School‐based targeted prevention compared to specialist mental health treatment for youth anxiety

Abstract

Background: The 'FRIENDS for life' program (FRIENDS) is a 10-session cognitive behavioral therapy (CBT) program used for prevention and treatment of youth anxiety. There is discussion about whether FRIENDS is best applied as prevention or as treatment. Methods: We compared FRIENDS delivered in schools as targeted prevention to a previous specialist mental health clinic trial. The targeted prevention sample (N = 82; M age = 11.6 years, SD = 2.1; 75.0% girls) was identified and recruited by school nurses in collaboration with a community psychologist. The clinical sample (N = 88, M age = 11.7 years, SD = 2.1; 54.5% girls) was recruited for a randomized controlled trial from community child-and adolescent psychiatric outpatient clinics and was diagnosed with anxiety disorders. Results: Both samples showed significantly reduced anxiety symptoms from baseline to postintervention, with medium mean effect sizes across raters (youths and parents) and timepoints (post; 12-months follow-up). Baseline youth-reported anxiety symptom levels were similar between the samples, whereas parent-reported youth anxiety was higher in the clinical sample. Conclusions: The study suggests that self-reported anxiety levels may not differ between youth recruited in schools and in clinic settings. The results indicate promising results of the FRIENDS program when delivered in schools by less specialized health personnel from the school health services, as well as when delivered in clinics by trained mental health professionals.

Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders

“…Implementation of GCBT in settings other than specialized child psychiatric clinics, to which access is very limited, is also supported. This view is congruent with a recent study [ 57 ] in which the FRIENDS program showed corresponding outcomes in reducing anxiety, depression, and conduct problems when implemented by less specialized personnel at schools or by trained mental health professionals in children´s mental health community clinics [ 57 ]. The FRIENDS program has been shown to be an effective school-based anxiety prevention program [ 58 ], which is also endorsed by the World Health Organization [ 59 ].…”

Assessing the range and evidence‐base of interventions in a cluster of schools

“…For example, one single-case multiple baseline design reported positive changes for pupils with emotional, behavioural and/or anxiety disorders (Schoenfeld & Mathur, 2009). Two further small-scale studies used a pre/post design with no control condition and found positive effects of FRIENDS when used selectively (Cooley et al, 2004;Fjermestad et al, 2020). Another moderate-scale pre-post design and its follow-up study both reported positive effects from universal delivery of FRIENDS (Stallard et al, 2005(Stallard et al, , 2008.…”

Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety

“…The SCAS-C/P has demonstrated sound psychometric properties (Nauta et al, 2004;Spence, 1998), which have been replicated for youth in Scandinavian samples (Arendt et al, 2014;Olofsdotter et al, 2016). Studies using the Norwegian translation have been published (e.g., Fjermestad et al, 2020;Wergeland et al, 2014). Internal consistency in the total sample was good to excellent (SCAS-C, α = 0.91; SCAS-P Mothers, α = 0.89; SCAS-P Fathers, α = 0.87).…”