Impact case study database

Anxiety disorders are the most common mental health disorders in children and young people. They have a negative impact on educational, social and health functioning, create a risk for ongoing mental health disorders in adulthood, and create substantial economic burden. For over 30 years, the ‘gold standard’ treatment for childhood anxiety disorders has been nine to 16 weekly sessions of individual cognitive-behavioural treatment (CBT) with children, but this requires specialist therapists and involves more sessions than is often feasible in the NHS. Indeed, research from the University of Reading has shown that less than 2% of children with an anxiety disorder access evidence-based treatment [3,4]. The body of research described in this case study has led to the development and provision of an evidence-based, brief (<5.5 hours) treatment for childhood anxiety disorders that can be delivered effectively by non-specialists. This provides a means to improve access to psychological treatments for children with anxiety disorders.

Training non-specialist mental health practitioners

GPD-CBT is one of three specialised interventions taught to child and adolescent wellbeing practitioner (CWPs), and also to a new cohort of education mental health practitioners (EMHPs). From the inception of the CWP (2017) and EMHP cohorts (from 2019), the team has provided skills training directly to four of the (then) six national CWP courses as well as the initial (EMHP), courses. Furthermore, in February 2020, the team ran a ‘train the trainer’ course, which was attended by 67 course tutors from across all the national CWP/EMHP courses. As such, thousands of low intensity psychological therapists who work in youth settings have been trained to use the GPD-CBT approach [E1, E2]. In addition, the team has provided training on request to several organisations, including to NHS Education for Scotland (34 practitioners, with 10 of 14 Boards across Scotland represented); and to Anxiety UK who have, since August 2019, offered GPD-CBT as part of their standard offer to families seeking support (46 therapists trained). Training has also been provided to practitioners in countries including China, Iceland, Ireland, and Japan.

Uptake and further development of resources for parents and clinicians

On the basis of the team’s phase one research and her clinical expertise in psychological interventions for children and families, Creswell co-wrote two books for parents with an NHS colleague (Willetts). ‘Overcoming your child’s fears and worries’ and ‘Overcoming your child’s shyness and social anxiety’ were published in 2007 by Constable Robinson. The first book was updated in April 2019 (‘Helping Your Child with Fears and Worries’, Little Brown). Collectively, these three books have sold more than 52,000 copies between August 2013 and December 2020. Sales have been predominantly in the UK where the first book is widely available on prescription [E3], but there have also been translations into Norwegian, Polish, Hebrew, Icelandic and Russian. Creswell also produced a manual to accompany the books on fears and worries, which guides clinicians to provide a brief treatment with families. The University of Reading has made the manual freely available via its repository, along with a slide pack for administration in a group format [E4]. The manual has been downloaded over 1,300 times between May 2016 and June 2020. Creswell et al. have also produced a more detailed clinician guide, ‘Parent-led CBT for Child Anxiety: Helping Parents help their Kids’ (published by Guilford Press). Over 3,700 copies have been sold since the clinician’s guide was published in 2016 and it has also been translated into Dutch. Furthermore:

• Users have produced summaries of GPD-CBT materials to increase access (e.g. Tower Hamlets NHS Trust produced audio versions in English and Sylheti).

• Creswell and colleagues set up an NHS future collaboration workspace for clinicians to share their experiences with GPD-CBT. This currently has 116 members.

• Based on the team’s findings that highlighted particular barriers faced by GPs in the management of childhood anxiety disorders, Creswell and colleagues produced a set of Top Tips for the Royal College of General Practitioners, in collaboration with two GPs and a parent representative [E5]

• The team has developed and disseminated webinars and podcasts through third sector and professional organisations (e.g. ACAMH, Anxiety UK) to raise awareness of their research and practice to a wider number of practitioners [E6].

