Although schools can improve children’s access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6–18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation. This study suggests that EBP implementation can be facilitated by having the necessary support from school leadership and peers.

New Orleans school children participated in an assessment and field trial of two interventions 15 months after Hurricane Katrina. Children (N = 195) reported on hurricane exposure, lifetime trauma exposure, peer and parent support, posttraumatic stress disorder (PTSD), and depressive symptoms. Teachers reported on behavior. At baseline, 60.5% screened positive for PTSD symptoms and were offered a group intervention at school or individual treatment at a mental health clinic. Uptake of the mental health care was uneven across intervention groups, with 98% beginning the school intervention, compared to 37% beginning at the clinic. Both treatments led to significant symptom reduction of PTSD symptoms but many still had elevated PTSD symptoms at post treatment. Implications for future postdisaster mental health work are discussed.

Objective Pediatric obsessive-compulsive disorder (OCD) is a chronic, impairing condition associated with high levels of family accommodation (i.e., participation in symptoms). Understanding of factors that may engender accommodation of pediatric OCD is limited. This study conducted exploratory analyses of parent-, child-, and family-level correlates of family accommodation, considering both behavioral and affective components of the response. Method The sample included 65 youth (mean age = 12.3 years; 62% male) with OCD and their parents who completed a standardized assessment battery comprised of both clinical and self-report measures (e.g., CY-BOCS, Brief Symptom Inventory). Results Family accommodation was common, with the provision of reassurance and participation in rituals the most frequent practices (respectively occurring on a daily basis among 56% and 46% of parents). Total scores on the Family Accommodation Scale were not associated with child OCD symptom severity; however, parental involvement in rituals was associated with higher levels of child OCD severity and parental psychopathology, and with lower levels of family organization. Comorbid externalizing symptomatology and family conflict were associated with parent report of worse consequences when not accommodating. Conclusions Although these findings must be interpreted in light of potential Type I error, they suggest that accommodation is the norm in pediatric OCD. Family-focused interventions must consider the parent, child, and family-level variables associated with this familial response when teaching disengagement strategies.

Although anxiety disorders are prevalent among children and adolescents, with a chronic and often disabling course, there is a paucity of research examining the specific ways in which anxiety interferes with various domains of functioning in childhood. The purpose of the current investigation was to examine the initial reliability and construct validity of the Child Anxiety Impact Scale-Parent version (CAIS-P). The CAIS-P is a parent-report measure consisting of School, Social, and Home/Family subscales. In a clinical sample (N = 92), the internal reliability and the convergent and divergent validity were evaluated. Internal consistency was good for the total score as well as each subscale (Cronbach's alpha ranged from 0.73-0.87). The CAIS-P total score demonstrated good construct validity, showing predicted significant correlations with the Child Behavior Checklist Internalizing Scale and the Child Depression Inventory but not the Externalizing Scale of the Child Behavior Checklist. The Social subscale of the CAIS-P was also significantly correlated with measures of social anxiety. The results provide initial support that the CAIS-P is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning.

Objective To examine the efficacy of exposure-based CBT plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with OCD. Methods Seventy-one 8–17 year old youngsters (mean 12.2 years, range 8–17, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for six months to assess treatment durability. Results FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs.35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT vs. 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6-months. Conclusions FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment. Clinical Trials Registry Information Behavior Therapy for Children and Adolescents with Obsessive-Compulsive Disorder (OCD); http://www.clinicaltrials.gov; Unique Identifier: NCT00000386