School-Based Treatment for Anxiety Research Study (STARS): a Randomized Controlled Effectiveness Trial
The current study compared the effectiveness of a school-clinician administered cognitive behavioral treatment (CBT) to treatment as usual (TAU) at post-treatment (i.e., after 12 weeks) and at a 1 year follow-up. Sixty-two school-based clinicians (37 in CBT; 25 in TAU) and 216 students (148 students in CBT; 68 in TAU) participated. Students were ages 6–18 (mean age 10.87; 64% Caucasian & 29% African American; 48.6% female) and all met DSM-IV diagnostic criteria for a primary anxiety disorder. Independent evaluators (IEs) assessed clinical improvement, global functioning, and loss of anxiety diagnoses; children and parents completed measures of anxiety symptoms. At post-treatment, no significant treatment main effects emerged on the primary outcome; 42% and 37% of youth were classified as treatment responders in CBT and TAU respectively. However, parent-report of child anxiety showed greater improvements in CBT relative to TAU (d = .29). Moderation analyses at post-treatment indicated that older youth, those with social phobia and more severe anxiety at baseline were more likely to be treatment responders in CBT compared to TAU. At the 1 year follow-up, treatment gains were maintained but no treatment group differences or moderators emerged. CBT and TAU for pediatric anxiety disorders, when delivered by school clinicians were generally similar in effectiveness for lowering anxiety and improving functioning at both post-treatment (on all but the parent measure and for specific subgroups) and 1 year follow-up. Implications for disseminating CBT in the school setting are discussed.
KeywordsChild anxiety Treatment School-based Treatment as usual Cognitive behavioral therapy
We are grateful for the hard work and support of many research assistants and school personnel throughout the course of the study. The authors would also like to thank all the clinicians, students, and parents who participated in the study. We are especially grateful to Jennifer Nail, Sarah Williams, Amy Hale, Elizabeth Casline, Michela Muggeo, Jamie LoCurto, Brian Padilla, and many students and fellows for their assistance with implementing this study.
The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A120405 to Dr. Ginsburg. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Connecticut institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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