New online tool that empowers parents to treat child anxiety could expand access to child mental health services

7 February 2024

New research from the University of Oxford has revealed that an online program that empowers parents to apply Cognitive Behavioural Therapy (CBT) principles in their child’s day to day lives is just as effective as traditional talking therapies for child anxiety problems, while substantially reducing the amount of therapist time required and making support more accessible for many families. The approach provides parents online tools and some therapist guidance to help children overcome problems with anxiety.

Published today in The Lancet Psychiatry, the findings suggest this parent-led online CBT model could allow health services to treat more families, at lower cost, and reducing potential barriers to access for families. This could have major implications for expanding access to much-needed mental health treatment for children.

Anxiety disorders are among the most common mental health problems faced by children, affecting over a quarter of people at some point in their lives. If left untreated, they can severely impact social development, education attainment, and wellbeing. While cognitive behavioural therapy (CBT) is an effective treatment, few children can access it due to high demands on mental health services.

To address this gap, researchers, with support from the National Institute for Health and Care Research (NIHR), developed ‘Online Support and Intervention’ (OSI) – an online program that guides parents through CBT strategies to help their anxious child. It includes educational content, tools like worksheets, quizzes, and brief weekly support from a therapist by phone or video.

Professor Cathy Creswell, Professor of Developmental Clinical Psychology at the University of Oxford explained:

“Anxiety problems often start early in childhood and bring substantial distress. Our study shows that by supporting parents to help their children using online tools with therapist support, we can dramatically increase how many children get timely, effective help.”

The study compared OSI plus therapist support to standard, in-person, care in over 400 children aged 5-12 treated across 34 child mental health services across England and Northern Ireland. The children receiving OSI with therapist support showed similar reductions in anxiety and improvements in daily functioning as those receiving standard CBT.

Importantly, OSI required almost half as much therapist time to deliver – 182 minutes on average compared to 307 minutes for usual care. Based on this, researchers determined that OSI could allow therapists to treat more children within busy mental health systems without compromising outcomes. If implemented widely, this could substantially expand access to effective anxiety treatment.

"The OSI programme shows that we can support children with anxiety problems in a way that fits into family life and potentially reach many more families by reducing demand on services," said Professor Creswell. “This approach could make a real difference to child and adolescent mental health services, offering a practical solution to the current gap between the need for treatment and its availability.”

The researchers also interviewed parents and therapists about their experiences. Parents found the online program flexible, user-friendly, and fitted well into family life. Many felt OSI equipped them with lifelong skills to manage anxiety in their child and other children. Therapists were enthusiastic about OSI’s potential to reach more families in need.

Co-author Dr Vanessa Raymont, Honorary Consultant Psychiatrist and Director of Research and Development at Oxford Health NHS Foundation Trust, said:

“Children’s mental health services across the country are strained, and waiting lists keep growing. This research shows that empowering parents to help anxious children via technology-supported treatment, is feasible and could bring major time and cost savings without compromising clinical benefits.”

The findings provide hope that innovations like OSI could be taken up by healthcare systems, learning from successful digital rollouts in other areas of healthcare, to transform children’s mental healthcare and allow many more families to access timely, effective treatment.

Notes to editors:

Publication details:
DOI: https://doi.org/10.1016/S2215-0366(23)00429-7

Contact
Please send all request for interview or comment to [email protected]

Funding
This work is independent research funded by the National Institute for Health and Care (NIHR) Research Policy Research Programme, the NIHR Applied Research Collaboration Oxford and Thames Valley, and the Oxford Health NIHR Biomedical Research Centre.

Funding was also supplied by UKRI/NIHR.

About the University of Oxford
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the eighth year running, and number 3 in the QS World Rankings 2024. At the heart of this success are the twin pillars of our ground-breaking research and innovation and our distinctive educational offer.
Oxford is world-famous for research and teaching excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research alongside our personalised approach to teaching sparks imaginative and inventive insights and solutions.
Through its research commercialisation arm, Oxford University Innovation, Oxford is the highest university patent filer in the UK and is ranked first in the UK for university spinouts, having created more than 300 new companies since 1988. Over a third of these companies have been created in the last five years. The University is a catalyst for prosperity in Oxfordshire and the United Kingdom, contributing £15.7 billion to the UK economy in 2018/19, and supports more than 28,000 full-time jobs.

Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine and life sciences, and it is home to the UK’s top-ranked medical school. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and healthcare delivery.

The University Department of Psychiatry’s mission is to conduct world-class research, teach psychiatry to medical students, develop future researchers in a graduate programme, teach doctors in training, promote excellence in clinical practice, and develop and provide innovative clinical services. It supports research in four key areas: neurobiology, psychological treatments, developmental psychiatry and social psychiatry. The Department is committed to the translation of scientific discovery into benefits for patients. www.psych.ox.ac.uk

About the National Institute for Health and Care Research (NIHR)
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

Funding high quality, timely research that benefits the NHS, public health and social care;
Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

The NIHR Oxford Health Biomedical Research Centre (OH BRC) led by Professor John Geddes is based at the Oxford Health NHS Foundation Trust. The OH BRC is run in partnership with the University of Oxford and involves 10 additional partner university and NHS Trusts across England. Support for infrastructure is provided by the National Institute for Health and Care Research (NIHR) for 11 research Themes focused on brain health.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
https://www.nihr.ac.uk/.

The NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, hosted by Oxford Health NHS Foundation Trust, is a partnership of regional health services, universities and industry which turns research into cost-saving and high-quality care through cutting-edge innovation. For further information, visit www.arc-oxtv.nihr.ac.uk

The Oxford Health Biomedical Research Centre (OH BRC) led by Professor John Geddes is based at the Oxford Health NHS Foundation Trust. The OH BRC is run in partnership with the University of Oxford and involves 10 additional partner university and NHS Trusts across England. Support for infrastructure is provided by the National Institute for Health and Care Research (NIHR) for 11 research Themes focused on brain health.