Comparison of stepped care delivery against a single, empirically validated cognitive-behavioral therapy program for youth with anxiety

a randomized clinical trial

Ronald M. Rapee*, Heidi J. Lyneham, Viviana Wuthrich, Mary Lou Chatterton, Jennifer L. Hudson, Maria Kangas, Cathrine Mihalopoulos

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)
74 Downloads (Pure)

Abstract

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.

Original languageEnglish
Pages (from-to)841-848
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume56
Issue number10
Early online date10 Aug 2017
DOIs
Publication statusPublished - Oct 2017

Keywords

  • Anxiety disorder
  • Child anxiety
  • Cost-efficacy
  • Stepped care
  • Treatment

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