Research award in child and adolescent psychiatry

Department news | December 31, 2018


The Division of Child and Adolescent Psychiatry is partnering on a new award from the Patient-Centered Outcomes Research Institute (PCORI) to conduct a comparative effectiveness trial of an evidence-based cognitive-behavioral therapy (CBT) for anxiety (Cool Kids) delivered through the traditional in person model of care or through an innovative online modality. Effective treatment involves patients (ages 3 to 17) learning about anxiety and then engaging in exposure practice. Parents are integrally involved in treatment and are the main participant for younger children (3 to 5 years old). The intervention is based on “Helping Your Anxious Child” developed by Ron Rapee, PhD, at Macquarie University in Australia.

PCORI awarded Lisa Fortuna MD, MPH, at Boston Medical Center $13.5 million to conduct this comparative effectiveness trial across four sites: Boston, Miami, Baltimore and Seattle. Kathleen Myers MD, MPH, MS and Molly Adrian, PhD at Seattle Children’s are leading the Seattle team. Local participating sites include Seattle Children’s outpatient clinic, Harborview Medical Center’s pediatric clinic, and Swedish outpatient pediatrics clinics. Pediatricians will refer youth who will receive the intervention at Seattle Children’s or from therapists embedded in their pediatric clinic. The sites will recruit a cohort of 1,800 English and Spanish speaking children with mild to moderate anxiety symptoms with the goal to reach racial and ethnic minority children.

Anxiety is reported to affect nearly one in three children. However, most children with anxiety do not receive treatment for many reasons, including lack of therapists, stigma, difficulty getting to appointments, and time commitment. Delivering an effective intervention online can reach children in living situations that preclude ready access to usual care, particularly children in lower-income and minority families that may not seek care elsewhere. Online therapies are predominantly being studied and implemented in countries with socialized healthcare. This study is the first in the United States to examine the effectiveness of online CBT delivery for a pediatric disorder, and to determine which service delivery model is best for selected patient groups. If the online delivery of CBT is found to be successful, it could offer a framework for implementation across the country.

The Cool Kids study was selected for funding through PCORI’s Pragmatic Clinical Studies Initiative, an effort to produce results that are broadly applicable to a diverse range of patients and care situations and can be more quickly taken up in routine clinical practice.