Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis.
OBJECTIVE
Most children with mental health disorders do not receive timely care because of access barriers. These initial trials aimed to determine whether distance interventions provided by nonprofessionals could significantly decrease the proportion of children diagnosed with disruptive behavior or anxiety disorders compared with usual care.


METHODS
In three practical randomized controlled trials, 243 children (80 with oppositional-defiant, 72 with attention-deficit/hyperactivity, and 91 with anxiety disorders) were stratified by DSM-IV diagnoses and randomized to receive the Strongest Families intervention (treatment) or usual care (control). Assessments were blindly conducted and evaluated at 120, 240, and 365 days after randomization. The intervention consisted of evidence-based participant materials (handbooks and videos) and weekly telephone coach sessions. The main outcome was mental health diagnosis change.


RESULTS
Intention-to-treat analysis showed that for each diagnosis significant treatment effects were found at 240 and 365 days after randomization. Moreover, in the overall analysis significantly more children were not diagnosed as having disruptive behavior or anxiety disorders in the treatment group than the control group (120 days: χ(2)(1) = 13.05, p < .001, odds ratio 2.58, 95% confidence interval 1.54-4.33; 240 days: χ(2)(1) = 20.46, p < .001, odds ratio 3.44, 95% confidence interval 1.99-5.92; 365 days: χ(2)(1) = 13.94, p < .001, odds ratio 2.75, 95% confidence interval 1.61-4.71).


CONCLUSIONS
Compared with usual care, telephone-based treatments resulted in significant diagnosis decreases among children with disruptive behavior or anxiety. These interventions hold promise to increase access to mental health services.


BACKGROUND
Strongest Families: Pediatric Disruptive Behaviour Disorder, http://www.clinicaltrials.gov, NCT00267579; Strongest Families: Pediatric Attention-Deficit/Hyperactivity Disorder, http://www.clinicaltrials.gov, NCT00267605; and Strongest Families: Pediatric Anxiety, http://www.clinicaltrials.gov, NCT00267566.
IWK Health Centre and Dalhousie University in Halifax, Nova Scotia, Canada.
Patrick J
PJ
McGrath
Patricia
P
Lingley-Pottie
Catherine
C
Thurston
Cathy
C
MacLean
Charles
C
Cunningham
Daniel A
DA
Waschbusch
Carolyn
C
Watters
Sherry
S
Stewart
Alexa
A
Bagnell
Darcy
D
Santor
William
W
Chaplin
D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005196:Family Therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D011569:Psychiatric Status Rating Scales; D019114:Remote Consultation; D016037:Single-Blind Method; D016896:Treatment Outcome