www.pspbc.ca

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Delivery of Effective Treatment for Anxiety
Disorders
6 Key Steps
1.
Identification of children at risk
2.
Useful methods for screening and diagnosis
3.
Treatment template
4.
Suicide assessment
5.
Safety/contingency planning
6.
Referral flags
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I. Identification of Children & Youth At Risk
 Ideal position of first contact health providers
 Screen usual-risk youth at routine vaccination and start of school visits
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Anxiety Disorder Identification Table
Significant
Risk Affect
Moderate
Risk Affect
Possible
“group” Identifiers
(not causal for anxiety disorder; may identify factors related to adolescent onset anxiety)
1. Family history of anxiety disorder
2. Severe and/or persistent environmental stressors in early childhood
1. Children with shy, inhibited and/or cautious temperament (innate personality type)
2.
Family history of a mental illness (mood disorder, substance abuse disorder)
3. Have experienced a traumatic event
1. School failure or learning difficulties
2. Socially or culturally isolated
3. Bullying (victim and/or perpetrator)
4. Gay, Lesbian, Bi-sexual,
Transsexual
5. Substance abuse and mis-use
(cigarettes & alcohol)
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A Child is Identified At Risk
 Educate about risk
 Obtain family history
 “Clinical review” threshold
 Standing “mental health check-up”
 Confidentiality, understanding & informed consent
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Standing “Mental Health Check-up”
Screen at-risk youth every 6 months
15 minute office/clinical visits every 6 months
Anxiety symptoms worsen:
During school year
Before first weeks of school
Should not cause severe distress or dysfunction
Anxiety symptoms decrease:
- In summer months
- After first few weeks of school
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School reports and patterns
Physical complaints
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Differentiating Distress from
Disorder
 Appropriate/Adaptive Anxiety
›
Short duration (< a few weeks)
›
Resolves spontaneously, or
›
Ameliorated by social supported or environmental modification
 Anxiety Disorder
›
Long duration (usually lasting many months)
›
Significantly interferes with functioning
›
Is often out of sync with magnitude of stressor
›
Usually require health provider intervention
›
Diagnosis made using DSM IV-TR criteria
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Useful Methods for Screening & Diagnosis
 Psychotherapeutic Support for Teens (PST)
 Kutcher Adolescent Depression Scale (KADS)
›
A screening tool for depression
 Teen or Child Functional Assessment (TeFA; CFA)
›
Self-report tool (child depending)
›
3 minutes to complete
›
Assists in evaluating four functional domains of teen mental health
 School
 Home
 Work
 Friends
 Tool for Assessment of Suicide Risk (TASR-A)
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Clinical Approach to Possible Child / Adolescent
Anxiety Disorder
Visit 1: SCARED Function
Use PST & MEP as indicated and as time allows
If SCARED is 25 or greater (parent and/or child) or shows decrease in function, review WRP/Stress management strategies and proceed to step 2 in 1-2 weeks.
If SCARED < 25 and/or shows no decrease in function, monitor again (SCARED) in a month. Advise to call if feeling worse or any safety concerns.
Visit 2: SCARED,
Function. Use PST & MEP
If SCARED > 25, and shows decrease in function, utilize PST strategies, review WRP and proceed to step 3 within a week.
If SCARED <25 and shows no decrease in function, monitor again in a month. Advise to call if feeling worse or any safety concerns.
Visit 3: SCARED, Function. Use
PST & MEP
If SCARED remains > 25 or shows decrease in function, proceed to diagnosis (DSM-IVTR criteria) and treatment
If SCARED <25 and shows no decrease in function, monitor again (SCARED) in one month. Advise to call if feeing worse or any safety concerns.
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Teen Anxiety Disorder is Suspected
SCARED score is 25 or higher
 Discuss issues/problems in the youth’s life/environment.
 Teen Functional Activities Assessment (TeFA)
 Supportive, non-judgmental problem solving assistance
›
Psychotherapeutic Support for Teens (PST) as a guide
 Strongly encourage and prescribe:
 Exercise
 Regulated sleep
 Regulated eating
 Positive social activities
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Teen Anxiety Disorder is Suspected
 Screen for depression
›
Use the Kutcher Adolescent Depression Screen (KADS)
 Screen for suicide risk
›
Use the Tool for Assessment of Suicide Risk (TASR)
 Mental Health Check-ups
›
Second visit one week from visit
 Can include TeFA and/or PST (15 – 20 mins)
 If suicide or depression concerns use KADS & TASR-A
›
Third visit two weeks later
 Repeat SCARED and other tools as indicated
 Make treatment plan as indicated
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Teen Anxiety Disorder is Suspected
 If Panic Disorder:
›
Complete Panic Attack Diary
›
Complete DPG:TD Diary
 If Social Anxiety Disorder
›
Complete K-GSADS-A
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Don’t Get Overwhelmed
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III. Childhood Anxiety Treatment Template
 Specific Factors
›
Evidence based treatments:
 Structured psychotherapies (e.g. Cognitive Behavioral Therapy
- CBT)
 Medication
 Non-specific Factors
›
Activities
 Decrease stress, improve mood and general well-being
›
Supportive psychological interventions
 PST in toolkit guide
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Psychotherapy
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