In a recent study published in lancet psychiatry, A group of researchers has found that digitally-enhanced, therapist-supported, parent-led cognitive behavioral therapy (CBT) is a cost-effective and clinically effective alternative to standard treatments for treating childhood anxiety. We evaluated whether the method is
study: Comparison of digitally enhanced parent-led CBT with usual treatment for child anxiety problems in child mental health services in England and Northern Ireland: a pragmatic, non-inferiority, randomized control of clinical effectiveness and cost-effectiveness. test. Image credit: Ground Picture/Shutterstock.com
background
Child mental health services around the world are struggling to meet demand, highlighting the need for more accessible care. Digital therapeutics has the potential to significantly expand service capabilities, but full integration into daily practice is pending.
Organizations such as the UK’s National Institute for Healthcare Excellence (NICE) have recognized this urgency and are highlighting the importance of digital solutions for young people’s mental health. Anxiety affects a large portion of the population from an early age and has significant personal and economic consequences.
CBT, particularly in brief parent-led formats supported by therapists, overcomes access barriers and provides viable solutions by engaging directly with families.
Digital platforms such as Online Support and Interventions (OSI) for Child Anxiety, developed in collaboration with families and therapists, hold promise in making effective treatments more accessible. However, further research is essential to assess its cost-effectiveness and potential for widespread use in various clinical settings.
About research
The study followed a registered and published protocol and aimed to involve a total of 34 participating sites, sites that were part of the National Health Service (NHS) or local authority. These include a diverse mix of NHS trusts and local authority, voluntary or community sector providers, and include 73 child mental health teams.
Eligibility criteria for children include parents aged 5 to 12 years with a primary anxiety disorder, adequate English proficiency, internet access, and willing consent.
Exclusions apply to children with certain comorbidities or child protection concerns, as well as parents with severe intellectual disabilities or severe mental health problems.
This study recognizes the unique circumstances of the coronavirus disease 2019 (COVID-19) pandemic, which necessitated a rapid shift to remote service delivery and questions about what constitutes ‘care as usual’. influenced the approach to testing.
Randomization was carefully managed using a web-based system to ensure balanced allocation across intervention and control groups, although it was not possible to blind the intervention to participants. .
The trial procedures were thorough, with families identified, consented, and assessed online and then systematically involved in the treatment process across both groups.
Qualitative interviews were conducted to assess acceptability of OSI and therapist support, providing rich insight into participants’ experiences.
The primary outcome focused on the impact of children’s anxiety on family life using the Child Anxiety Impact Scale-Parent Report (CAIS-P), with a comprehensive set of secondary outcomes to capture a wide range of impacts. accompanied by.
research result
From December 5, 2020 to August 3, 2022, 706 families were referred, and of these referrals, 444 met inclusion criteria, provided consent, and were randomized equally between the two study arms. It was done.
Despite the original plan, only 79% of participants started their assigned treatment within the specified 12 weeks after randomization.
By the end of the study, the OSI group, which included regular therapist support and treatment, had a 79% and 74% completion rate for the 14-week and 26-week assessments, respectively.
The demographics of the participants were predominantly White British, with slightly more girls than boys, and the average age of the children was 9.20 years. Treatment, as usual, consisted primarily of CBT for him, often through his parents.
Before treatment, parents in both groups had similar expectations regarding the logical nature of the intervention and the likelihood of success. However, the parents were initially confident in the success of OSI and the therapist’s support.
After treatment, therapists felt more comfortable administering conventional treatment than OSI and expressed hesitancy about using OSI in the future, primarily due to its novelty and the temporary nature of the trial. It was due to access.
This study found that OSI and therapist support were noninferior to conventional treatment across all primary and secondary outcomes, demonstrating minimal differences in effectiveness. This was consistent across different sensitivity analyses.
Additionally, there were few differences in utility scores and quality-adjusted life years (QALYs) between groups.
However, the combination of OSI and therapist support departments lowered the associated costs, primarily due to faster turnaround times. Although there is some uncertainty, a cost-effectiveness analysis suggested that his OSI and therapist support may be cost-effective in certain scenarios.
Health economic results revealed modest differences in treatment and resource utilization outcomes, suggesting potential cost-effectiveness of OSI and therapist support, although noting uncertainty. Ta.
Despite this uncertainty and lack of serious adverse events, this trial supports OSI and therapists as an effective and potentially more efficient alternative to traditional treatments for anxiety problems in children. emphasized the feasibility of
This finding highlights the value of further consideration of digitally enhanced treatments within child mental health services.
