None listed
Conditions
Brief summary
Anxiety disorders are the most common mental disorder in childhood affecting up to 10% of youth, and are associated with significant burden on individuals, families, schools, communities and the economy. Delivery of mental health services to treat adolescents is costly with many barriers to accessing evidence-based treatment. Primary Health Networks are encouraged to implement stepped care approaches to mental health treatment to increase service-efficiency. However, few scientific evaluations of stepped care models have been conducted. Our team are the first to demonstrate the efficiency of stepped care for anxious adolescents in a university clinic. This project partners with a New South Wales Local Health District (NSLHD) community mental health services (headspace and Child & Youth Mental Health Services [CYMHS]) to evaluate in a pilot randomised controlled trial, the service-efficiency and efficacy of implementing evidence based psychosocial treatments for adolescent anxiety using a stepped care approach. Adolescents will receive either treatment as usual or stepped care consisting of an internet intervention [step 1], and then if required, additional face-to-face evidence-based therapy [step 2]. The superiority of stepped care on service-efficiency and treatment effectiveness will be compared in two headspace and two CYMHS sites. The results will provide preliminary evidence for stepped care approaches in community mental health that can be used to further evaluate translation of stepped care on a larger scale.
Interventions
Stepped Care of cognitive behavioural therapy.
Step 1 will consist of the Chilled Out cognitive behavioural therapy internet program delivered over 14 weeks and supported by 4 x 30 minute structured phone calls from a community mental health intake officer or youth access worker (at CYMHS and HeadSpace). The Chilled Out program (from the Cool Kids anxiety management program suite) teaches cognitive behavioural therapy skills in eight modules (goal setting, psychoeducation, cognitive restructuri
Stepped Care of cognitive behavioural therapy. Step 1 will consist of the Chilled Out cognitive behavioural therapy internet program delivered over 14 weeks and supported by 4 x 30 minute structured phone calls from a community mental health intake officer or youth access worker (at CYMHS and HeadSpace). The Chilled Out program (from the Cool Kids anxiety management program suite) teaches cognitive behavioural therapy skills in eight modules (goal setting, psychoeducation, cognitive restructuring, graded exposure, coping skills) that take approximately 30 minutes each week. All modules are accessible from first log in, and participants are recommended to complete one module per week. Each module contains educational videos, text and worksheets. Step 1 support telephone calls are provided by intake officers and youth access clinicians trained in the Chilled Out program by the lead CI. These calls check program adherence and homework exercises, skills understanding, risk management, and problem solve challenges to skill implementation. Program adherence is checked via session attendance checklists and website analytics monitoring log ins. At the end of Step 1, the participant and clinician will discuss whether or not they need to progress to Step 2. Progression will be based on a clinical review of current symptoms and preference by the participant. Step 2 consists of up to 10 face-to-face (1 hour) sessions over 14 weeks delivered individually at CYMHS/HeadSpace by a psychologist using the Chilled manualised cognitive behavioural therapy program (from the Cool Kids anxiety management suite of programs). This manualised program uses the same core cognitive behavioural skills (goal setting, psychoeducation, cognitive restructuring, graded exposure) as Chilled Out (step one), however, in more detail, and with more one-on-one therapist time to apply skills to the participant (up to 10 x 1 hours). Treatment goals are collaboratively set between participant and clinician and therapy skills are extended as needed to address remaining anxiety symptoms. Clinicians are trained in the Chilled program by the lead CI.
Sponsors
Macquarie University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
12 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
Aged 12 years to 18 years. Assessed by clinicians at the participating Child & Youth Mental Health Services (CYMHS) and HeadSpace sites. Participants determined to have a clinically relevant anxiety problem as their main interfering problem via the usual clinical assessment processes.
Exclusion criteria
Primary clinical problem that is not anxiety. e.g. depression, psychosis. Current self-harm, active suicidal risk,bipolar disorder, psychosis, unsafe family circumstance, and insufficient literacy as determine by usual intake procedures
Outcome results
None listed