Establishment of the AnDY Clinic

The team has also directly influenced local clinical practice through the development of the University of Reading run Anxiety and Depression in Young people (AnDY) research clinic which was established in 2017 to complement existing local NHS childhood and adolescent mental health service (CAMHS) provision. The AnDY research clinic provides brief evidence-based treatments for children and young people before they reach CAMHS, as well as providing a high-quality research and training environment. Between January 2017 and September 2020, the AnDY Clinic assessed over 600 children and young people from across Berkshire, providing treatment to 427. Furthermore, the AnDY Clinic has provided clinical placements for over 60 trainee practitioners, undergraduate and postgraduate students.

Evidence of effectiveness of GPD-CBT in routine settings

Data compiled from CAMHS teams from five NHS Trusts who had independently applied the approach showed that 75% did not need to be ‘stepped up’ to more intensive services after the brief treatment [E7]. This is supported by routine data from the AnDY Research Clinic, which indicated that 74% of children (n=49) treated by CWPs between April 2018 and June 2019 recovered after receiving GPD-CBT, defined as being below clinical cut off (t-score below 70).

Wider influence on children’s mental health policy and practice

Between February 2016 and November 2017, Creswell was a member of the children and young people working group which supported the development of the Department of Health’s Framework for Mental Health Research. Creswell subsequently worked with the Chief Medical Officer’s team to build on the framework, developing a series of goals to set the agenda for mental health research in the UK over the next decade (from 2020 to 2030); she led the development of goals relating to children and young people’s mental health [E8]. In addition:

• The team’s research was cited in the 2017 economic case for the UK Government green paper ‘Transforming children and young people’s mental health provision’ [E9].

• In 2019, Waite was a clinical advisor to Public Health England (PHE) during the development of online resources to promote good mental health among secondary school students.

• In 2019, PHE extended their ‘Every Mind Matters’ campaign to include support for parents of children and young people with mental health concerns, broadening the campaign’s existing focus on adult mental health problems. Waite also consulted on the development of the relevant mental health sections of the ‘Every Mind Matters’ website [E10].

• Creswell has acted as a clinical advisor to Anxiety UK since May 2017.

• In September 2017, Creswell was invited to produce an evidence note for the Cabinet Office, for presentation to the Prime Minister, describing the impact that child and adolescent mental health problems have on families. As a result, in November 2017 Creswell contributed to a roundtable discussion, hosted by the Cabinet Office, to explore opportunities on how best to support families, which included representatives from major charities, NHS England, NHS Foundation Trusts, the Department of Health, PHE, and the Department of Work and Pensions.

Increasing access through the provision of e-therapies

Creswell was a member of the expert advisory panel which guided the National Collaborating Centre for Mental Health’s systematic review of e-therapies in CAMHS. The 2014 report from the review stated that “ Evidence-based therapies for children and young people with mental health conditions can be delivered in computerised formats effectively and can be beneficial”. The report also recommended that the government and other funding bodies invest in the development and evaluation of a range of e-therapies for children and young people with mental health conditions. Creswell and colleagues are also helping to deliver online therapies:

• Creswell and team worked with parents, clinicians and a tech partner to develop online support and intervention (OSI), an online version of the GPD-CBT approach, funded by the NIHR. The AnDY Clinic has provided OSI alongside its GPD-CBT provision since February 2020, which has enabled AnDY’s clinicians to provide ongoing, flexible support for families throughout the Covid pandemic.

• As part of their rapid response to Covid, the NIHR funded a trial of OSI. Between October 2020 and December 2020, 243 therapists from 41 clinical teams across 20 NHS trusts and Local Authorities in England had enrolled on the trial to implement OSI within their service.

• Healios, a provider of online mental health services, consulted with Creswell on ThinkNinja. This app was launched in December 2018 to provide early support in schools and is available via the NHS app library.

Summary: A new, cost-effective treatment for childhood anxiety, developed from University of Reading research, is enabling families to access the help that they need more quickly and in greater numbers. This increased access is underpinned by the research team’s active role in training a new workforce of CYP mental health workers, the publication of valuable resources used by thousands of parents and clinicians, as well as their influence at a national level, and direct service delivery at a local level.