Title: The Treatment of Child Anxiety in Primary Care via Guided CBT Self-Help: A Randomised Controlled Trial
Funder: Department of Health (England)

Abstract: Background Anxiety disorders are the most common mental health disturbance in childhood and significantly impact on socio-emotional and academic development. Cognitive Behaviour Therapy (CBT) is associated with good outcomes, including when delivered to parents. However CBT is expensive and not widely available. CBT self-help has been shown to be efficacious for other disorders, especially when guidance is provided. We have recently completed an RfPB funded feasibility study of CBT self-help for child anxiety disorders guided by Primary Mental Health Workers (PMHWs), which demonstrated PMHWs deliver the treatment well, parents and PMHWs report high satisfaction, and there are clear improvements in child anxiety. This proposal is to assess the effectiveness and cost-effectiveness of this intervention. Aims We produced a CBT self-help manual for the management of childhood anxiety, entitled ‘Overcoming your child’s fears and worries’, which provides a potential basis for an inexpensive means of delivering CBT widely to children with problematic anxiety. Findings of a recent RfPB funded feasibility study show promising results from using this manual to deliver a guided self-help treatment within Primary Care. The aims of the proposed study are to assess the effectiveness and cost-effectiveness of this therapeutic approach in comparison to standard care in Primary Child and Adolescent Mental Health Service (PCAMHS) across the whole of Oxfordshire. In addition we aim to explore which patients benefit most from this treatment approach,in order to guide treatment decision-making. Plan of Investigation The study will be conducted within the Oxfordshire Primary Care Child and Adolescent Mental Health Service (PCAMHS). All the PCAMHS workers will be trained in the delivery of the CBT self-help manual. A research assistant (RA) will assess all children and their parents where the referrer identifies anxiety as a primary problem, to confirm primary anxiety status and obtain baseline assessments. Eligible participants will be randomised to either parent-focussed guided self-help or PCAMHS standard care (SC). Outcome and economic assessments will be conducted (blind to treatment condition) 3 months later (i.e. post treatment). Follow-up assessments will be conducted 6 months post-treatment. Treatment sessions will be recorded and assessed for treatment adherence. Potential Impact Demonstrating that guided CBT self-help for childhood anxiety is an effective and cost-effective treatment, that is deliverable within primary care and represents an improvement over the usual treatment that is provided, will be of considerable benefit to families and the NHS. Children with anxiety difficulties will be able to receive an evidence-based treatment rapidly within primary care across the country, which is likely to prevent future social, academic and mental health problems The cost to the NHS of supporting children with anxiety difficulties will be significantly reduced as a result of both the inexpensive first line treatment and the reduction in referrals to specialist child and adolescent mental health services.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH