Trial Outcomes & Findings for A Single-Session Intervention for Families on Waitlists for Child Anxiety Treatment (NCT NCT05841680)
NCT ID: NCT05841680
Last Updated: 2025-11-24
Results Overview
Posttreatment child rating of youth anxiety symptom severity over the past week. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Child Version (SCARED-C). The SCARED-C is a child rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-C range from 0 to 82, with higher scores representing more severe anxiety.
COMPLETED
NA
59 participants
1 week after first session
2025-11-24
Participant Flow
59 children were enrolled in this trial. Only children were enrolled. Parents provided parental consent for their child to participate, but were not considered enrolled. These 59 children were assigned to one of two arms: Waitlist Control or Single Session Intervention. Data were collected on these children and are reported in the Results. Data correspond to Aim 2 Test Phase Acceptability and Aim 3 Test Phase Anxiety Outcomes. Aim 1 Pilot Phase did not include quantitative data collection.
Participant milestones
| Measure |
Waitlist Control
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Overall Study
STARTED
|
29
|
30
|
|
Overall Study
COMPLETED
|
29
|
30
|
|
Overall Study
NOT COMPLETED
|
0
|
0
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
A Single-Session Intervention for Families on Waitlists for Child Anxiety Treatment
Baseline characteristics by cohort
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
Total
n=59 Participants
Total of all reporting groups
|
|---|---|---|---|
|
Sex: Female, Male
Female
|
17 Participants
n=45 Participants
|
14 Participants
n=12929 Participants
|
31 Participants
n=6349 Participants
|
|
Sex: Female, Male
Male
|
12 Participants
n=45 Participants
|
16 Participants
n=12929 Participants
|
28 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
American Indian or Alaska Native
|
0 Participants
n=45 Participants
|
1 Participants
n=12929 Participants
|
1 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
Asian
|
1 Participants
n=45 Participants
|
0 Participants
n=12929 Participants
|
1 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
|
0 Participants
n=45 Participants
|
0 Participants
n=12929 Participants
|
0 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
Black or African American
|
1 Participants
n=45 Participants
|
2 Participants
n=12929 Participants
|
3 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
White
|
25 Participants
n=45 Participants
|
26 Participants
n=12929 Participants
|
51 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
More than one race
|
2 Participants
n=45 Participants
|
1 Participants
n=12929 Participants
|
3 Participants
n=6349 Participants
|
|
Race (NIH/OMB)
Unknown or Not Reported
|
0 Participants
n=45 Participants
|
0 Participants
n=12929 Participants
|
0 Participants
n=6349 Participants
|
|
Ethnicity (NIH/OMB)
Hispanic or Latino
|
24 Participants
n=45 Participants
|
25 Participants
n=12929 Participants
|
49 Participants
n=6349 Participants
|
|
Ethnicity (NIH/OMB)
Not Hispanic or Latino
|
5 Participants
n=45 Participants
|
5 Participants
n=12929 Participants
|
10 Participants
n=6349 Participants
|
|
Ethnicity (NIH/OMB)
Unknown or Not Reported
|
0 Participants
n=45 Participants
|
0 Participants
n=12929 Participants
|
0 Participants
n=6349 Participants
|
|
Age, Categorical
<=18 years
|
29 Participants
n=45 Participants
|
30 Participants
n=12929 Participants
|
59 Participants
n=6349 Participants
|
|
Age, Categorical
Between 18 and 65 years
|
0 Participants
n=45 Participants
|
0 Participants
n=12929 Participants
|
0 Participants
n=6349 Participants
|
|
Age, Categorical
>=65 years
|
0 Participants
n=45 Participants
|
0 Participants
n=12929 Participants
|
0 Participants
n=6349 Participants
|
PRIMARY outcome
Timeframe: 1 week after first sessionPosttreatment parent rating of youth anxiety symptom severity over the past week. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Parent Version (SCARED-P). The SCARED-P is a parent rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-P range from 0 to 82, with higher scores representing more severe anxiety.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Screen for Child Anxiety Related Emotional Disorders - Parent Version at Posttreatment
