implementation of a computer-assisted intervention for anxious youth (Camp Cope-A-Lot; CCAL). Participants (N = 45) included school staff in first through fourth grades. Providers attended a training in CCAL and received weekly, hour-long group consultation calls for three months. In the second year, the sustainability of CCAL use was assessed. Qualitative interviews were conducted after the first year (initial implementation) and second year (sustainability). Interviews were analyzed using the Consolidated Framework for Implementation Research domains to classify themes. Although participants reported that CCAL included useful skills, they expressed concerns about recommended session length (45 minutes) and frequency (weekly). Time burden of consultation calls was also a barrier. School staff facilitated implementation by enabling flexible scheduling for youth to be able to participate in the CCAL program. However, the sustainability of the program was limited due to competing school/time demands. Results suggest that even with computer assisted programs, there is a need to tailor interventions and implementation efforts to account for the time restrictions experienced by school-based service providers. Optimal fit between the intervention and specific school is important to maintain the potential benefits of computer-assisted treatments delivered by lay service providers in schools.
PMCID:8223963
PMID: 34178162
ISSN: 1866-2625
CID: 4926122

Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes

Swan, Anna J; Kendall, Philip C; Olino, Thomas; Ginsburg, Golda; Keeton, Courtney; Compton, Scott; Piacentini, John; Peris, Tara; Sakolsky, Dara; Birmaher, Boris; Albano, Anne Marie
OBJECTIVE:To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization). METHOD/METHODS:Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education. RESULTS:Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life. CONCLUSION/CONCLUSIONS:Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. (PsycINFO Database Record
PMCID:6110105
PMID: 30138013
ISSN: 1939-2117
CID: 3246182

Assessing and Treating Sleep Difficulties in Anxious Children and Adolescents

Swan, Anna; Carpenter, Johanna
ORIGINAL:0012879
ISSN: n/a
CID: 3260022

Anxiety disorders among children and adolescents

Chapter by: Kendall, Philip C; Swan, Anna J; Carper, Matthew M; Hoff, Alexandra L
in: APA handbook of psychopathology: Child and adolescent psychopathology by Butcher, James N [Ed]; Kendall, Philip C [Ed]
Washington, DC, US: American Psychological Association, 2018
pp. 213-230
ISBN: 1-4338-2835-9
CID: 2973582

A Multi-Informant Examination of Maternal Symptoms and Autonomy Granting in Youth Anxiety

Wei, Chiaying; Swan, Anna J; Makover, Heather B; Kendall, Philip C
Evidence suggests the important role of (a) parenting behaviors and (b) parental psychopathology in the development and maintenance of youth anxiety. Using a multi-informant approach, the current study examined the association of maternal autonomy granting and maternal symptoms (i.e., anxiety and depression) with youth anxiety among mothers and 88 youth (ages of 6-17) diagnosed with a principal anxiety disorder. Results from the generalized estimating equations (GEE) analyses indicated that mothers reported higher youth anxiety symptoms compared to youth self-reports. Youth-perceived maternal autonomy granting was inversely associated with youth anxiety, and maternal self-reported anxiety and depressive symptoms significantly moderated this relationship: As mothers reported higher anxiety and depressive symptoms, the inverse association between parental autonomy granting and youth anxiety weakened. The interaction between parenting behavior and parental psychopathology significantly influenced youth anxiety symptoms, which presents important clinical implications to integrate into parenting work in the treatment of youth anxiety disorders.
PMID: 28389842
ISSN: 1573-3327
CID: 2697022

Living in her parents' shadow : separation anxiety disorder : psychotherapeutic perspective

Chapter by: Swan, Anna J; Makover, H; Frank, H
in: DSM-5 casebook and treatment guide for child mental health by Galanter, Cathryn A; Jensen, Peter S [Eds]
Arlington, VA, US: American Psychiatric Publishing, Inc., 2017
pp. 29-39
ISBN: 978-1-58562-490-4
CID: 3260032

Psychotherapy with children and adolescents : theory and practice

Chapter by: Hoff, AI; Swan, Anna J; Mercado, RJ; Kagan, ER; Crawford, EA; Kendall, PC
in: Comprehensive textbook of psychotherapy : theory and practice by Consoli, Andres; Beutler, Larry E; Bongar, Bruce Michael (Eds)
Oxford ; New York : Oxford University Press, 2017
pp. ?-?
ISBN: 9780199358021
CID: 3260042

Fear and Missing Out: Youth Anxiety and Functional Outcomes [Review]

Swan, Anna J; Kendall, Philip C
Anxiety disorders are prevalent and associated with functional impairments. Outcome research has focused on symptom reduction, rather than positive factors such as life satisfaction and improved functioning. We review the impact of youth anxiety disorders and elevated anxiety symptoms on academic, occupational, family, social, and legal functioning. Emphasis is placed on the degree to which developmental trajectories differ for youth with and without anxiety disorders. In some areas, psychopathology generally, rather than anxiety specifically, is associated with functional impairment. Other studies support youth anxiety as a unique predictor of functional impairment. In particular, social anxiety is associated with impairments in social functioning throughout development. The short- and long-term impacts of anxiety treatment in youth are discussed. Last, research directions are suggested.
ISI:000391047600008
ISSN: 1468-2850
CID: 2697092

What Steps to Take? How to Approach Concerning Anxiety in Youth [Review]

Kendall, Philip C.; Makover, Heather; Swan, Anna; Carper, Matthew M.; Mercado, Roger; Kagan, Elana; Crawford, Erika
Anxiety in youth is a concern, and stepped care provides appropriate services for differential levels of distress and increases the number of youth able to receive services. Youth, and families, with mild anxiety benefit from print and Internet resources. Youth whose anxiety persists can receive direct guidance (e.g., computer-assisted programs). A third step increases the intensity of services (e.g., therapy). Finally, for severely problematic anxiety, intensive programs may be needed. Throughout, it is important to monitor anxiety and related impairment as well as to take into account client and family characteristics. Research on interventions within each step has identified many to be efficacious, but studies are needed to examine the decision-making features as well as the effectiveness of a stepped care approach.
ISI:000385356600001
ISSN: 0969-5893
CID: 2897172

In Pursuit of Generalization: An Updated Review

Swan, Anna J; Carper, Matthew M; Kendall, Philip C
Stokes and Osnes (1989) outlined three principles to facilitate the generalization and maintenance of therapeutic gains. Use of functional contingencies, training diversely, and incorporating functional mediators were recommended. Our review, with most illustrations from studies of youth, updates Stokes and Osnes's original paper with a focus on evidence-based strategies to increase generalization of therapeutic gains across settings, stimuli, and time. Research since 1989 indicates that training for generalization by increasing the frequency of naturally occurring reinforcers for positive behaviors, and altering maladaptive contingencies that inadvertently reinforce problem behaviors, are associated with favorable treatment outcomes. Training diversely by practicing therapy skills across contexts and in response to varying stimuli is also implicated in clinical outcomes for internalizing, externalizing, and neurodevelopmental disorders. Preliminary research recommends the use of internal (e.g., emotion identification) and external (e.g., coping cards) functional mediators to prompt effective coping in session and at home. Strategies for increasing generalization, including the use of technology, are examined and future research directions are identified.
PMID: 27816084
ISSN: 1878-1888
CID: 2897162