Consumers' and Providers' Perceptions of Utilizing a Computer-Assisted Cognitive Behavioral Therapy for Childhood Anxiety

Purpose: Computer-assisted cognitive behavioral therapy (CCBT) programs for childhood anxiety are being developed and tested, although research about the factors that contribute to implementation of CCBT in community mental health centers (CMHC) is limited. Potential advantages of CCBT include reduced costs for services, treatment availability in different settings, decreased stigma, improved standardization and adherence to treatment, exposures via video, systematic treatment record keeping and data collection, and increased client access to evidence-based practice (EBP).  Potential disadvantages associated with CCBT include decreased therapeutic alliance, lack of individualization of treatment, limited capability to address all of the client’s needs, and possible privacy and security breaches. As the field moves forward with the development of CCBT for childhood anxiety, it is important to gather feedback from consumers and providers about their perceptions of utilizing CCBT to advance its implementation in CMHC, where the treatment need is great and EBP are limited. The purpose of this mixed-methods study was to explore consumers’ and providers’ perceptions of utilizing a CCBT for childhood anxiety in CMHC in an effort to identify factors that may impact implementation of CCBT in CMHC. 

Methods: Qualitative methods were based on the phenomenological tradition that aims to provide an in-depth understanding and description of a person’s specific experiences, and the quantitative surveys were used to triangulate the data exploring consumers’ perceptions of CCBT. Focus groups and interviews occurred with 7 parents, 6 children, 3 therapists, 3 project coordinators and 3 administrators who had participated in CCBT for childhood anxiety called Camp Cope-A-Lot (Khanna & Kendall, 2008). The Barriers to Treatment Participation Scale (Kazdin et al., 1997; Wuthrich et al., 2012) was administered to parents and children.  Parents and children completed the Client Satisfaction Questionnaire (Nguyen et. al., 1983).

Results: Participation in and implementation of Camp Cope-A-Lot within the CMHC was well-received. Thirteen themes emerged that addressed child, parent and therapist implementation factors (i.e. receptiveness, therapist factors, treatment components, applicability of treatment, and treatment content) and agency/organization implementation factors (i.e., initial implementation challenges, resources, dedicated staff, support, outreach, opportunities with the CMHC, payment, and treatment availability).  Both parents and children reported high satisfaction levels with regard to the treatment. The therapists and the children found the computer-assisted program easy to use and both consumers and providers liked the idea of providing a computer-assisted program for children. Therapists, parents and children liked the exposures, and despite concerns about standardized treatments limiting therapeutic alliance, parents and children reported feeling supported by the therapist. Administrators noted initial implementation challenges, but also reported many potential benefits of offering an evidence-based CCBT within the CMHC.

Implications: Implementing an evidence-based CCBT within CMHC for childhood anxiety may be an innovative solution to increasing access to EBP and assisting with fidelity to treatment. As treatment outcome studies continue to demonstrate the effectiveness of CCBT for childhood anxiety, research needs to continue to examine factors that contribute to the successful implementation of such treatments in CMHC.