O3289: Tools to Manage Anxiety in School and Childcare Settings

Background: Anxiety is common among students, impacting their academic performance, social interactions, and well-being. Recognizing the need for a structured approach to support students experiencing anxiety, a multidisciplinary team developed an anxiety action plan for school settings.

Project Description: The development of the anxiety action plan was driven by the increasing need for schools to have a standardized, evidence-based approach to addressing anxiety in students. Many schools lack licensed mental health professionals and RN’s on-site, making it essential for unlicensed personnel (UPs) to have a straightforward guide that enables them to provide appropriate support. The team identified key components that would make the plan both practical and effective, emphasizing the importance of teaching coping skills and providing guidance on the management of as-needed medications when applicable.

The plan was modeled after the widely recognized asthma action plan, which categorizes intervention strategies into green, yellow, and red zones. The green zone represents a baseline state where students are managing well and utilizing self-regulation strategies effectively. The yellow zone signals increasing anxiety symptoms that require intervention, such as guided breathing exercises, grounding techniques, or brief supportive conversations with a trusted adult. The red zone indicates a crisis state, in which immediate and intensive intervention is necessary, including contacting parents or guardians, providing a safe space, or involving mental health professionals when available.

The plan was designed to be adaptable, recognizing that each school community has unique needs and resources. It was piloted tested with the Children’s Hospital Colorado (CHCO) school nurses from October 2023 through June 2024. Evaluation included a survey of nurses and facilitated discussions in May 2023 and 2024.

Discussion: More than half of CHCO school nurses reported using the plan (61% in 2023 and 52% in 2024) in elementary, middle, and high school and before/after school programs. Around 70% reported that parents had sometimes or usually been involved in developing the plan. Most (85%) reported that the plan was somewhat or very helpful for helping students manage anxiety. The most common reasons for not using the plan were that another school professional manages students with anxiety or students already had a plan (504/IEP). In discussion, nurses described triggers for anxiety action plan use, successes, and barriers to use. Based on initial pilot testing, additional training and implementation strategies were provided to school nurses with recommendations to help UPs understand and effectively utilize the plan.

Conclusion: The anxiety action plan provides a practical framework for managing anxiety in school settings, ensuring students receive timely and appropriate support. By equipping UPs with a structured guide, the plan fosters a school culture that prioritizes mental health, helping students remain engaged and successful in their education.