Are Children with Anxiety Disorders Privately Referred to a University Clinic Like Those Referred from the Public Mental Health System?

  • Michael A. Southam-GerowEmail author
  • Bruce F. Chorpita
  • Lauren M. Miller
  • Alissa A. Gleacher
Original Paper


Compared two groups of children with anxiety disorders served at a single mental health clinic whose referral source differed: private referrals (i.e., parent/legal guardian initiated) and public referrals (e.g., via state contracts—Departments of Health and Education, juvenile justice system). Comparisons were made across three domains of variables: (a) symptoms/diagnoses, (b) functioning, and (c) environments. Few symptom differences emerged. However, large differences were evident for contextual variables like family income and life stressors. Overall, the pattern of differences point to possible directions for adaptation of treatments for use with children with anxiety disorders served in public mental health systems.


Child anxiety Dissemination research Effectiveness research Public mental health clinics Services research 



Preparation of this article was supported in part by National Institute of Mental Health Grant K23 MH69421 to Southam-Gerow and R03 MH60134 to Chorpita as well an award from the University of Hawai’i Research Council, and awards from the Hawai’i Departments of Health and Education to Chorpita. We are grateful to Tina Donkervoet and John Weisz for their support and to A. Aukahi Austin, Sarah Francis, Jennifer Gray, Farrah Greene, Cassian Kimhan, Catherine Moffitt, Brad Nakamura, and John Young for their assistance with data collection.


