OBJECTIVE: Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program. METHOD: A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. RESULTS: Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. CONCLUSION: Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819.
RCT Entities:
OBJECTIVE: Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for childanxiety delivered via a stepped-care framework compared against a single, empirically validated program. METHOD: A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. RESULTS: Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. CONCLUSION: Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819.
Authors: Alison Salloum; Yuanyuan Lu; Henian Chen; Troy Quast; Judith A Cohen; Michael S Scheeringa; Kristen Salomon; Eric A Storch Journal: J Am Acad Child Adolesc Psychiatry Date: 2022-01-12 Impact factor: 13.113
Authors: Bridianne O'Dea; Mirjana Subotic-Kerry; Catherine King; Andrew J Mackinnon; Melinda R Achilles; Melissa Anderson; Belinda Parker; Aliza Werner-Seidler; Michelle Torok; Nicole Cockayne; Simon T E Baker; Helen Christensen Journal: Lancet Reg Health West Pac Date: 2021-06-12
Authors: Simona Scaini; Federica Rossi; Ronald M Rapee; Francesca Bonomi; Giovanni M Ruggiero; Alessia Incerti Journal: Int J Environ Res Public Health Date: 2022-01-14 Impact factor: 3.390