5.2 Research on the Taming Sneaky Fears Program
5.2.6 Quality Improvement Study
While the aforementioned randomized controlled trial was being conducted, Monga and Benoit continued to refine the Taming Sneaky Fears program and evaluate the impact of changes brought to the program. One major additional refinement included the creation of an illustrated children’s storybook and companion workbook,Taming Sneaky Fears–Leo the Lion’s story of bravery&Inside Leo’s den: The workbook (Benoit & Monga,2018b), which has also been translated into the French language, Apprivoiser les Peurs-pas-fines–L’histoire de bravoure de Léo le lionceau & Dans la tanière de Léo: Le cahier de travail (Benoit & Monga, 2018a). The English language storybook and companion workbook are now being used as the basis to deliver the child component of the Taming Sneaky Fears program in our clinic. A second refinement included a reduction in the total number of sessions from ten to nine (one parent-only Introduction Session followed by eight child and parent group sessions held separately but concurrently; thus going back to the original number of sessions Monga had envisioned when she first developed the Taming Sneaky Fears program in the early 2000s).
The Hospital for Sick Children authorized Monga and Benoit to conduct a Quality Improvement study to obtain feedback from parents and children and evaluate the further revised version of the Taming Sneaky Fears program, as the Taming Sneaky Fears group CBT program has become the standard of care at the Hospital for Sick Children. This Quality Improvement study was completed between December 2016 and August 2017. According to the hospital policy, this work was primarily intended to improve the current standard of care and not to provide generalizable, scientific knowledge in this field, and as such it was exempt from Research Ethics Board review.
Although there was no formal consenting process, permission was still obtained from parents to participate in the Quality Improvement study, which involved two parts, as described below.
As seen in Table 5.1, thirty-five four- to seven-year-old children (M age 6.1 years; SD 1.0; 19 males) and their parents participated in the first part of the Quality Improvement study in which parents were asked to rate main aspects of the revised Taming Sneaky Fears program, using a five-point rating scale, with 4 very helpful, 3quite helpful, 2somewhat helpful, 1a little helpful, and 0 not at all helpful. A mean score of 3.26 (SD0.72) was obtained for the question,
‘How helpful was the Taming Sneaky Fears program to you in figuring out how to help your child?’ A mean score of 3.00 (SD0.84) was obtained for the question,
‘How helpful was the Taming Sneaky Fears program to your child in learning how to manage anxiety symptoms?’ Parents’ responses to these two main questions sug- gested that parents who participated in this small Quality Improvement study found the revised Taming Sneaky Fears program helpful overall.
As mentioned, the purpose of a Quality Improvement study is not to provide sci- entific evidence, therefore the data provided below are descriptive only, must not be viewed as empirical evidence, and require formal scientific confirmation with proper ethical approval and scientific design. A subgroup of 22 children (Mage6.1 years;
SD1.07; 12 males) with a primary anxiety disorder diagnosis as diagnosed using the parent interview of the Anxiety Disorders Interview Schedule (Silverman &
Albano,1996), participated in the second part of the Quality Improvement study as they attended both a baseline and post-treatment follow-up assessment visit within two weeks of group treatment initiation or completion as protocolized in our previ- ous research studies. This Quality Improvement sample of 22 children was not sig- nificantly different from the sample of children who participated in the comparative research study described in Sect.5.2.3on gender, enthnicity, baseline Anxiety Disor- ders Interview Schedule Clinician Severity Rating, or Children’s Global Assessment Scale score; however, the Quality Improvement sample was slightly older (Mage 6.1 years;SD1.1); as compared with the comparative research study sample (M age5.5 years;SD1.0;t(66) −2.1,p0.040).
Of note, the two clinical assessments conducted as part of the Quality Improve- ment study were conducted by independent but non-blinded clinicians. Data analyses, in the context of a Quality Improvement study with its significant limitations (e.g., meant to be descriptive only and without the stringent ethical and scientific require- ments of research studies), provide clinical support that the revised nine-session Taming Sneaky Fears program might be as efficacious as the previous ten-session program, based on the following: (1) baseline Anxiety Disorders Interview Sched- ule Clinician Severity Rating (M 5.73;SD1.07) significantly decreased post- treatment (M 4.5;SD2.16)t3.47 (1,21),p0.002; (2) Children’s Global Assessment Scale scores improved significantly from pre-treatment (M48.3;SD 10.17) to post-treatment (M 57.7; SD15.80)Z −3.140, p0.002; and (3) parent report on the Spence Preschool Anxiety Scale (Spence & Rapee,1999) improved significantly from baseline 44.19 (SD18.86) to post-treatment 37.52 (SD15.65),t2.60 (1,20),p0.017. In addition, parents completed the Spence Preschool Anxiety Scale (Spence & Rapee,1999) at baseline and post-treatment with total scores improving significantly from 44.19 (SD18.86) to 37.52 (SD 15.65),t2.60 (1,20),p0.017.
