(PS3-D87) Understanding Predictors and Outcomes of Engagement in a School-nurse Delivered Intervention for Child Anxiety

Treatment engagement is a multi-dimensional construct which has been shown to impact a number of psychotherapy outcomes for children including symptom change and overall functioning. Research on treatment engagement has focused largely on mental healthcare delivered in a traditional psychotherapy context. Given the current access to care problem for youth and the shortage of mental health care providers in the US, it is important to understand whether non-traditional providers (e.g., teachers, nurses) are able to engage children in treatment and whether treatment engagement in these non-traditional contexts impacts outcomes. This study added to the growing body of treatment engagement research by examining the impact of three dimensions of engagement (child in-session engagement, in-session comprehension, and homework completion) on outcomes for children aged 5-12 (N=54) enrolled in a randomized controlled trial of two brief anxiety interventions (CBT-based and relaxation-based) delivered by school nurses. Additionally, this study explored potential predictors of treatment engagement at the child level including child age, child hyperactivity/ impulsivity and child anxiety symptom severity. Data on child symptoms and global functioning were collected through parent surveys and semi-structured interviews with families conducted by independent evaluators at pre and post treatment. Nurse-reported child in-session engagement, understanding, and homework completion data were collected through brief surveys following each treatment session. Average homework completion across sessions was 71%. Average in-session engagement was 5.9 on a 7-point scale of engagement (1 = not at all engaged, 7 = extremely engaged) and average in-session understanding was 5.98 on a 7-point scale of understanding (1 = not at all, 7 = completely understood). Linear regressions were conducted in SPSS to examine the impact of child level variables of interest on treatment engagement dimensions, controlling for intervention group, and global functioning at baseline. Greater child age at baseline significantly predicted greater average session comprehension (β = .32, p = .024). No other variables emerged as significant predictors of engagement dimensions. A second set of regression analyses were conducted to understand the impact of treatment engagement dimensions on child outcomes of interest (anxiety severity, anxiety improvement, global functioning), controlling for child age, intervention group, and outcomes at baseline. Greater session comprehension significantly predicted reduced child anxiety severity (β = -.464, p = .048) and increased child anxiety symptom improvement (β = -.55, p = .026) at post treatment. Results suggest that school nurses are able to successfully engage students in anxiety treatment. Younger children may have a more difficult time understanding the content of anxiety treatment sessions which predicted worse treatment outcomes. As we continue to task shift child mental healthcare, it will be important to support non-traditional providers in tailoring session content to meet the needs (e.g., developmental level) of the children they are working with to ensure maximum benefit from treatment.