|
35 units on a scale
Standard Deviation 14
|
30 units on a scale
Standard Deviation 12
|
PRIMARY outcome
Timeframe: 1 week after first sessionPosttreatment child rating of youth anxiety symptom severity over the past week. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Child Version (SCARED-C). The SCARED-C is a child rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-C range from 0 to 82, with higher scores representing more severe anxiety.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Screen for Child Anxiety Related Emotional Disorders - Child Version at Posttreatment
|
33 units on a scale
Standard Deviation 14
|
23 units on a scale
Standard Deviation 12
|
PRIMARY outcome
Timeframe: 4 weeks after first sessionFollow up parent rating of youth anxiety symptom severity over the past 3 weeks. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Parent Version (SCARED-P). The SCARED-P is a parent rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-P range from 0 to 82, with higher scores representing more severe anxiety.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Screen for Child Anxiety Related Emotional Disorders - Parent Version at Follow up
|
34 units on a scale
Standard Deviation 13
|
26 units on a scale
Standard Deviation 14
|
PRIMARY outcome
Timeframe: 4 weeks after first sessionFollow up child rating of youth anxiety symptom severity over the past 3 weeks. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Child Version (SCARED-C). The SCARED-C is a child rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-C range from 0 to 82, with higher scores representing more severe anxiety.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Screen for Child Anxiety Related Emotional Disorders - Child Version at Follow-Up
|
31 units on a scale
Standard Deviation 14
|
23 units on a scale
Standard Deviation 13
|
SECONDARY outcome
Timeframe: first session at baselineChild rating of youth anxiety symptom severity over the past month. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Child Version (SCARED-C). The SCARED-C is a child rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-C range from 0 to 82, with higher scores representing more severe anxiety.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Screen for Child Anxiety Related Emotional Disorders - Child Version at Pre
|
36 units on a scale
Standard Deviation 13
|
36 units on a scale
Standard Deviation 10
|
SECONDARY outcome
Timeframe: first session at baselineParent rating of youth anxiety symptom severity over the past month. The name of the measure is the Screen for Child Anxiety Related Emotional Disorders - Parent Version (SCARED-P). The SCARED-P is a parent rated measure of the severity of youths' anxiety symptoms. Total scores on the SCARED-P range from 0 to 82, with higher scores representing more severe anxiety.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Screen for Child Anxiety Related Emotional Disorders - Parent Version at Pre
|
34 units on a scale
Standard Deviation 13
|
37 units on a scale
Standard Deviation 13
|
SECONDARY outcome
Timeframe: first session at baselineBrief parent-report measure of anxiety-related functional impairment over the past month. The name of the measure is the Child Anxiety Impact Scale-Parent Version (CAIS-P). The CAIS-P is a parent rated measure of anxiety-related functional impairment. Total scores on the CAIS-P range from 0 to 81, with higher scores representing more functional impairment.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Child Anxiety Impact Scale - Parent Version at Pre
|
28 units on a scale
Standard Deviation 14
|
22 units on a scale
Standard Deviation 15
|
SECONDARY outcome
Timeframe: first session at baselineBrief youth-report measure of anxiety-related functional impairment over the past month. The name of the measure is the Child Anxiety Impact Scale-Child/Adolescent Version (CAIS-C). The CAIS-C is a parent rated measure of anxiety-related functional impairment. Total scores on the CAIS-C range from 0 to 81, with higher scores representing more functional impairment.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Child Anxiety Impact Scale - Child Version at Pre
|
24 units on a scale
Standard Deviation 14.