  1. Achenbach, T. M. (1991). Manual for the child behavior checklists/4-18 and 1991 profile. Burlington: University of Vermont.Google Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: Author.Google Scholar
  3. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  4. Berman, S. L., Weems, C. F., Silverman, W. K., & Kurtines, W. M. (2000). Predictors of outcome in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children. Behavior Therapy, 31, 713–731.CrossRefGoogle Scholar
  5. Bird, H. R., Canino, G. J., Davies, M., Ramirez, R., Chavez, L., Duarte, C., et al. (2005). The Brief Impairment Scale (BIS): A multidimensional scale of functional impairment for children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 699–707.PubMedCrossRefGoogle Scholar
  6. Bird, H., Shaffer, D., Fisher, P., Gould, M., Staghezza, B., Chen, J., et al. (1993). The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167–176.Google Scholar
  7. Brent, D. A., Kolko, D. J., Birmaher, B., Baugher, M., Bridge, J., Roth, C., et al. (1998). Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 906–914.PubMedCrossRefGoogle Scholar
  8. Burns, B. J., & Hoagwood, K. (Eds.) (2002). Community treatment for youth: Evidence-based interventions for severe emotional and behavioral disorders. New York: Oxford.Google Scholar
  9. Capage, L. C., Bennett, G. M., & McNeil, C. B. (2001). A comparison between African American and Caucasian children referred for treatment of disruptive behavior disorders. Child and Family Behavior Therapy, 23, 1–14.CrossRefGoogle Scholar
  10. Chorpita, B. F. (2002). Treatment manuals for the real world: Where do we build them? Clinical Psychology: Science and Practice, 9, 431–433.CrossRefGoogle Scholar
  11. Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy, 43, 309–322.PubMedCrossRefGoogle Scholar
  12. Chorpita, B. F., Plummer, C., & Moffitt, C. E. (2000). Relations of tripartite dimensions of emotion to childhood anxiety and mood disorders. Journal of Abnormal Child Psychology, 28, 299–310.PubMedCrossRefGoogle Scholar
  13. Chorpita, B. F., & Southam-Gerow, M. A. (2006). Treatment of anxiety disorders in youth. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders, 3rd edn. New York: Guilford Press.Google Scholar
  14. Chorpita, B. F., Yim, L. M., Donkervoet, J. C., Arensdorf, A., Amundsen, M. J., McGee, C., et al. (2002). Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawai’i Empirical Basis to Services Task Force. Clinical Psychology: Science and Practice, 9, 165–190.CrossRefGoogle Scholar
  15. Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38, 835–855.PubMedCrossRefGoogle Scholar
  16. Cohen, J. (1988). Statistical power analysis for the behavioral sciences, 2nd edn. Hillsdale: Lawrence Erlbaum Associates, Inc.Google Scholar
  17. Cunningham, P. B., & Henggeler, S. W. (1999). Engaging multiproblem families in treatment: Lessons learned throughout the development of multisystemic therapy. Family Process, 38, 265–286.PubMedCrossRefGoogle Scholar
  18. de Ross, R., Gullone, E., & Chorpita, B. F. (2002). The Revised Child Anxiety and Depression Scale: A psychometric investigation with Australian youth. Behaviour Change, 19, 90–101.CrossRefGoogle Scholar
  19. Francis, S. E., & Chorpita, B. F. (2004). Behavioral assessment of children in outpatient settings. In S. N. Haynes & E. M. Heiby (Eds.), Comprehensive handbook of psychological assessment: Vol. 3. Behavioral assessment (pp. 291–319). Hoboken: John Wiley & Sons.Google Scholar
  20. Griffith, J. D., Knight, D. K., Joe, G. W., & Simpson, D. D. (1998). Implications of family and peer relations for treatment engagement and follow-up outcomes: An integrative model. Psychology of Addictive Behaviors, 12, 113–126.CrossRefGoogle Scholar
  21. Hammen, C., Rudolph, K., Weisz, J., Rao, U., & Burge, D. (1999). The context of depression in clinic-referred youth: Neglected areas in treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 64–71.PubMedCrossRefGoogle Scholar
  22. Henggeler, S. W., Schoenwald, S. K., Rowland, M. D., & Cunningham, P. B. (2002). Serious emotional disturbance in children and adolescents: Multisystemic therapy. New York: Guilford Publications, Inc.Google Scholar
  23. Hoagwood, K., Jensen, P. S., Petti, T., & Burns, B. J. (1996). Outcomes of mental health care for children and adolescents: I. A comprehensive conceptual model. Journal of the American Academy of Child and Adolescent Psychology, 35, 1055–1063.CrossRefGoogle Scholar
  24. Hoagwood, K., & Olin, S. S. (2002). The NIMH blueprint for change report: research priorities in child and adolescent mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 760–767.PubMedCrossRefGoogle Scholar
  25. Hodges, K., & Wong, M. M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The child and adolescent functional assessment scale. Journal of Child and Family Studies, 5, 445–467.CrossRefGoogle Scholar
  26. Hodges, K., & Wong, M. M. (1997). Use of the Child and Adolescent Functional Assessment Scale to predict service utilization and cost. Journal of Mental Health Administration, 24, 278–290.PubMedCrossRefGoogle Scholar
  27. Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6, 65–70.Google Scholar
  28. Huey, S. J., & Polo, A. J. (in press). Evidence-based psychosocial treatments for ethnic minority youth: A review and meta-analysis. Journal of Clinical Child & Adolescent Psychology.Google Scholar
  29. Jaccard, J., & Guilamo-Ramos, V. (2002). Analysis of variance frameworks in clinical child and adolescent psychology: Advanced issues and recommendations. Journal of Clinical Child and Adolescent Psychology, 31, 278–294.PubMedCrossRefGoogle Scholar
  30. Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., et al. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 311–318.PubMedCrossRefGoogle Scholar
  31. Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Clinical and Consulting Psychology, 65, 453–463.CrossRefGoogle Scholar
  32. Kazdin, A. E., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60, 733–740.PubMedCrossRefGoogle Scholar
  33. Kazdin, A. E., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28, 60–172.Google Scholar
  34. Kendall, P. C., Marrs-Garcia, A., Nath, S., & Sheldrick, R. C. (1999). Normative comparisons for the evaluation of clinical significance. Journal of Consulting and Clinical Psychology, 67, 285–299.PubMedCrossRefGoogle Scholar
