School Mental Health

, Volume 11, Issue 4, pp 719–727 | Cite as

Exploring Treatment as Usual for Pediatric Anxiety Disorders Among School-Based Clinicians

  • Golda S. GinsburgEmail author
  • Michela Muggeo
  • E. B. Caron
  • Heather R. Souer
  • Paige J. Pikulski
Original Paper


Cognitive-behavioral therapy (CBT) remains the only evidenced-based psychosocial treatment for pediatric anxiety. Adoption of CBT in community settings has been slow, and data on CBT use in schools specifically are limited. This study examined: (1) school-based clinicians’ perceptions of their treatment approach for pediatric anxiety disorders, use of therapeutic strategies reported after each session, and overall perceived confidence in treating anxiety disorders, and (2) independent evaluator (IE) ratings of clinicians’ use of CBT, the frequency and quality of specific CBT elements in sessions, and overall competence in treating anxiety. An exploratory aim examined whether clinician characteristics were associated with IE-rated CBT use. Participants included 25 school-based clinicians who delivered treatment as usual in a randomized controlled trial of treatments for anxious children and adolescents. At baseline, clinicians reported their approach to treating anxious youth. After each session (N = 475), they reported the therapeutic strategies they used. IEs rated audiotaped therapy sessions (N = 90). Results indicated a majority of school clinicians reported using a behavioral or cognitive-behavioral approach for anxiety (68% at baseline and in 76% of sessions). In contrast, 14% of the IE-rated sessions had the primary therapeutic strategy coded as cognitive-behavioral. Clinician confidence and IE competence ratings were also discrepant, with clinicians rating themselves as somewhat confident in treating anxious youth but IEs assigning a low competence rating. Use and quality of CBT elements based on IE-rating were low. Several clinician characteristics were associated with CBT use. Findings suggest a need to improve the training of school-based clinicians in EBTs for students with anxiety.


Child anxiety School-based treatment Cognitive-behavioral therapy Treatment as usual 



We are grateful for the hard work and support of many research assistants and school personnel throughout the course of the study. The authors would also like to thank all the clinicians, students, and parents who participated in the study. We are especially grateful to Kelly Drake, Jeff Pella, Sarah Williams, Amy Hale, Courtney Keeton, and Brian Padilla.


The research reported here was supported by the Institute of Education Sciences, US Department of Education, through Grant R324A120405 to Dr. Ginsburg. The opinions expressed are those of the authors and do not represent views of the institute or the US Department of Education.

Compliance with Ethical Standards

Conflict of interest

Dr. Ginsburg serves as a consultant for Syneos Heath and receives funding from the National Institute of Mental Health and the Institute of Education Sciences. The other authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Golda S. Ginsburg
    • 1
    Email author
  • Michela Muggeo
    • 2
  • E. B. Caron
    • 1
  • Heather R. Souer
    • 1
  • Paige J. Pikulski
    • 1
  1. 1.Department of PsychiatryUniversity of Connecticut School of MedicineWest HartfordUSA
  2. 2.Clarus Health AllianceNorwichUSA

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