Title: Development and evaluation of a pathway from 'universal screening' to online intervention for children with anxiety problems
Funder: Department of Health and Social Care

Abstract: Research question Does a pathway that incorporates universal screening , feedback and brief intervention for child anxiety problems reduce child distress, improve life course outcomes, and bring significant economic benefits compared to usual school provision? Background Anxiety disorders are common and have a greater economic burden than any other mental health condition. Half of all anxiety disorders emerge by 11 years of age, and 6.5% of children are affected at any time. Effective psychological treatments for childhood anxiety disorders exist, yet very few children access them. Families face a range of barriers, particularly problems with identification of anxiety disorders and access to prompt support. Aim 1: Establish an assessment system for universal screening of anxiety problems in children. Objective: To establish and optimise an assessment system to identify children with anxiety disorders with sufficient accuracy. Methods: Children, parents and teachers will complete questionnaires (test) and children and parents will be administered diagnostic interviews (reference standard), in order to identify the best questionnaire items/reporters to identify child anxiety disorders. Aim 2: Develop the pathway from 'universal screening' for problematic child anxiety to brief intervention Objective: To develop procedures and materials that are practical, acceptable, secure and maximise engagement. Methods: Children, parents, school staff and other key stakeholders will participate in co-design procedures to iteratively develop the pathway procedures. Aim 3: Test the feasibility of the pathway Objective: To ensure the pathway is acceptable, that there are no unacceptable impacts, that trial recruitment and retention targets are feasible, and proposed clinical and economic measures are relevant and meaningful. Methods: A single arm feasibility study. Aim 4: Model the economic impact of elevated child anxiety Objective: To establish the short/medium-term mental health outcomes and economic burden of elevated child anxiety in order to model longer-term economic benefits/costs in WP5 Methods: (i) Pragmatic literature review; (ii) Analysis of existing UK cohort studies to identify the social, health and economic consequences of childhood anxiety problems. Aim 5: Evaluate the pathway from universal screening to brief intervention for children with anxiety problems Objective: To compare outcomes for children who score above the anxiety assessment system cut-off scores in schools which have received usual school practice + the pathway (intervention arm) versus usual school practice + assessment only (control arm). Estimate the cost-effectiveness of usual school practice + the pathway versus usual school practice +assessment only, extrapolating results beyond the trial duration. Evaluate experiences of the pathway. Methods: Cluster randomised controlled trial, including clinical, educational and health economic outcomes, and evaluations of participant experiences. Timelines for delivery We will work closely with stakeholders to ensure that the pathway is in a form that can be directly incorporated into schools on completion of the project if indicated. Anticipated Impact If effective, this pathway will provide schools/ mental health practitioners with resources and procedures to support identification and early intervention for child anxiety problems, and will set out a model for identification and access to good quality care that can be expanded to other common mental health conditions in children.

Lay abstract: BACKGROUND Everybody experiences anxiety sometimes but if it is severe, long lasting and interferes with daily life it is called an anxiety disorder. One in four people experience an anxiety disorder - for half these people it starts by 11 years of age. This puts them at risk of ongoing anxiety, other mental health problems and impaired quality of life into adulthood. Treatments have been developed that work well for children with anxiety disorders but few children access them. Primary school-aged children typically rely on parents/caregivers to seek help for them, but parents face many barriers to getting help. Our previous work suggests that (i) brief questionnaires can identify children with anxiety disorders, and (ii) children with anxiety disorders can be helped by a brief treatment that supports parents to help their child overcome anxiety (now available online). AIMS To reduce anxiety problems in children by developing and testing a new way of identifying children with anxiety disorders and offering treatment in which (a) all children complete measures of anxiety in primary school, (b) parents receive feedback, (c) where there seem to be problems, parents are offered an online treatment and therapist support to help them to help their child overcome difficulties with anxiety. DESIGN AND METHODS We will (i) adapt brief child anxiety questionnaires and check that they can identify children likely to benefit from treatment for anxiety; (ii) work with families, school staff and others to develop a new way of identifying and offering treatment; (iii) make sure families and schools are happy with the early identification and treatment system and that a full study can be conducted; (iv) use data from previous research to work out the short and medium-term costs of child anxiety; and (v) compare outcomes for children (identified as likely to benefit) who do and do not receive early identification and treatment. We will assess whether early identification and treatment is good value for money (in the short and the medium term) and explore experiences of the process. PATIENT AND PUBLIC INVOLVEMENT Parents told us that they wanted to know whether, when and how to seek help, and how to get help quickly. Parents and children with anxiety problems have provided extensive input in the study design and will continue to do so throughout the study to make sure everything we do is acceptable, and to support recruitment, analysis of interview data, and share findings. DISSEMINATION We will share our results directly with the public, health and education professionals, commissioners and policy makers as well as through publications, conference talks, newsletters, online information, through our broad networks, and in other ways as advised by families, school representatives, and other stakeholders.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH