Helping young people with chronic medical conditions experiencing anxiety and depression

This study aims to adapt and test the feasibility, acceptability, appropriateness, and efficacy of a transdiagnostic intervention called Unified Protocol for the Treatment of Emotional Disorders in Children and Adolescents (UP-C/A), to reduce anxiety and depression in children and adolescents with a chronic mental conditions. The UP-C/A is a transdiagnostic intervention program adapted from the original version for adults. Using a manualised program, it targets underlying factors that are common to many emotional disorders, thereby addressing the primary emotional disorder, as well as comorbid emotional disorders. It is a child-focused program based in cognitive behavioural therapy and incorporates mindfulness, flexible thinking, avoidance, interoceptive and situational experiences. The program also includes a parent treatment component which focus on teaching parents anxiety management strategies, reinforcement skills, and plan for at-home exposures. In consultation with young people with lived experience of chronic medical conditions and emotional disorders, we will be adapting the lead characters in the UP-A/C program to feature characters that have a chronic medical condition to ensure that the program is relatable and developmentally appropriate. This lived experience group will be engaged as a first step of the study, and prior to the commencement of participant recruitment. The group will include four children (8-11 years), four adolescents (15 - 20 years) with a chronic medical condition who present with depression and/or anxiety as well as three parents who have children living with chronic medical conditions and depression and/or anxiety, and three adults (18 - 40 years) with lived experience of chronic medical conditions in childhood. They will be selected through a formal invitation process organised via the Royal Children’s Hospital Clinical Psychology Service (RCH Lived Experience Network) and will be invited to contribute to the design of the study, and interpretation of results. Lived experience group members will have the options of providing their feedback either in group workshop sessions or in one-on-one call sessions (audio or video calls), depending on their preference. The first feedback/workshop session will focus on soliciting feedback on the study design (e.g., length of assessments) and the adapted version of the UP-C/A. A follow-up workshop is scheduled to take place within two to four weeks, where participants will receive updates on how their feedback has been integrated into the study design. Each of these two workshops/feedback sessions will last about 90 minutes (for the adults and parent groups), 60 minutes (for the adolescent group,), and 30 minutes for younger children. To address the power imbalance and make the lived experience group feel comfortable to provide feedback we have designed this information gathering in the following way. We will invite a member of the RCH Lived Experience Network to serve as a group facilitator and we will have this person review the study methods before we start recruitment the lived experience group members. We will also consult clinicians (e.g., psychologists) working with young people with chronic medical conditions to get their feedback during the UP-C/A adaptation process. This feedback session will be in a form of a workshop, where clinicians will learn about the UP-C/A program, learn about the proposed program adaptations and the research design, and will be asked to provide their feedback on how they think the adapted program can be better tailored for this target group. The feedback gathered from these sessions will be incorporated in the study design and submitted as an ethics amendment to the Royal Children's Hospital Human ethics Committee prior to commencing data collection for this study. Recruitment of study participants will commence following ethics approval Study participants between 8 – 11 years and 12 – 17.11 years will receive the child (UP-C) and adolescent (UP-A) versions of the intervention, respectively. These are two separate versions of the UP-C/A intervention and selection of appropriate version will be based on each individual child's age. The child version (UP-C) includes 15 sessions with corresponding parent components for each session. Parents are required to attend each session to learn the skills their child is learning so they are equipped to support their child. It is divided into five modules or CLUES skills - “Consider How I Feel”, “Look at My Thoughts”, “Use Detective Thinking and Problem Solving”, “Experience My Emotions”, and “Stay Healthy and Happy”. The adolescent version (UP-A) comprises eight core modules (five core and three supplementary modules), including modules on emotion-focused education, awareness techniques, cognitive strategies, and problem-solving. The adolescent version has an optional parent module (on parenting the emotional adolescents). The UP-C/A modules are designed to be flexible in length to accommodate patient heterogeneity. Most therapy sessions will last for about 50 minutes, but there will be flexibility to ensure that each child's unique needs are catered for. Therapy sessions with each participant will be completed weekly, up to a maximum of 6 months, including 3 to 21 sessions, depending on the individual needs of the client. Sessions will be administered both face to face and online (via RCH telehealth). Participants will be required to attend a minimum of three face-to-face sessions and the remaining can be either face-to-face or online. The intervention will be delivered by Psychologists with certification from the Australian Health Practitioner Regulation Agency, who will complete training from a highly experienced UP-A/C therapist prior to delivering the intervention. The study will include a total of 60 children/adolescents, with 30 participants receiving the UP-A/C program immediately upon enrolling in the study. The other 30 participants will be assigned to a waitlist control group and will only receive the UP-A/C intervention 8 weeks after enrolling in the study. Participants will be recruited from the Royal Children's Hospital Clinical Clinical Psychology Service (Australia), when they attend the clinic for psychological assessment. To assess the psychologist’s adherence to the treatment protocol, the psychologists will participate in fortnightly clinical supervision either in-person or via teleconference with a Senior Psychologist trained in the UP-C/A. A member of the UP-A/C development team will also be consulted for supervision and advice on the administration protocol as and when needed. Ten percent (10%) of therapy sessions will be recorded (with participant and parental permission) and will be reviewed/rated by the Research Coordinator to ensure the program is adhered to. A study-developed checklist will be used to evaluate each therapy session, and the entries will be scored to provide a quantitative measure of treatment fidelity.