  35. Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65, 883–888.PubMedCrossRefGoogle Scholar
  36. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales, 2nd edn. Sydney: Psychology Foundation of Australia.Google Scholar
  37. McKay, M. M., McCadam, K., & Gonzales, J. J. (1996). Addressing the barriers to mental health services for inner city children and their caretakers. Community Mental Health Journal, 32, 353–361.PubMedCrossRefGoogle Scholar
  38. McMahon, R. J., Wells, K. C., & Kotler, J. S. (2006). Conduct problems. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders, 3rd edn. New York: Guilford Press.Google Scholar
  39. Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10, 155–180.CrossRefGoogle Scholar
  40. Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73, 872–879.PubMedCrossRefGoogle Scholar
  41. Patterson, G. R., & Chamberlain, P. (1994). A functional analysis of resistance during parent training therapy. Clinical Psychology: Science and Practice, 1, 53–70.CrossRefGoogle Scholar
  42. Persons, J. B., & Silberschatz, G. (1998). Are results of randomized controlled trials useful to psychotherapists? Journal of Consulting and Clinical Psychology, 66, 126–135.PubMedCrossRefGoogle Scholar
  43. Rodríguez, M. D., Rodríguez, J., & Davis, M. (2006). Recruitment of first-generation Latinos in a rural community: The essential nature of personal contact. Family Process, 45, 87–100.PubMedCrossRefGoogle Scholar
  44. Rogers, J. L., Howard, K. I., & Vessey, J. T. (1993). Using significance tests to evaluate equivalence between two experimental groups. Psychological Bulletin, 113, 553–565.PubMedCrossRefGoogle Scholar
  45. Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 660–668.PubMedCrossRefGoogle Scholar
  46. Safren, S. A., Gonzalez, R. E., Horner, K. J., Leung, A. W., Heimberg, R. G., & Juster, H. R. (2000). Anxiety in ethnic minority youth: Methodological and conceptual issues and review of the literature. Behavior Modification, 24, 147–183.PubMedCrossRefGoogle Scholar
  47. Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when. Psychiatric Services, 52, 1190–1197.PubMedCrossRefGoogle Scholar
  48. Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.PubMedGoogle Scholar
  49. Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV: Child version. San Antonio: Psychological Corporation.Google Scholar
  50. Silverman, W. K., & Nelles, W. B. (1988). The influence of gender on children’s ratings of fear in self and same-aged peers. Journal of Genetic Psychology, 149, 17–21.PubMedGoogle Scholar
  51. Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937–944.PubMedCrossRefGoogle Scholar
  52. Siqueland, L., Crits-Christoph, P., Gallop, B., Gastfriend, D., Lis, J., Frank, A., Griffin, M., Blaine, J., & Luborsky, L. (2002). Who starts treatment: Engagement in the NIDA collaborative cocaine treatment study. American Journal on Addictions, 11, 10–23.PubMedCrossRefGoogle Scholar
  53. Southam-Gerow, M. A. (2005). Using partnerships to adapt evidence-based mental health treatments for use outside labs. Report on Emotional and Behavioral Disorders in Youth, 5, 58–60, 77–79.Google Scholar
  54. Southam-Gerow, M. A., Austin, A. A., & Marder, A. M. (in press). Transportability and dissemination of psychological treatments: Research models and methods. In D. McKay (Ed.), Handbook of research methods in abnormal and clinical psychology. Newbury Park: Sage.Google Scholar
  55. Southam-Gerow, M. A., Kendall, P. C., & Weersing, V. R. (2001). Examining outcome variability: Correlates of treatment response in a child and adolescent anxiety clinic. Journal of Clinical Child Psychology, 30, 422–436.PubMedCrossRefGoogle Scholar
  56. Southam-Gerow, M. A., Ringeisen, H. L., & Sherrill, J. T. (2006). Introduction to Special Issue: Integrating interventions and services research: Progress and prospects. Clinical Psychology: Science and Practice, 13, 1–8.CrossRefGoogle Scholar
  57. Southam-Gerow, M. A., Silverman, W. K., & Kendall, P. C. (2006). Client similarities and differences in two childhood anxiety disorders research clinics. Journal of Clinical Child and Adolescent Psychology, 35, 528–538.PubMedCrossRefGoogle Scholar
  58. Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2003). Youth with anxiety disorders in research and service clinics: Examining client differences and similarities. Journal of Clinical Child and Adolescent Psychology, 32, 375–385.PubMedCrossRefGoogle Scholar
  59. U.S. Department of Health and Human Services. (2003). Outreach notebook for the inclusion, recruitment and retention of women and minority subjects in clinical research (NIH publication no. 03-7036). Retrieved 1 Nov 2007, from
  60. Weiss, B., Catron, T., & Harris, V. (2000). A 2-year follow-up of the effectiveness of traditional child psychotherapy. Journal of Consulting and Clinical Psychology, 68, 1094–1101.PubMedCrossRefGoogle Scholar
  61. Weisz, J. R. (2000). Lab-clinic differences and what we can do about them: I. The Clinic-Based Treatment Development Model. Clinical Child Psychology Newsletter, 15(1–3), 10.Google Scholar
  62. Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688–701.PubMedCrossRefGoogle Scholar
  63. Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132, 132–149.PubMedCrossRefGoogle Scholar
  64. Weisz, J. R., Southam-Gerow, M. A., Gordis, E. B., & Connor-Smith, J. K. (2003). Primary and Secondary Control Enhancement Training for youth depression: Applying the Deployment-Focused Model of treatment development and testing. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based treatments for children and adolescents (pp. 165–183). New York: Guilford.Google Scholar
  65. Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. American Psychologist, 47, 1578–1585.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Michael A. Southam-Gerow
    • 1
    Email author
  • Bruce F. Chorpita
    • 2
  • Lauren M. Miller
    • 1
  • Alissa A. Gleacher
    • 2
    • 3
  1. 1.Department of PsychologyVirginia Commonwealth UniversityRichmondUSA
  2. 2.University of Hawai’iManoa, HonoluluUSA
  3. 3.Center for Advancement of Children’s Mental HealthColumbia UniversityNew YorkUSA

Personalised recommendations