Researchers led by a team at the University of Oxford say their ‘screening to intervention’ model, delivered in schools, could reduce the child anxiety treatment gap, enabling more children to get effective support more quickly.
In the randomised controlled trial, children from 84 schools in England were screened for anxiety problems using a questionnaire delivered to parents through schools. Of the 409 who screened positive for anxiety problems, around half were given support using a parent-led Cognitive Behaviour Therapy-based (CBT) online support tool called OSI (Online Support and Intervention), while the other half received usual school provision. The children’s anxiety levels were then checked at four, 12 and 24 months.
The study, published in the Lancet Psychiatry and funded by the National Institute for Health and Care Research (NIHR), found that 61% of children allocated to the intervention no longer had anxiety problems after 12 months, as reported by their parents, compared to 38% in the control group. Teachers also reported anxiety had a lower impact in the classroom up to two years after the intervention was delivered.
Dr Tessa Reardon, lead author from Oxford’s Departments of Psychiatry and Experimental Psychology, said:
‘We found that the screening-to-intervention pathway for child anxiety problems was superior to usual provision at reducing anxiety problems. Children who screened positive for anxiety problems at the start of the study had 2.3 times the odds of screening negative for anxiety problems at 12-months compared to the control arm, with benefits still being seen after two years.
‘This trial provides robust evidence that screening for anxiety problems in primary schools, then sharing screening outcomes with families, and offering CBT delivered in an accessible way via online and telephone support for parents, reduces child anxiety problems and brings wider clinical benefits for these families.’
Anxiety disorders are among the most common mental health problems faced by children. If left untreated, they can severely impact social development, wellbeing and educational attainment. While cognitive behavioural therapy (CBT) is an effective treatment, few children can access it due to high demands on mental health services.
Children on the ‘screening to intervention’ pathway were offered the parent-led Online Support and Intervention (OSI) tool, based on CBT principles and developed by the same Oxford team. OSI was previously recommended by the National Institute of Clinical Excellence (NICE) in an Early Value Assessment in the UK. It has been shown to be effective in reducing anxiety problems, has lower delivery costs to standard in-person CBT, and is already being delivered in some NHS child mental health services.
Paul Foundation Professor of Developmental Clinical Psychology Cathy Creswell, senior author of the paper and Director of the Centre for Emerging Minds Research at Oxford, said:
Anxiety is a growing problem and can have a lasting impact on primary age children, but barriers such as long waiting lists and difficulties identifying children who might benefit from help, mean many do not get support when they need it.
‘Our OSI tool has already been shown to be both effective in reducing anxiety and more efficient and accessible than in-person treatments, but is currently restricted to families who reach mental health services, which means some children who need it are unlikely to access it. Being able to screen for anxiety problems via schools and deliver effective treatment online has the potential to ensure we reach more children more quickly, bringing positive benefits for them, their families, classrooms and communities.’
Professor Mara Violato, Professor of Health Economics at Oxford Population Health’s Health Economics Research Centre and lead for the economic evaluation alongside the ‘screening to intervention’ study, said:
‘In the intervention group, families who completed the main parts spent on average about 2½ hours with a therapist, although this varied between families. It is reassuring that this is similar to what we found in related studies, suggesting the programme can work with a relatively small amount of therapist time’.
The research was also supported by the NIHR Oxford Health Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, and the Prudence Trust.