Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies.

March, Sonja and Donovan, Caroline L. and Baldwin, Sarah and Ford, Martelle and Spence, Susan H. (2019) Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies. Internet Interventions, 18 (Article 100281). pp. 1-13.

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Abstract

Background
There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution.

Objective
This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT.

Methods
Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices).

Results
In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment.

Conclusions
The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Psychology and Counselling (1 Jan 2015 -)
Faculty/School / Institute/Centre: Historic - Institute for Resilient Regions - Centre for Health, Informatics and Economic Research (1 Aug 2018 - 31 Mar 2020)
Date Deposited: 19 Jan 2020 23:41
Last Modified: 13 May 2020 03:52
Uncontrolled Keywords: Internet CBT; Child and adolescent; Anxiety disorders; Stepped-care; Self-help
Fields of Research : 17 Psychology and Cognitive Sciences > 1701 Psychology > 170106 Health, Clinical and Counselling Psychology
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111714 Mental Health
Socio-Economic Objective: C Society > 92 Health > 9202 Health and Support Services > 920209 Mental Health Services
Identification Number or DOI: 10.1016/j.invent.2019.100281
URI: http://eprints.usq.edu.au/id/eprint/37079

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