Community Mental Health Journal

, Volume 53, Issue 1, pp 53–61 | Cite as

Delivering CBT to Rural Latino Children with Anxiety Disorders: A Qualitative Study

  • Denise A. Chavira
  • Cristina E. Bustos
  • Maritza S. Garcia
  • Bernardo Ng
  • Alvaro Camacho
Original Paper


Qualitative methods were used to understand community perspectives about ways to deliver cognitive behavior therapy (CBT) to rural Latino youth with anxiety. First, four focus groups were conducted with 28 bilingual Latino mental health providers to examine perceptions of CBT using telephone based, therapist supported bibliotherapy, and bibliotherapy without therapist support. Second, qualitative interviews were conducted with 15 Latino parents from a rural community to better understand attitudes toward CBT, and modes of service delivery. Qualitative findings revealed that parents were mostly positive about psychotherapy, and the core elements of CBT for anxiety. However, both parents and providers emphasized the need for adaptations to address practical and perceived barriers to treatment, such as time, convenience, homework, and literacy. Many parents spoke favorably of a telephone-based approach that could address many of their perceived barriers, while providers were expressed more negative views. Such findings are important for data-driven treatment development efforts.


Latino Rural Child anxiety Cognitive behavior therapy Telemedicine 



This study was supported by a Grant to DAC from the National Institute of Mental Health (R34MH090149). The authors wish to acknowledge our collaborators at the affiliated healthcare clinics as well as our research assistants, and participating providers/families.


