Translating Anxiety-Focused CBT for Youth in a First Nations Context in Northwestern Ontario

We sought to evaluate a translation of anxiety-focused cognitive behavioral therapy (CBT) to a First Nations children's mental health provider in rural Ontario and to enhance our understanding of CBT challenges and adaptations unique to the First Nations context.

The study was conceptualized as a mixed methods sequential explanatory approach using a quasi-experimental (before and after) design with quantitative and qualitative components. Data were produced in two ways: questionnaires completed by therapists, parents and clients pre- and post-training, and through a focus group with therapists working with First Nations clients. Participants of this study were a subset of a larger knowledge translation study involving ten agencies, and comprised nine therapists (two males and seven females), and seven children (six males and one female) from a single First Nations agency. The mean age of children was 11.8 years (±2.71), comparable to children in other agencies.

First Nations therapists' scores on a child CBT knowledge questionnaire post-training did not differ from those of therapists in other agencies when controlling for initial values, suggesting comparable training benefit. Children did not differ between groups on any key measures, and all key measures showed improvement from pre- to post-training. Four key themes emerged from therapist focus groups: client challenges, value of supervision, practice challenges, and Northern/rural/remote challenges.

The study highlights the importance of delivering a culturally appropriate CBT program to First Nations populations in Northern Ontario, and provides preliminary evidence of its effectiveness.