|
19 units on a scale
Standard Deviation 11
|
SECONDARY outcome
Timeframe: 1 week after first sessionBrief parent-report measure of anxiety-related functional impairment over the past week. The name of the measure is the Child Anxiety Impact Scale-Parent Version (CAIS-P). The CAIS-P is a parent rated measure of anxiety-related functional impairment. Total scores on the CAIS-P range from 0 to 81, with higher scores representing more functional impairment.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Child Anxiety Impact Scale - Parent Version at Posttreatment
|
27 units on a scale
Standard Deviation 15
|
18 units on a scale
Standard Deviation 14
|
SECONDARY outcome
Timeframe: 1 week after first sessionBrief youth-report measure of anxiety-related functional impairment over the past week. The name of the measure is the Child Anxiety Impact Scale-Child/Adolescent Version (CAIS-C). The CAIS-C is a parent rated measure of anxiety-related functional impairment. Total scores on the CAIS-C range from 0 to 81, with higher scores representing more functional impairment.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Child Anxiety Impact Scale - Child Version at Posttreatment
|
21 units on a scale
Standard Deviation 12
|
17 units on a scale
Standard Deviation 14
|
SECONDARY outcome
Timeframe: 4 weeks after first sessionBrief parent-report measure of anxiety-related functional impairment over the past 3 weeks. The name of the measure is the Child Anxiety Impact Scale-Parent Version (CAIS-P). The CAIS-P is a parent rated measure of anxiety-related functional impairment. Total scores on the CAIS-P range from 0 to 81, with higher scores representing more functional impairment.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Child Anxiety Impact Scale - Parent Version at Follow Up
|
25 units on a scale
Standard Deviation 15
|
15 units on a scale
Standard Deviation 13
|
SECONDARY outcome
Timeframe: 4 weeks after first sessionBrief youth-report measure of anxiety-related functional impairment over the past 3 weeks. The name of the measure is the Child Anxiety Impact Scale-Child/Adolescent Version (CAIS-C). The CAIS-C is a parent rated measure of anxiety-related functional impairment. Total scores on the CAIS-C range from 0 to 81, with higher scores representing more functional impairment.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Child Anxiety Impact Scale - Child Version at Follow Up
|
18 units on a scale
Standard Deviation 12
|
16 units on a scale
Standard Deviation 14
|
SECONDARY outcome
Timeframe: first session at baselineParent-report measure of the frequency with which parents participate in their child's anxiety-related behaviors (e.g., assisting avoidance, providing reassurance) and modification of family routines because of child anxiety over the past month. The name of the measure is the Family Accommodation Scale Anxiety - Parent Version (FASA-P). The FASA-P is a measure of parental accommodation. Total scores on the FASA-C range from 0 to 36, with higher scores representing more parental accommodation.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Family Accommodation Scale Anxiety - Parent Version at Pre
|
15 units on a scale
Standard Deviation 8
|
13 units on a scale
Standard Deviation 8
|
SECONDARY outcome
Timeframe: first session at baselineYouth-report measure of the frequency with which parents participate in their child's anxiety-related behaviors (e.g., assisting avoidance, providing reassurance) and modification of family routines because of child anxiety over the past month. The name of the measure is the Family Accommodation Scale Anxiety - Child Version (FASA-C). The FASA-C is a measure of parental accommodation. Total scores on the FASA-C range from 0 to 36, with higher scores representing more parental accommodation.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Family Accommodation Scale Anxiety - Child Version at Pre
|
15 units on a scale
Standard Deviation 6
|
14 units on a scale
Standard Deviation 7
|
SECONDARY outcome
Timeframe: 1 week after first sessionParent-report measure of the frequency with which parents participate in their child's anxiety-related behaviors (e.g., assisting avoidance, providing reassurance) and modification of family routines because of child anxiety over the past week. The name of the measure is the Family Accommodation Scale Anxiety - Parent Version (FASA-P). The FASA-P is a measure of parental accommodation. Total scores on the FASA-C range from 0 to 36, with higher scores representing more parental accommodation.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Family Accommodation Scale Anxiety - Parent Version at Posttreatment
|
14 units on a scale
Standard Deviation 8
|
11 units on a scale
Standard Deviation 8
|
SECONDARY outcome
