Addressing the Needs of Diverse Youth with ASD and Anxiety in Public Schools: Stakeholder Input on Adaptations of Clinic-Based Facing Your Fears

  • Judy ReavenEmail author
  • Nuri Reyes
  • Katherine Pickard
  • Tanea Tanda
  • Megan A. Morris
Original Paper


Anxiety disorders are among the most common co-occurring psychiatric conditions for youth with ASD (van Steensel et al. in Clin Child Fam Psychol Rev 14:302–317, 2011). Although modified cognitive behavioral therapies (CBT) have yielded significant reductions in anxiety, substantial disparities in access to mental health services exist for youth from diverse and low-income families. Schools represent a consistent resource for underserved communities; thus, there is a critical need to adapt and implement CBT programs in school settings. Engaging stakeholders in the initial phase of adaptation is essential to support adoption and sustainability of best practice interventions in schools. The primary purpose of the study was to adapt group CBT (Facing Your Fears (FYF); Reaven et al. in Facing your fears: group therapy for managing anxiety in children with high-functioning autism spectrum disorders, Paul Brookes Publishing, Baltimore, 2011) via iterative processes with key stakeholders to create a feasible, effective, and sustainable school-based program to manage anxiety in underserved students with ASD. Two rounds of parent and professional focus groups were conducted across three school districts (total 14 groups), using qualitative content analysis methodology. Details regarding the delivery of FYF, selection of students, training considerations for staff, and identifying meaningful outcomes were obtained in anticipation of an implementation trial of FYF.


Autism spectrum disorder Anxiety Cognitive Behavioral Therapy School mental health 



The authors extend a special thanks to the administrators from the participating school districts, professionals, and parents who participated in this study, as well as other clinicians who helped to facilitate the focus groups: Audrey Blakeley-Smith, Susan Hepburn, and Allison Meyer. We also wish to thank Aubyn Stahmer, Ph.D., for her invaluable consultation


The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by Health Resources and Services Administration (HRSA) (PI: Reaven—1 R41 MC31075-01-00). Judy Reaven receives royalties from the publication of Facing your fears: group therapy for managing anxiety in children with high-functioning autism spectrum disorders (FYF; Reaven et al., 2011). Judy Reaven is supported in part, by the Health Resources and Services Administration (HRSA) under the Leadership Education in Neurodevelopmental Disabilities (LEND) Grant T73MC11044 and by the Administration on Intellectual and Developmental Disabilities (AIDD) under the University Center of Excellence in Developmental Disabilities (UCDEDD) Grant 90DD0632 of the U.S. Department of Health and Human Services (HHS). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. There are no other disclosures for the other authors.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board at the University of Colorado Anschutz Medical Campus, Protocol #17-1656 and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained for all individual participants.


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

Authors and Affiliations

  1. 1.Department of Psychiatry, JFK PartnersUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Children’s Hospital ColoradoAuroraUSA
  3. 3.Adult and Child Consortium for Health Outcomes and Delivery ScienceUniversity of Colorado Anschutz Medical CampusAuroraUSA

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