Dr Hill

Tackling child anxiety one click at a time


Dr Claire Hill, Clinical Postdoctoral Research Fellow & Clinical Psychologist, Anxiety & Depression in Young People (AnDY) Unit, University of Reading

Date: 01 March 2017

When was the last time you were anxious? Maybe you had a presentation to give, or a trip to the dentist. Perhaps this was today, or last week. It’s normal to feel anxious from time to time, but for some people anxiety is a debilitating, everyday experience.  

For many, difficulties with anxiety start in childhood. Anxiety disorders are among the most common psychiatric disorders in childhood, with 6.5 per cent of children meeting criteria for a diagnosis. That’s about two per classroom. The impact can be massive, with friendships, social and family life, school attendance and performance all affected. So, what are we doing about it? Well not enough it would seem.  

Waiting lists for treatment at Child and Adolescent Mental Health Services (CAMHS) are shameful, with families sometimes waiting a year or more for treatment. The frustration is that we do have effective treatments for child anxiety disorders, but less than a quarter of affected children access them. Put simply, demand outstrips supply and the pressure to do more with less is ever present.  

So, what’s the solution? Providing treatment online is one way to increase access to evidence-based interventions. Currently online treatments are offered in many adult psychological services as part of a stepped care model of working, where the more intensive treatments are reserved for those who are unresponsive, or unlikely to respond to low intensity treatments.  But online treatments are seldom offered in CAMHS. This is despite randomised controlled trials (RCTs) demonstrating online treatments to be just as effective in treating child anxiety as working face-to-face, with likely added benefits of cost-effectiveness and added appeal to those who don’t wish to, or would struggle to attend appointments.

Why then has this seemingly no-brainer solution not made it into the NHS? Somehow it seems that dissemination into routine clinical practice is lost, despite trial success. Rather than reaching those who need it, these online programmes end up in the academic graveyard with no one driving adoption in the clinic.  

Determined not to fall foul of this, together with NIHR Research Professor Cathy Creswell at the Anxiety and Depression in Young People (AnDY) Research Clinic, University of Reading, I embarked on an ambitious project to translate a brief face-to-face treatment for parents of children with anxiety disorders into an online version for use in the NHS. From the outset, we were keen to ensure that the online programme was scalable and sustainable beyond the period of the funding award, which we received as part of Cathy’s NIHR Research Professorship.  

It quickly became clear that we needed to think about dissemination right from the very start.  As Academics and Clinical Psychologists, we knew we would not be well placed to take any resultant online intervention to market within the NHS. Instead, we decided to partner with a company who not only had experience of developing digital mental health solutions, but also in getting them adopted by the NHS. This meant we could contribute the necessary clinical and research skills whilst the company could focus on the technical side and ultimately the commercialisation of the resultant product within the NHS on a not-for-profit basis.

One year and an epic EU tender later we have partnered with an innovative company called Red Ninja. We are currently in the process of co-designing our online treatment with those it’s aimed at, in this case children treated for anxiety and their parents, as well as clinicians.  Through a series of workshops, we’re discovering the functionalities we were wrong about and are gathering a ton of new ideas. These relate to the look of the product and how understandable the content is. This is such a valuable and indispensable part of the development process that is unfortunately lacking in the online child anxiety treatments that already exist.  

Like most academics, we are impatient to get to the stage where we can publish trials that hopefully show our digital intervention works, is cost-effective and acceptable to families and services. But for me, this project will only be a success if this online treatment is not only read about, but is offered as part of routine clinical practice. Because really what is the point of all this effort, if not to increase access to treatment for child anxiety disorders?

The 2018 NIHR Challenge Award provides an opportunity to enable technologies find their way, fully developed, into the NHS to have an impact on the patient pathway. If you’ve got a solution to the NIHR Invention for Innovation (i4i) Challenge Award submit an application by 4 April.

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.
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    With NIHR Professorship funding Dr Hill and team are developing an online intervention for young people with anxiety. Find out how they plan to translate into clinical practice.
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    Dr Claire Hill, Clinical Postdoctoral Research Fellow & Clinical Psychologist, Anxiety & Depression in Young People (AnDY) Unit, University of Reading

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