Enhancing the Capacity of School Nurses to Reduce Anxiety in Children: Lessons Learned from Developing the CALM Intervention

Anxiety disorders are the most common psychiatric illnesses in youth and severely impair daily functioning. Unfortunately, most anxious youth are never identified and do not receive treatment. Intervening to reduce anxiety in the school setting is ideal because 1) access to care is more available; 2) the school context is often anxiety-provoking (e.g., separation, worry about academic performance, fear of negative social evaluation); and 3) children with excessive anxiety are at greater risk for poor academic performance, excessive school absences and school refusal. Because a key feature of anxiety is physical complaints, anxious children frequently seek help from the school nurse, who often represents the first point of contact. Thus, school nurses are in an ideal position to identify and intervene early with anxious children.

This presentation describes preliminary findings from an IES-funded project that is developing a nurse-administered intervention (CALM; Child Anxiety Learning Modules). CALM is based on cognitive behavioral therapy (CBT) strategies to reduce anxiety symptoms and improve academic functioning. Despite the advantages of working in schools and training school nurses, a number of barriers—both at the school system level (e.g., getting school approvals) and individual school/nurse level (e.g., limited time for nurses due to competing demands) were identified. This presentation will discuss lessons learned and progress to date.

Three iterative stages (expert feedback, two open trials, pilot RCT) are being used to develop the CALM intervention. Outcomes on anxiety symptoms are collected from parents, children, nurses, teachers and independent evaluators at pre, post and 3 month follow-up. To date, 9 nurses have completed the CALM intervention training for both open trials and children are being enrolled on an ongoing basis.

Feedback from the nurse training was positive and nurses, children and parents who completed the intervention reported high levels of intervention satisfaction. Children (n = 13) enrolled in the open trials are showing reduction in anxiety severity and improvement in global functioning. Barriers identified by nurses included: finding time for training that would not interfere with the work week, locating a private room for child meetings, and freeing up uninterrupted time to meet with the youth. Preliminary results suggest that the intervention is acceptable and feasible in a school setting. Nurses were successfully trained and delivered a psychosocial intervention for anxiety with high fidelity. Barriers for school nurse-delivered interventions remain and additional solutions are needed.