  1. Alegría, M., Canino, G., Lai, S., Ramirez, R. R., Chavez, L., Rusch, D., & Shrout, P. E. (2004). Understanding caregivers’ help-seeking for latino children’s mental health care use. Medical Care, 42(5), 447–455.CrossRefPubMedGoogle Scholar
  2. Angold, A., Erkanli, A., Farmer, E. M., Fairbank, J. A., Burns, B. J., Keeler, G., & Costello, E. J. (2002). Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry, 59(10), 893–901.CrossRefPubMedGoogle Scholar
  3. Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236. doi: 10.1097/00004583-199910000-00011.CrossRefPubMedGoogle Scholar
  4. Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545–553. doi: 10.1097/00004583-199704000-00018.CrossRefPubMedGoogle Scholar
  5. Cabassa, L. J., Zayas, L. H., & Hansen, M. C. (2006). Latino adults’ access to mental health care: A review of epidemiological studies. Administration and Policy In Mental Health, 33(3), 316–330. doi: 10.1007/s10488-006-0040-8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Castro, F. G., Barrera, M, Jr, & Holleran Steiker, L. K. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Reviews of Clinical Psychology, 6, 213–239. doi: 10.1146/annurev-clinpsy-033109-132032.CrossRefGoogle Scholar
  7. Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2003). Parental opinions regarding treatment for social anxiety disorder in youth. Journal of Developmental and Behavioral Pediatrics, 24(5), 315–322.CrossRefPubMedGoogle Scholar
  8. Chorpita, B. F. (2002). Treatment manuals for the real world: Where do we build them? Clinical Psychology: Science and Practice, 9(4), 431–433. doi: 10.1093/clipsy.9.4.431.Google Scholar
  9. Cuffe, S. P., Moore, C. G., & McKeown, R. (2009). ADHD and health services utilization in the national health interview survey. Journal of Attention Disorders, 12(4), 330–340. doi: 10.1177/1087054708323248.CrossRefPubMedGoogle Scholar
  10. Elgar, F. J., Arlett, C., & Groves, R. (2003). Stress, coping, and behavioural problems among rural and urban adolescents. Journal of adolescence, 26(5), 574–585. doi: 10.1016/S0140-1971(03)00057-5.CrossRefGoogle Scholar
  11. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gryter.Google Scholar
  12. Howell, E., & McFeeters, J. (2008). Children’s mental health care: differences by race/ethnicity in urban/rural areas. Journal of Health Care for the Poor and Underserved, 19(1), 237–247.CrossRefPubMedGoogle Scholar
  13. Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311–318.CrossRefPubMedGoogle Scholar
  14. Kazdin, A. E. (2001). Bridging the enormous gaps of theory with therapy research and practice. Journal of clinical child psychology, 30(1), 59–66.CrossRefPubMedGoogle Scholar
  15. Kazdin, A. E., & Wassell, G. (2000). Therapeutic changes in children, parents, and families resulting from treatment of children with conduct problems. Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 414–420. doi: 10.1097/00004583-200004000-00009.CrossRefPubMedGoogle Scholar
  16. Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65(5), 883–888.CrossRefPubMedGoogle Scholar
  17. Lau, A. S. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295–310.Google Scholar
  18. Lyneham, H. J., & Rapee, R. M. (2006). Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Research and Therapy, 44(9), 1287–1300.CrossRefPubMedGoogle Scholar
  19. Montero-Marin, J., Carrasco, J. M., Roca, M., Serrano-Blanco, A., Gili, M., Mayoral, F., & Garcia-Campayo, J. (2013). Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: Protocol for a qualitative study. BMC Psychiatry, 13, 64. doi: 10.1186/1471-244X-13-64.CrossRefPubMedPubMedCentralGoogle Scholar
  20. NVivo qualitative data analysis software, Version 8. QSR International Pty Ltd (2008).Google Scholar
  21. Paul, L. A., Gray, M. J., Elhai, J. D., Massad, P. M., & Stamm, B. H. (2006). Promotion of evidence-based practices for child traumatic stress in rural populations: Identification of barriers and promising solutions. Trauma, Violence & Abuse, 7(4), 260–273.CrossRefGoogle Scholar
  22. Pescosolido, B. A., Perry, B. L., Martin, J. K., McLeod, J. D., & Jensen, P. S. (2007). Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services, 58(5), 613–618. doi: 10.1176/ Scholar
  23. Pina, A. A., Silverman, W. K., Weems, C. F., Kurtines, W. M., & Goldman, M. L. (2003). A comparison of completers and noncompleters of exposure-based cognitive and behavioral treatment for phobic and anxiety disorders in youth. Journal of Consulting and Clinical Psychology, 71(4), 701–705.CrossRefPubMedGoogle Scholar
  24. Pina, A. A., Zerr, A. A., Villalta, I. K., & Gonzales, N. A. (2012). Indicated prevention and early intervention for childhood anxiety: A randomized trial with Caucasian and Hispanic/Latino youth. Journal of Consulting and Clinical Psychology, 80(5), 940–946. doi: 10.1037/a0029460.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Plain Action Language Network. (2011, March, 2011). Improving communication from the federal government to the public. In Federal plain language guidelines. Retrieved November, 2014.Google Scholar
  26. Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 37(1), 105–130. doi: 10.1080/15374410701817907.CrossRefPubMedGoogle Scholar
  27. Skriner, L. C., & Chu, B. C. (2014). Cross-ethnic measurement invariance of the SCARED and CES-D in a youth sample. Psychological Assessment, 26(1), 332–337. doi: 10.1037/a0035092.CrossRefPubMedGoogle Scholar
  28. U.S. Congress, Office of Technology Assessment. (1990). Health care in rural America OTA-H-434. Washington, DC.Google Scholar
  29. Whitfield, G., & Williams, C. (2004). If the evidence is so good, why doesn’t anybody use them? A national survey of the use of computerize cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy, 32(01), 57–65.CrossRefGoogle Scholar
  30. Williams, C., & Garland, A. (2002). A cognitive behavioral therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8, 172–179. doi: 10.1192/apt.8.3.172.CrossRefGoogle Scholar
  31. Willms, D. G., Johnson, N. A., & White, N. F. (1992). A qualitative study of family practice physician health promotion activities. Thousand Oaks, CA: Sage Publications.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Denise A. Chavira
    • 1
    • 2
  • Cristina E. Bustos
    • 2
  • Maritza S. Garcia
    • 2
  • Bernardo Ng
    • 2
    • 3
  • Alvaro Camacho
    • 2
    • 3
  1. 1.Department of PsychologyUniversity of California Los AngelesLos AngelesUSA
  2. 2.Department of PsychiatryUniversity of California San DiegoLa JollaUSA
  3. 3.Sun Valley Research CenterImperialUSA

Personalised recommendations