The results from this Quality Improvement study provide descriptive support only, and warrant replication using scientifically sound design. However, together with clinical experience with the revised nine-session program, they provide cautious confidence that the revised (and current) nine-session Taming Sneaky Fears group CBT program continues to be helpful to young anxious children and their parents.
The current Taming Sneaky Fears program is detailed in Chaps.6–11.
References
Beck, A. T., & Steer, R. A. (1990).Manual for the Beck anxiety inventory. San Antonio, TX:
Psychological Corporation.
Bennett, K., Manassis, K., Walter, S. D., Cheung, A., Wilansky-Traynor, P., Diaz-Granados, et al.
(2013). Cognitive behavioral therapy age effects in child and adolescent anxiety: An individual patient data metaanalysis.Depression and Anxiety, 30(9), 829–841.
Benoit, D., & Monga, S. (2018a).Apprivoiser les Peurs-pas-fines—L’histoire de bravoure de Léo le lionceau & Dans la tanière de Léo: Le cahier de travail. Victoria, British Columbia: FriesenPress.
Benoit, D., & Monga, S. (2018b).Taming sneaky fears—Part A. Leo the Lion’s story of bravery and Part B. Inside Leo the Lion’s den: How to tame your Sneaky Fears. Victoria, B.C.: FriesenPress.
Bergman, R. L., Keller, M. L., Piacentini, J., & Bergman, A. J. (2008). The development and psychometric properties of the selective mutism quesitonnaire.Journal of Clinical Child and Adolescent Psychology, 37(2), 456–464.
Bergman, R. L., Keller, M. L., Wood, J., Piacentini, J., & McCracken, J. (2001). Selective mutism questionnaire: development and FINDINGS.Proceedings of the American Academy of Child and Adolescent Psychiatry Meeting, 48,163.
Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., et al. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics.Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545–553.https://doi.org/10.1097/00004583-199704000-00018.
Cartwright-Hatton, S., Roberts, C., Chitsabesan, P., Fothergill, C., & Harrington, R. (2004). System- atic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders.British Journal of Clinical Psychology, 43,421–436.
Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998). The revised Conners’ Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity.Journal of Abnormal Child Psychology, 26(4), 257–268.
Kendall, P. C., Lerner, R., & Craighead, W. E. (1984). Human development and intervention in childhood psychopathology.Child Development, 55,71–82.
Monga, S., Rosenbloom, B. N., Tanha, A., Owens, M., & Young, A. (2015). Comparison of child- parent and parent-only cognitive-behavioral therapy programs for anxious children aged 5 to 7 years: Short- and long-term outcomes.Journal of the American Academy of Child and Adoles- cent Psychiatry, 54(2), 138–146.https://doi.org/10.1016/j.jaac.2014.10.008.
Monga, S., Young, A., & Owens, M. (2009). Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study.Depression and Anxiety, 26(3), 243–250.https://doi.org/10.1002/da.20551.
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children’s global assessment scale (CGAS).Archives of General Psychiatry, 40(11), 1228–1231.
Shirk, S. R. (1999). Developmental therapy. In W. K. Silverman & T. H. Ollendick (Eds.),Devel- opmental issues in the clinical treatment of children. Boston, MA: Allyn & Bacon.
Silverman, W. K., & Albano, A. M. (1996).The Anxiety disorders interview schedule for children for DSM-IV: Clinician manual (Child and parent versions).
Spence, S. H., & Rapee, R. (1999). The preschool anxiety scale. Retrieved from http://www.
scaswebsite.com/docs/scas-preschool-scale.pdf.
Weisz, J. R., & Weersing, V. R. (1999). Developmental outcome research. In W. K. Silverman &
T. H. Ollendick (Eds.),Developmental issues in the clinical treatment of children. Boston, MA:
Allyn & Bacon.