Timeframe: 1 week after first sessionYouth-report measure of the frequency with which parents participate in their child's anxiety-related behaviors (e.g., assisting avoidance, providing reassurance) and modification of family routines because of child anxiety over the past week. The name of the measure is the Family Accommodation Scale Anxiety - Child Version (FASA-C). The FASA-C is a measure of parental accommodation. Total scores on the FASA-C range from 0 to 36, with higher scores representing more parental accommodation.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Family Accommodation Scale Anxiety - Child Version at Posttreatment
|
11 units on a scale
Standard Deviation 7
|
9 units on a scale
Standard Deviation 6
|
SECONDARY outcome
Timeframe: 4 weeks after first sessionParent-report measure of the frequency with which parents participate in their child's anxiety-related behaviors (e.g., assisting avoidance, providing reassurance) and modification of family routines because of child anxiety over the past 3 weeks. The name of the measure is the Family Accommodation Scale Anxiety - Parent Version (FASA-P). The FASA-P is a measure of parental accommodation. Total scores on the FASA-C range from 0 to 36, with higher scores representing more parental accommodation.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Family Accommodation Scale Anxiety - Parent Version at Follow Up
|
14 units on a scale
Standard Deviation 9
|
11 units on a scale
Standard Deviation 7
|
SECONDARY outcome
Timeframe: 4 weeks after first sessionYouth-report measure of the frequency with which parents participate in their child's anxiety-related behaviors (e.g., assisting avoidance, providing reassurance) and modification of family routines because of child anxiety over the past 3 weeks. The name of the measure is the Family Accommodation Scale Anxiety - Child Version (FASA-C). The FASA-C is a measure of parental accommodation. Total scores on the FASA-C range from 0 to 36, with higher scores representing more parental accommodation.
Outcome measures
| Measure |
Waitlist Control
n=29 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
n=30 Participants
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Family Accommodation Scale Anxiety - Child Version at Follow Up
|
11 units on a scale
Standard Deviation 7
|
8 units on a scale
Standard Deviation 6
|
SECONDARY outcome
Timeframe: 1 week after first sessionParent report measure of consumer satisfaction with services received (e.g., "How would you rate the quality of the services you received?" and "If a friend were in need of similar help, would you recommend our program to him or her?"). The name of the measure is Client Satisfaction Questionnaire (CSQ-8). Total scores on the CSQ-8 range from 8 to 32, with higher scores representing more satisfaction with services received.
Outcome measures
| Measure |
Waitlist Control
n=30 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Client Satisfaction Questionnaire - Parent Report at Posttreatment
|
29 units on a scale
Standard Deviation 3
|
—
|
SECONDARY outcome
Timeframe: 1 week after first sessionYouth-report measure of consumer satisfaction with services received (e.g., "How would you rate the quality of the services you received?" and "If a friend were in need of similar help, would you recommend our program to him or her?"). The name of the measure is Client Satisfaction Questionnaire (CSQ-8). Total scores on the CSQ-8 range from 8 to 32, with higher scores representing more satisfaction with services received.
Outcome measures
| Measure |
Waitlist Control
n=30 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Client Satisfaction Questionnaire - Youth Report at Posttreatment
|
29 units on a scale
Standard Deviation 2
|
—
|
SECONDARY outcome
Timeframe: 1 week after first sessionParent-report measure of perceived acceptability of a single session intervention (e.g. "I enjoyed the program"). The name of the measure is the Program Feedback Scale (PFS). Total scores on the PFS range from 0 to 35, with higher scores representing more acceptability.
Outcome measures
| Measure |
Waitlist Control
n=30 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Program Feedback Scale - Parent Report
|
34 units on a scale
Standard Deviation 2
|
—
|
SECONDARY outcome
Timeframe: 1 week after first sessionYouth-report measure of perceived acceptability of a single session intervention (e.g. "I enjoyed the program"). The name of the measure is the Program Feedback Scale (PFS). Total scores on the PFS range from 0 to 35, with higher scores representing more acceptability.
Outcome measures
| Measure |
Waitlist Control
n=30 Participants
Participants complete pre, post, and follow-up questionnaires. They have the option to view the SSI module after completing follow-up questionnaires.
|
Single Session Intervention Receivers
Participants complete pre then receive the SSI module. Then they complete post and follow-up questionnaires.
|
|---|---|---|
|
Program Feedback Scale - Youth Report
|
29 units on a scale
Standard Deviation 5
|
—
|
Adverse Events
Waitlist Control
Single Session Intervention Receivers
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place