Targeted Prevention of Childhood Anxiety: Engaging Parents in an Underserved Community

Childhood anxiety disorders are prevalent and clinically distressing among young children. While prevention programs hold the promise of alleviating child anxiety symptoms, the few studies that have implemented programs have been limited by low participation, especially among parents experiencing high levels of sociodemographic adversity, despite being acutely at risk. While no studies have specifically investigated factors related to parent engagement in a prevention program targeting anxiety, similar programs for childhood behavior problems with poor, urban samples have achieved engagement rates of approximately 20%. However, parents are generally less likely to seek help for anxiety, compared to externalizing problems, suggesting that recruiting parents for anxiety programming may be even more challenging. This study investigated the feasibility of a parent-focused anxiety prevention program by assessing parent engagement at a one session program in a diverse, urban sample. Participants were poor, ethnic minority parents of children aged 1-5 years (n=256) participating in WIC programs in Boston, MA, who completed a developmental survey, including parent and child symptom measures and parent service preferences (phase 1). Parents meeting criteria for elevated parent anxiety symptoms, elevated child anxiety symptoms, or child trauma exposure (n=101), were then invited to a developmental group session focused on emotional development targeting anxiety (phase 2). Half of these parents were randomized to an enhanced recruitment group, which included personalized outreach, matching parent service preferences, and community endorsement. Recruitment rates were 75% and 19% for phases 1 and 2, respectively. More parents planned to attend sessions in the enhanced group (49%), compared to the control group (6%). Parents in the enhanced group were 3.5 times more likely to attend sessions, but this difference did not reach statistical significance. Neither child anxiety, parent anxiety, nor trauma exposure were related to either planning to attend or actual attendance. Significant predictors of attendance included planning to attend (r = .49; p \u3c .001) and selecting childcare provided as a service preference (÷² = 4.99; p\u3c .05). Despite low levels of attendance, all attending parents reported high levels of satisfaction with the groups. Consistent with other research on parent engagement in prevention programming, this study highlights the need for improvements in approaches for engaging parents in preventive research. Results also highlight the importance of investigating the complex process related to parents\u27 decisions to participate in research, differentiating between cognitive processes related to planning to attend and actually attending programs