Interesting Stuff from the New England Journal: Teens, Anxiety and Treatment

Last week's New England Journal should be of interest to all of us trying to build evidence-based systems of care for children with mental health issues; a new study showed that anxiety disorder in teens can be treated relatively effectively by both pharmacological and non-pharmacological means. (abstract is here- they charge for the whole article) It was a straightforward study:  488 kids between 7 and 17 (interesting choice of ages) got randomized to placebo, cognitive-behavioral therapy (CBT), sertraline, or CBT + sertraline treatment for 12 weeks.  CBT worked, sertraline worked and the combination did better than either individually.  Oh, and the folks on CB with placebo had fewer side effects.  Big study, lots of statistical power, should do us a lot of good in improving the quality of care for kids with anxiety disorders of various kinds.  To my mind, this says:  send them for 3 months of CBT first, then think about medication.  Or start the medication with the CBT- you will get more bang for the buck.

Except,  I have no way of knowing if the therapist that my patient finds, through the insurance or the agency or the friend that they are seeing, is actually doing  CBT.   In my neck of the woods, when I refer to an agency, they evaluate the child and assign them to a provider.  None of my patients can tell me what kind of therapy they are receiving and I only sometimes get feedback from the mental health agency about the nature of the treatment that they are using.  So I don't know what or if they are getting therapy.  Operationalizing this exciting bit of evidence may be harder than it looks.