A Team-Based Partner-Driven Model for Delivering Outpatient Exposure Treatment for Pediatric Anxiety and Obsessive-Compulsive Disorder.

Objective: Anxiety disorders are among the most common and earliest forms of psychopathology, yet few providers in community practice settings use or are trained in evidence-based treatments (EBTs) for pediatric anxiety. Delivery of EBTs is further limited by the "provider-centered" manner in which they are often administered (ie, office-based). This paper presents the rationale, design, and methods for a team-based approach to the treatment of pediatric anxiety that was developed with substantial patient, caregiver, and community partner involvement, and that addresses quality and workforce issues inherent in the current child mental health crisis. Method: This study aims to compare team-based community delivered cognitive behavioral treatment (CBT) and office-based CBT for pediatric anxiety and obsessive-compulsive disorder (OCD) in a sample of 333 children and adolescents 5 to 18 years of age. Rather than reporting outcomes, the purpose of this paper is to spotlight study design, methods, and procedures, including processes for fostering and maintaining strong partner engagement, training strategies, supervision structures, and implementation of quality and fidelity monitoring tools. Discussion: Treatment delivered outside of a traditional office setting using a team-based approach has the potential to increase patient access to care. In addition to describing specific design considerations, we provide a roadmap for the integration of community-based partners and for rigorous supervision and quality monitoring. Future directions are discussed, particularly in the context of lack of access to care that has a longstanding disproportionate impact on youth of color and youth from low-income communities. Clinical trial registration information: Improving Access to Child Anxiety Treatment (IMPACT); https://clinicaltrials.gov/study/. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group.