Exploring Treatment as Usual for Pediatric Anxiety Disorders Among School-Based Clinicians

Cognitive-behavioral therapy (CBT) remains the only evidenced-based psychosocial treatment for pediatric anxiety. Adoption of CBT in community settings has been slow, and data on CBT use in schools specifically are limited. This study examined: (1) school-based clinicians’ perceptions of their treatment approach for pediatric anxiety disorders, use of therapeutic strategies reported after each session, and overall perceived confidence in treating anxiety disorders, and (2) independent evaluator (IE) ratings of clinicians’ use of CBT, the frequency and quality of specific CBT elements in sessions, and overall competence in treating anxiety. An exploratory aim examined whether clinician characteristics were associated with IE-rated CBT use. Participants included 25 school-based clinicians who delivered treatment as usual in a randomized controlled trial of treatments for anxious children and adolescents. At baseline, clinicians reported their approach to treating anxious youth. After each session (N = 475), they reported the therapeutic strategies they used. IEs rated audiotaped therapy sessions (N = 90). Results indicated a majority of school clinicians reported using a behavioral or cognitive-behavioral approach for anxiety (68% at baseline and in 76% of sessions). In contrast, 14% of the IE-rated sessions had the primary therapeutic strategy coded as cognitive-behavioral. Clinician confidence and IE competence ratings were also discrepant, with clinicians rating themselves as somewhat confident in treating anxious youth but IEs assigning a low competence rating. Use and quality of CBT elements based on IE-rating were low. Several clinician characteristics were associated with CBT use. Findings suggest a need to improve the training of school-based clinicians in EBTs for students with anxiety.