انتقال رفتاردرمانی شناختی برای اختلالات اضطرابی دوران کودکی به کلینیک های بهداشت روانی داخل شهر مبتنی بر مدرسه

The systematic expansion of evidence-based cognitive behavioral (CBT) protocols into the schools provides an opportunity for training front-line service providers in the early identification of anxious children and in the delivery of evidence-based treatments to children who might otherwise go without such treatment [Weist, M. D., & Evans, S. W. (2005). Expanded school mental health: Challenges and opportunities in an emerging field. Journal of Youth and Adolescence, 3, 3­6]. In this article, we discuss the progress of our ongoing study aimed at transporting manualized CBT for anxious youth into inner-city school-based clinics. In this context, we outline the rationale for the study and specific adaptations and obstacles encountered to date.

Psychological science has enhanced clinical practice through the development, identification, and utilization of treatments supported by research (Task Force on Promotion and Dissemination of Psychological Procedures, 1995). Recent studies with children and adolescents document the efficacy of treatments for childhood psychiatric disorders, including the use of cognitive behavioral therapy (CBT) for children with anxiety disorders (e.g., Barrett et al., 1996, Kendall, 1994, Kendall et al., 1997, Silverman et al., 1999 and Silverman et al., 1999). The challenges that continue to confront psychology, however, are the dissemination of empirically supported assessment and treatment strategies to children's community mental health treatment settings and the evaluation of treatment effectiveness with youth from diverse racial and ethnic backgrounds (Barlow, 2000 and Weisz et al., 1995). The systematic expansion of evidence-based CBT protocols into inner-city schools provides an opportunity to address these gaps in services and research by training school-based clinicians in the early detection of anxious children and in the delivery of treatment to children who might otherwise go without treatment (Weist & Evans 2005). However, this task is fraught with challenges and requires numerous adaptations to both the intervention and evaluation process. The Baltimore Child Anxiety Treatment Study in the Schools (BCATSS) was designed to address these issues.

The delivery of CBT to anxious youth in the school setting offers an opportunity to provide treatment to youth who may not otherwise receive services. The empirical literature provides preliminary evidence for the feasibility and effectiveness of school-based CBT interventions. The training of school-based clinicians to deliver CBT is a critical step toward the dissemination and sustainability of empirically supported treatments to community providers and the availability of such treatments to underserved populations, such as African American youth living in the inner city. Challenges arise in transporting these interventions into new contexts and assessing the effectiveness of CBT for anxiety disorders in this population and context. But, in true CBT fashion, the best strategies for overcoming obstacles involve a collaborative approach between researchers, clinicians, and consumers and an empirical evaluation of treatment strategies to inform future CBT interventions implemented in school settings.