Feasibility and Acceptability of a Toolkit to Facilitate Clinician Use of Exposure Therapy for Youth

ABSTRACT

Exposure therapy is a key element of cognitive-behavioral therapy for youth with anxiety. However, few clinicians outside of specialty anxiety clinics routinely use exposures with anxious youth. This study reports on the acceptability and feasibility of a clinician support toolkit for exposures with anxious youth in community settings. The toolkit was developed through an extensive literature review of exposure science and cited barriers to exposure therapy, with input from multiple experts in pediatric anxiety (n = 10). Acceptability and feasibility data were gathered via survey from 70 community clinicians attending a training on exposure therapy for youth. Qualitative data were collected from a subset of participants who used the toolkit with youth on their caseload for approximately 1 month. Survey data suggested that the toolkit was viewed highly favorably. Qualitative interviews indicated that the toolkit was viewed as a feasible therapeutic tool that positively impacted clinician motivation to use exposure. Primary challenges related to exposure use more generally and included client and service-setting barriers. Results suggested initial toolkit acceptability and feasibility. Future work to refine the toolkit and test its efficacy as an implementation strategy to increase clinician use of exposure therapy is warranted. Next steps include development of additional content in partnership with key stakeholders and testing the toolkit’s impact on increasing clinician use of exposure therapy.

Acknowledgments

We gratefully acknowledge the assistance of the following individuals who provided feedback on the development of the Resource for Exposures for Anxiety Disordered Youth: Emily Bilek, Lauren Brumley, Mark Fereira, Golda Ginsburg, Aimee Hildenbrand, Amanda Jensen-Doss, Emily Lattie, Sarah Morris, Lauren Swift, Alex Tice, Courtney Weiner, Ariel Williamson, and Hana Zickgraf. We are also grateful to Shannon Dorsey, Lucy Berliner, and the Washington State CBT+ Initiative funded by the Division of Behavioral Health and Recovery, without whom this work would not have been possible. Finally, we acknowledge Lesley Sasnett and Kelsie Okamura for their assistance in the preparation of this manuscript.

Disclosure statement

Dr. Beidas receives royalties from Oxford University Press and has served as a consultant for Merck. The remaining authors report no conflicts of interest.

Funding

The work was supported by a grant from the Health Resources & Services Administration, Maternal and Child Health Bureau #6 T73MC00051-16-01 to the Children’s Hospital of Philadelphia and K23 MH099179 from the National Institute of Mental Health awarded to the last author.

Additional information

Funding

The work was supported by a grant from the Health Resources & Services Administration, Maternal and Child Health Bureau #6 T73MC00051-16-01 to the Children’s Hospital of Philadelphia and K23 MH099179 from the National Institute of Mental Health awarded to the last author.