Online Support and Intervention (OSI) for child anxiety: a case series within routine clinical practice

Abstract

Background: Online treatments for child anxiety offer a potentially cost-effective and non-stigmatizing means to widen access to evidence-based treatments and meet the increasing demand on services; however, uptake in routine clinical practice remains a challenge. This study conducted an initial evaluation of the clinical effectiveness, feasibility and acceptability of OSI (Online Support and Intervention for child anxiety) within clinical practice. OSI is a co-designed online therapist-supported, parent-led CBT treatment for pre-adolescent children with anxiety problems. Method: This case series was part of routine service evaluation in a clinic in England where families were offered OSI to treat a primary anxiety difficulty among 7- to 12-year-old children; 24 families were offered OSI, and 23 took it up. Measures of anxiety symptomatology, functional impairment and progress towards therapeutic goals were taken at pre-treatment, post-treatment and 4-week follow-up. Treatment satisfaction and engagement were also measured throughout the intervention. Results: Mean anxiety symptoms significantly improved to below the clinical cut-off post-treatment, with further reduction at follow-up. Functional impairment also significantly improved and significant progress was made towards treatment goals. The majority of children showed reliable change in anxiety symptoms and reliable recovery by follow-up, and were discharged without needing further treatment for anxiety. Uptake, adherence and engagement in OSI were excellent, and parents reported high levels of satisfaction with the treatment. Conclusions: We have provided initial evidence that OSI is feasible, acceptable to families, and appears to be associated with good outcomes within routine clinical practice.

Increasing access to evidence‐based treatment for child anxiety problems: online parent‐led CBT for children identified via schools

“…Furthermore, as also found by Hill, Chessell, et al. ( 2022 ), improvements were particularly large on the Goal Based Outcome measure, which is encouraging given that such idiographic outcome measures may be more sensitive to change than standardised outcome measures (Edbrooke‐Childs, Jacob, Law, Deighton, & Wolpert, 2015 ). In addition, despite the relatively low baseline scores among this early intervention sample, rates of reliable change and reliable deterioration compare favourably to those found in a recent meta‐analysis of outcomes in routine clinical practice in specialist mental health services (Bear, Edbrooke‐Childs, Norton, Krause, & Wolpert, 2020 ) although notably that study included children and adolescents whereas our study only included preadolescent children.…”

“…Unsurprisingly, given that this study aimed to evaluate early intervention, some effect sizes from the start to the end of treatment were somewhat smaller than in a previous evaluation of OSI that was conducted within a clinical setting (e.g., CORS pre to follow‐up here d = 0.84 compared to 0.96 in Hill, Chessell, et al. ( 2022 )). However, the improvements seen were nonetheless in keeping with those found in trials of far more intensive interventions for child anxiety disorders (e.g.…”

“…Built in routine outcome monitoring within OSI ensured high levels of data completion, which demonstrated session on session improvements across all measures, which continued to the follow-up assessment, 1 month after the core treatment ended. Unsurprisingly, given that this study aimed to evaluate early intervention, some effect sizes from the start to the end of treatment were somewhat smaller than in a previous evaluation of OSI that was conducted within a clinical setting (e.g., CORS pre to follow-up here d = 0.84 compared to 0.96 in Hill, Chessell, et al (2022)). However, the improvements seen were nonetheless in keeping with those found in trials of far more intensive interventions for child anxiety disorders (e.g.…”

“…It was developed in response to parents' requests for improved access to CBT through engaging, self‐study online content that parents could access at times that suit them. A preliminary evaluation of OSI with children aged 7–12 years in a clinical setting indicated that OSI is feasible, acceptable to families and appears to be associated with positive outcomes within routine clinical practice (Hill, Chessell, Percy, & Creswell, 2022 ). However, limiting delivery to clinical settings inevitably introduces barriers to access to psychological interventions for children and families.…”

Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment

“…In this study with parents of 3-to 6-year-olds, although the online treatment was superior to waitlist the outcomes were relatively modest (see Table 1), but the authors concluded that 'given that the program : : : was not tailored specifically for parents of children in this age group and was somewhat makeshift in nature, the positive results obtained are particularly promising' (Donovan and March, 2014). Further promising evidence that an online approach may be a feasible, efficient and acceptable approach that is associated with good outcomes comes from a recent clinical case series in which we examined routinely captured outcome measures from a new online parent-led CBT intervention that was designed in collaboration with parents, children and clinicians (Hill et al, 2021).…”