Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies

Abstract

BackgroundThere are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution.ObjectiveThis case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT.MethodsThree case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices).ResultsIn-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment.ConclusionsThe findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials.

Trajectories of Change in an Open-access Internet-Based Cognitive Behavior Program for Childhood and Adolescent Anxiety: Open Trial

“…HAS participants could be easily identified at the beginning of the program (due to higher initial scores), and subsequently referred, monitored, and provided with additional support or intervention elements if their response to the program was poor. Preliminary results from case studies of a stepped-care model of BRAVE highlight the potential of this approach [ 29 ].…”

Intervenções Cognitivo-Comportamentais Baseadas Na Internet Autoguiadas Para Adolescentes: Uma Revisão

“…Nine studies showed favorable results for these interventions' use (Calear et al, 2009;Chillemi et al, 2020;Hill and Pettit, 2016;March et al, 2019;Perry et al, 2017;Rapoff et al, 2014;Rees et al, 2016;Saulsberry et al, 2013;Wade et al, 2019). Despite this, it is concerning how much the number of interventions found in this study contrasts with the number and pace at which e-Health apps are being released in app stores (Olff, 2015).…”

“…The 19 articles describe the 13 interventions through: seven efficacy studies with at least two groups (Calear et al, 2009;Hetrick et al, 2017;O'Kearney et al, 2006;Perry et al, 2017;Rapoff et al, 2014;Saulsberry et al, 2013;Van Voorhees et al, 2009), five efficacy studies protocols (Baldwin et al, 2021;Gladstone et al, 2015;Hides et al, 2020;Palermo et al, 2018;Rees et al, 2015), four pilot or preliminary data studies (Chillemi et al, 2020;Hill e Pettit, 2016;Rees et al, 2016;Wade et al, 2019), two complementary aspects studies -such as lessons learned and adherence (Anderson et al, 2017;Calear et al, 2013), and three case studies (March et al, 2019). Interventions and their main characteristics are described in Table 1.…”

Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study

“…Third, they are able to deliver a service experience that is tailored to the needs and preferences of each individual young person through personalization [ 21 ]. Finally, there are many evidence-based digital mental health services that can be accessed for free or at a low cost, with no waiting period [ 22 , 23 ]. Digital services might also act as an alternative or adjunct intervention when young people have had previous negative experiences with mental health professionals.…”