The management of childhood anxiety disorders in Ontario’s public mental health system.
Bibliographic record
Abstract
Although cognitive-behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for childhood anxiety disorders, the extent to which these interventions comprise usual care is unclear. This study evaluated the management of childhood anxiety in Ontario within 56 publicly funded community- and hospital-based mental health centers using a population survey. Psychologists and psychiatrists rated the frequency of interventions provided within their settings, with results highlighting only moderate access to evidence-based CBT and SSRI treatments. Exposure, a core component of CBT for anxiety, was underutilized. Usual care most often entailed psychoeducation, relaxation training, and family-based approaches. Consistent with established guidelines, combined interventions were typically used to treat moderate to severe levels of anxiety. Practitioners recommended similar care sequences, with the majority beginning with psychotherapy. Difficulties accessing CBT in publicly funded settings in Ontario may be due to the low number of practitioners with expertise in CBT. Implications for the translation and dissemination of evidence-based treatments into clinical settings are discussed.Keywords: childhood, anxiety disorders, cognitive- behavioural therapy, selective serotonin reuptake inhibitors, usual careResumeIl est reconnu que la therapie cognitivo-comportementale (TCC) et les inhibiteurs selectifs de la recapture de la serotonine (ISRS) sont des methodes efficaces pour traiter les troubles d'anxiete chez l'enfant. Or, la mesure dans laquelle ces interventions compren- nent des soins habituels n'est pas claire. Cette etude a evalue la gestion de l'anxiete chez des enfants repartis a travers 56 centres de sante mentale communautaires et hospitaliers publics de l'Ontario au moyen d'une enquete en population. Les psycho- logues et psychiatres ont evalue la frequence des interventions pratiquees dans leurs etablissements dont les resultats ont revele un acces minime a la TCC et a l'ISRS, deux methodes de traitement fondees sur les preuves. L'exposition, un element central de la TCC en ce qui a trait a l'anxiete, a ete sous-utilisee. Les soins habituels incluaient le plus souvent la psychopedagogie, les tech- niques de relaxation et les approches axees sur la famille. Confor- mement aux directives etablies, les interventions combinees etaient generalement utilisees pour traiter les cas d'anxiete de niveau modere a eleve. Les praticiens ont recommande des sequences de soins similaires, dont la majorite commencait avec la psycho- therapie. La difficulte d'acces a la TCC dans les etablissements de sante publics de l'Ontario pourrait etre attribuable au faible nom- bre de praticiens ayant une expertise en TCC. Les implications relatives a la traduction et la diffusion de traitements fondes sur des preuves dans des contextes cliniques y sont abordees.Mots-cles : enfance, troubles d'anxiete, therapie cognitivo- comportementale, inhibiteurs selectifs de la recapture de la sero- tonine, soins habituels.Substantial empirical data support the use of cognitivebe- havioural therapy (CBT) and pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) in the treatment of child- hood anxiety disorders (Cartwright-Hatton, Roberts, Chitsabesan, Fothergill, & Harrington, 2004; Ipser, Stein, Hawkridge, & Hoppe, 2009; Ishikawa, Okajima, Matsuoka, & Sakano, 2007; James, Soler, & Weatherall, 2005; Kodish, Rockhill, & Varley, 2011; Reinblatt & Riddle, 2007; Silverman, Pina, & Viswesvaran, 2008; Walkup et al., 2008). Some evidence suggests that their combina- tion may be most effective, with results from a randomized control trial showing that combined CBT and SSRI (Sertraline) treatment was superior to either monotherapy (Walkup et al., 2008). Based on research evidence, several professional organisations have de- veloped practice guidelines. For instance, the American Aca- demy of Child and Adolescent Psychiatry (AACAP; Connolly, Bernstein, & Work Group on Quality Issues, 2007) issued practice parameters for the treatment of childhood anxiety advocating for the use of combined treatment with SSRIs and psychotherapy, such as CBT, for moderate to severe anxiety in children. …
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".