Innovative model expected to increase care access and improve outcomes
The Pediatric Anxiety Research Center (PARC) at the Bradley/Hasbro Children’s Research Center, has received a $3.4 million funding award from The Patient-Centered Outcomes Research Institute (PCORI) to compare patient-centered (primarily in the home/community) to provider-centered (primarily in the office) outpatient treatment for kids with anxiety and obsessive compulsive disorder (OCD). The aim of the study is to devise an alternative outpatient treatment model featuring a bachelor’s level clinician, or mobile exposure coach, working in conjunction with PhDs to conduct in-home therapy visits.
“We know from our research and work with pediatric patients that exposure therapy is a highly effective behavioral treatment for anxiety and OCD, but it is very challenging for kids and families to practice those skills at home,” said Jennifer Freeman, Ph.D., director of research and training at PARC and the study’s principal investigator. The current outpatient treatment model for youth with anxiety disorders includes shortages of appropriate providers, logistical problems with getting to treatment, and trouble getting an adequate dose of exposure treatment in the home. “We’re exploring creation of a comprehensive patient care model that delivers home-based exposure coaching at an outpatient level of care to better meet the needs of families with anxious children.”
The first evidence-based study of its kind, the five-year randomized trial will assess the effectiveness of the two treatments and provide data to determine the feasibility and acceptability of the model for families. More than 330 patients, ages five to18 years old, seeking treatment for anxiety or OCD at PARC will be randomized to receive patient-centered treatment using home-based services or traditional provider-centered care.
Anxiety disorders and OCD are among the most common and earliest of psychiatric disorders to occur among children and persist if left untreated, often leading to depression, substance abuse, suicide attempts, and disability into adulthood. “The need for this study stems from families asking us for more help following intensive treatment in our program, and we expect the results to validate the role of home-based treatment and create better access to care and patients and families who are more engaged in treatment,” added Freeman.
In addition to patient and family engagement, the study will measure participants’ anxiety and OCD symptoms and severity and functional impairment. Study results are expected to include identifying methods for increasing outpatient treatment access, continuation, effectiveness, and efficiency for kids with anxiety and OCD. In the longer term, project stakeholders – ranging from patients and their families to insurers – will contribute to establishing a new patient-centered service delivery model. “We are working to create a better, more accessible model of care for patients and families in need,” said Freeman.
“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI Executive Director Joe Selby, MD, MPH. “We look forward to following the study’s progress and working with PARC to share the results.”
PARC’s study was selected for PCORI funding through a highly competitive review process in which patients, clinicians and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders and their methodological rigor among other criteria.
Freeman’s award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.