Efficacy Trial of the CALM Intervention

The CGI-I provides a global rating of improvement in anxiety, relative to baseline. The measure yields a single rating of clinical improvement during the past week, relative to the baseline rating. Scores range from 1 (very much improved) to 7 (very much worse).

The CGI-I provides a global rating of improvement in anxiety, relative to baseline. The measure yields a single rating of clinical improvement during the past week, relative to the baseline rating. Scores range from 1 (very much improved) to 7 (very much worse).

The CSI-24 is a is 24-item child- and parent-report measure of the child's somatic symptoms. Parents and children respond to the items using a 5-point scale ranging from "not at all" to "a whole lot." One total score calculated by summing the items. Items are scored 0-4 (range: 0-96); higher scores reflect higher levels of subjective severity of somatic symptoms.

The Behavioral Avoidance form is a 3-item measure assesses how frequently the student avoids specific anxiety provoking situations. The independent evaluator creates a list of the top 3 anxiety-provoking situations and estimates the frequency with which the child avoids those situations over a two week period prior to evaluation. Avoidance for each situation is measured on a 7-point Likert scale, ranging from 1 (never avoid) to 7 (avoid every time).

The CATS is a 40-item measure that assesses frequency of students' maladaptive thoughts associated with anxiety. Children respond to items using a 5-point Likert-type scale describing the frequency with which they have had various thoughts over the past week (not at all, sometimes, fairly often, often, all the time). Higher scores reflect greater frequency of negative self-statements. Three scores are derived from the CATS: one total score (20 items, score range 0-80) plus two subscale scores reflecting the content of self-statements: physical threat (10 items, score range 0-40), social threat (10 items, score range 0-40).

The CGAS is a rating scale that indicates a child's global functioning on a scale of 1 (lowest) to 100 (highest). In general, scores below 70 are indicative of increasingly severe impairment in functioning.

The student attendance form is completed by teachers to assess the child's recent (past two weeks) school attendance including number of full and partial days missed as well as the amount of extra time and attention spent on the child.

The School Attendance and Discipline form is an 8-item measure completed by parents that collects information regarding absences from school related to emotional/behavioral problems as well as disciplinary actions at school.

Student records will be obtained from the school that will provide information regarding number of absences, tardiness, and early dismissals during the marking period closest to the dates of baseline, 8-weeks after baseline, and 12-month follow up

Student records will be obtained from the school that will provide information regarding number of referrals for disciplinary action during the marking period closest to the dates of baseline, 8-weeks after baseline, and 12-month follow up

Student records will be obtained from the school that will provide information regarding English and math grades, as well as any grade retention during the marking period closest to the dates of baseline, 8-weeks after baseline, and 12-month follow up. Grades will be categorized into 4 categories: below expectations/not meeting expectations/needs more time (D); near expectations/exhibits progress towards meeting expectations/developing (C); meets expectations/consistently evident (B); exceeds expectations (A)

Student records will be obtained from the school that will provide information regarding if the student received special education services (i.e., 504 plan and/or IEP) during the marking period closest to the dates of baseline, 8-weeks after baseline, and 12-month follow up

Subtests from the WJ-IV (i.e., reading, math fluency, and digits backwards) will be administered by the IE to measure cognitive factors (e.g., efficiency, speed, working memory) that are believed to be affected by anxiety. Standard scores will be derived for the Reading Sentences Fluency, Math Facts Fluency, and Numbers Reversed subtests. Standard scores reflect the following ability level: <69=very low; 70-79=low; 80-89=low average; 90-110=average; 111-120=high average; 121-130=superior; >131=very superior.

The SDQ assesses a range of emotional and behavioral difficulties in children 4-17 years old (e.g., conduct problems, hyperactivity/ inattention, peer relationship problems, and prosocial behaviors). Nine scores can be derived from the SDQ. (1-5) Five subscales, each of which corresponds to 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, prosocial problems. Subscale scores are summed. (6) The total score is generated by summing the scores from all the scales except the prosocial scale. (7-8) Externalizing scores (conduct and hyperactivity) and internalizing scores (emotional and peer problems) are also provided. (9) The impact score is a sum of questions reflecting distress and impairment. Subscale scores each range from 0-10. Externalizing and internalizing scores range from 0-20. The total score can range from 0 to 40. The impact score ranges from 0-6. Higher scores indicate higher levels of the behavior in question.

The TOCA-C concentration subscale is a 7-item subscale of the TOCA that assesses teachers' perceptions of a student's classroom concentration problems. Teachers rate student concentration on a 6-point Likert scale that ranges from "never (1)" to "almost always (6)." Only the Concentration Problems subscale is used in this study. This subscale includes 7 items (range = 7-42). Higher scores on indicate more maladaptive behaviors.

The ACES is a 32-item teacher report measure that assesses classroom skills and behaviors. Each item is rated on a 5 point scale (1 = never, 5= almost always), with the option to indicate that the behavior is not observed (N/O). The measure is divided in 2 main scales: Academic Skills (14, score range 0-70), consisting of Reading/Language Arts (6 items, score range 0-30), Mathematics (4 items, score range 0-20), and Critical Thinking (4 items, score range 0-20); Academic Enablers (18 items, score range 0-90), consisting of Motivation (5 items, score range 0-25), Engagement (4 items, score range 0-20), Study Skills (4 items, score range 0-20), and Interpersonal Skills (5 items, score range 0-25). Higher scores reflect higher abilities.

