Abstract
BackgroundSchools present a context with great potential for the implementation of psychosocial evidence-based practices. Cognitive behavioral therapy (CBT) is an evidence-based practice that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) is an efficacious group CBT protocol for anxiety. Unfortunately, evidence-based practices for anxiety are seldom employed in under-resourced urban schools, because many treatment protocols are not a good fit for the urban school context or the population, existing behavioral health staff do not receive adequate training or support to allow them to implement the treatment with fidelity, or school districts do not have the resources to contract with external consultants. In our prior work, we adapted FRIENDS to create a more culturally sensitive, focused, and feasible CBT protocol for anxiety disorders (CBT for Anxiety Treatment in Schools (CATS)).Methods/designThe aim of this 5-year study is to evaluate both the effectiveness of CATS for urban public schools compared to the original FRIENDS as well as compare the implementation strategies (train-the-trainer vs. train-the-trainer + ongoing consultation) by conducting a three-arm, parallel group, type 2 hybrid effectiveness-implementation trial in 18 K-8 urban public schools. We will also assess the cost-effectiveness and the mediators and moderators of fidelity. Ninety therapists, 18 agency supervisors, and 360 children will participate. The interactive systems framework for dissemination and implementation guides the training and support procedures for therapists and supervisors.DiscussionThis study has the potential to demonstrate that agency therapists and supervisors who have had little to no prior exposure to evidence-based practices (EBPs) can implement an anxiety disorder EBP with fidelity. Comparisons of the implementation strategies would provide large urban mental health systems with data to make decisions about the adoption of EBPs.Trial registrationClinicalTrials.gov, NCT02651402
Highlights
Schools present a context with great potential for the implementation of psychosocial evidence-based practices
Four conditions must be satisfied for service context to be a mediator: (1) therapist intention is significantly associated with fidelity
This study has the potential to show that masters-level therapists from public mental health agencies providing services in schools can implement evidence-based practices (EBPs) with high levels of fidelity, provided that they receive ongoing evidencebased supervision from their own clinical supervisors
Summary
Schools present a context with great potential for the implementation of psychosocial evidence-based practices. Anxiety disorders are highly prevalent among inner city school children and often go unidentified and untreated [2] Children with these disorders are more likely than their peers to have problems with social, peer and parent-child relations [3], academic achievement [4], school refusal [5], and future socio-emotional adjustment [6]. School factors, such as peer problems, academic pressures, and school violence, can contribute to and exacerbate symptoms [7]. Benefits of providing evidence-based practices (EBPs) in schools include the ability to implement interventions in the very environment in which most symptoms are triggered [9] and to incorporate protocolspecific interventions, with peer and teacher involvement, as needed for generalizability [10]
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