TY - JOUR
T1 - Comparison of stepped care delivery against a single, empirically validated cognitive-behavioral therapy program for youth with anxiety
T2 - a randomized clinical trial
AU - Rapee, Ronald M.
AU - Lyneham, Heidi J.
AU - Wuthrich, Viviana
AU - Chatterton, Mary Lou
AU - Hudson, Jennifer L.
AU - Kangas, Maria
AU - Mihalopoulos, Cathrine
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - Anxiety disorder
KW - Child anxiety
KW - Cost-efficacy
KW - Stepped care
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85028549005&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/nhmrc/1027556
U2 - 10.1016/j.jaac.2017.08.001
DO - 10.1016/j.jaac.2017.08.001
M3 - Article
C2 - 28942806
AN - SCOPUS:85028549005
SN - 0890-8567
VL - 56
SP - 841
EP - 848
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 10
ER -