The CAIS is a 27-item child- and parent-report measure of anxiety-related interference in social, academic and family functioning. Children and parents respond to items using a 4-point Likert scale (not at all, just a little, pretty much, very much); higher scores represent greater interference of anxiety in child functioning. The CAIS-C has a total score (27 items, score range 0-81) and three subscales: school (10 items, score range 0-30), social (11 items, score range 0-33), and home/family (6 items, score range 0-18).

The SAS is a 16-item teacher questionnaire that assesses anxiety in the school setting, with a specific focus on social and generalized anxiety symptoms relevant to classroom participation. Teachers rate student anxiety on a 4-point Likert scale that ranges from "never (0)" to "always (3)." The SAS-TR contains a total score (16 items, range of 0 to 48) and two subscales: social anxiety (7 items, range of 0-21) and generalized anxiety (9 items, range of 0 to 27). Higher scores represent higher levels of anxiety; scores of 8 and more on the social anxiety, 10 or more on the generalized anxiety, and 17 or more on the total anxiety is considered to represent high anxious condition.

The CGI-S provides a global rating of anxiety severity. The measure yields a single rating of anxiety symptom severity during the past week. Scores range from 1 (Normal; Not at all ill) to 7 (Extremely ill)

The ADIS-V is a structured interview that assesses anxiety diagnoses and severity in youth. Impairment ratings are generated for each diagnosis using the Clinician Severity Rating (CSR, range = 0-8; higher CSRs indicate higher severity of anxiety disorders, a CSR of 4 is required to assign a diagnosis). Diagnoses are derived separately from the child and parent report, which yields a Composite Diagnosis that is one measure used to determine study eligibility.

The SCARED is a 41-item child- and parent-report measure of anxiety. Youth and parents respond to items using a 3-point Likert-type scale describing the degree to which statements are true (0 = not true or hardly ever true, 1 = somewhat true or sometimes true, 2 = very true or often true). Higher scores represent higher levels of anxiety. Six scores can be derived from the SCARED: one total score (41 items, score range 0-82) plus five subscale scores: panic/somatic (13 items, score range 0-26), generalized anxiety (9 items, score range 0-18), (3) separation anxiety (8 items, score range 0-16), social anxiety (7 items, score range 0-14), and school phobia (4 items, score range 0-8).

The CALM and CALM-R Intervention Fidelity, Adherence, Differentiation, and Competence forms contain key points/principles that should be covered during each CALM and CALM-R module and assesses whether they were covered (yes/no), the quality of administration (using a 4 point scale where 1 = poor to 4 = very good), and non-specific factors (e. g., maintains a positive working relationship). For adherence, a yes indicates nurses adhere to the manual; no indicates nurses did not adhere for that particular item. For quality, highest scores indicate greater quality of competence in delivering the intervention components.

The IE masking form is a 1-item measure that asks the IE to guess the student's intervention assignment in order to assess the integrity of the masking procedures.

The SSF captures pertinent information about the session such as duration, attendance, intervention strategy, and ratings of the quality of the therapeutic relationship, child compliance, and nurse's perceived competence.

The nurse background form assesses demographic characteristics and professional experience (e.g., training, years of experience, license).

The Maslach Burnout Inventory - General Survey is a 16-item measure completed by nurses that assesses overall levels of burnout on a 6-point likert scale (0=never, 6=every day; scores range from 0-96), with higher scores indicating higher levels of burnout. There are three subscales: exhaustion (5 items, score range 0-30), cynicism (5 items, score range 0-30), and personal efficacy (reverse-scored; 6 items, score range 0-36)

The student-nurse relationship scale is a 7-item assesses the quality of the student-nurse relationship on a _-point Likert scale (1=definitely does not apply/is not true, 5=definitely applies/is true); scores range from 7-35), with higher scores indicating a stronger relationship.

The family demographic form collects information from the parent about the child and the family including age, sex, race, economic status, household family members and parents' marital status.

The WTP questionnaire obtains a dollar-denominated measure of CALM sites' principals/senior administrator willingness to support the implementation of CALM in their schools and therefore to re-allocate a portion of their budgets to the costs of implementing, operating, and sustaining CALM.

The CHUD is a population-based preference-weighted utility index for use in cost-effectiveness analyses. There are a total of 9 dimensions/items (worried, sad, pain, tired, annoyed, schoolwork/homework, sleep, daily routine, and joining in activities) with 5 levels within each dimension. Parents are asked to indicate which level within each dimension is most like their child on the day that they complete the questionnaire. Scores range between 0.33 and 1. Higher scores reflect poorer overall general health-related quality of life.

The CASA is a 20-item measure that assesses use of general medical health, mental health, social service, and education services. Items are dichotomous (no=0, yes=1), with checkboxes to indicate details about services (e.g., frequency, indication, provider).

This form asks parents to report their total missed days of work due to emotional difficulties of their child.

Nurses will complete time logs for each encounter with students enrolled in the study; these logs are used to capture the amount of time spent by the school nurse addressing the needs of the anxious child - at any time - during the active intervention phase (from enrollment through last session). Nurses will record the start and end times of each encounter and a brief checklist of intervention tasks completed, and will also record any other tasks they completed in connection with the encounters, including any communication with school staff members or parents.