Are School Nurses the Cure? Development of a School-Nurse Intervention for Anxious Students

• In Event: 2-210 - Mental Health in Schools: Providing Strategies to Students Across the K-12 Grade Span

Integrative Statement

Introduction: Anxiety disorders are the most common psychiatric illnesses in youth and impair academic functioning. The majority of anxious youth are never identified and do not receive the assistance they need to thrive in school. Because a key feature of excessive anxiety is physical complaints (headaches, stomachaches), anxious students frequently visit the school nurse. Thus, school nurses are in an ideal position to identify and intervene early. However, nurses currently lack training in evidenced-based mental health interventions. The goals of this IES-funded project were to develop and assess the feasibility of a brief nurse-administered intervention (CALM; Child Anxiety Learning Modules) based on cognitive behavioral strategies, to reduce anxiety symptoms and improve academic functioning. After an iterative development process, a pilot RCT was conducted comparing CALM to an active comparison condition. Students were assessed at baseline, post intervention, and at a 3 month follow-up.
Hypotheses: We hypothesized that school nurses would be able to administer CALM with adequate fidelity and that students would experience a reduction in anxiety symptoms and improvements in academic outcomes.

Study Population: 29 school nurses and 54 elementary aged students with excessive anxiety

Methods: Twenty-nine nurses (100% were female, 89.7% Caucasian, M age = 51.42 years, SD = 7.08) were randomized (1:1) and trained to deliver CALM (n = 14) or CALM-R (n = 15; an active comparison condition incorporating only relaxation strategies). Fifty-four anxious students (68.5% females, 84.9% Caucasian, mean age 8.34) were enrolled (CALM = 20; CALM-R = 34). Pre-post measures on anxiety symptoms, academic functioning, and proposed mediators were completed by teachers, children, and independent evaluators.
Results and Discussion: The mean nurse fidelity rating using a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good) was M = 2.94 (SD = .59) suggesting average to good quality of administration and adherence to the CBT components. With respect to student outcomes, no baseline group differences were identified with respect to gender, age, race, or anxiety severity. Youth in both groups showed significant pre-post reductions on measures of anxiety (including somatic symptoms). Students in CALM, compared to CALM-R showed greater overall response and reductions in avoidance behaviors measured by independent evaluators. Findings highlight that nurses can administer brief mental health interventions and represent an untapped resource within the school. CALM, the nurse-delivered invention based on CBT developed in this IES Goal 2 project may be useful in reducing anxiety symptoms among anxious youth. Training school-nurses in brief mental health interventions could expand the network of school-based providers of mental health services resulting in a better trained workforce and improved social, emotional, and academic outcomes for students.

Authors

• Kelly L Drake, Anxiety Treatment Center of Maryland
  Presenting Author

• Golda S Ginsburg, University of Connecticut School of Medicine
  Non-Presenting Author