Six and a half percent of children have an anxiety disorder at any given time, but most never receive treatment. This matters because anxiety disorders carry a greater economic burden than any other mental health condition in childhood, yet families face barriers at every step—from identifying the problem to accessing prompt support. Effective psychological treatments exist, but they rarely reach the children who need them. The research team will build and test a complete pathway: universal screening in schools, feedback to families, and a brief online intervention. They will first determine which questionnaire items and reporters most accurately identify children with anxiety disorders, then co-design the pathway with children, parents, and school staff. A feasibility study will check whether the procedures are acceptable and practical, followed by a cluster randomised controlled trial comparing schools with the pathway against schools with assessment alone. The team will also model the long-term economic impact of childhood anxiety using existing UK cohort data. If successful, this pathway would give schools and mental health practitioners a ready-to-use system for identifying and supporting anxious children early. It could also serve as a model for other common childhood mental health conditions.
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Research question Does a pathway that incorporates universal screening , feedback and brief intervention for child anxiety problems reduce child distress, improve life course outcomes, and bring significant economic benefits compared to usual school provision? Background Anxiety disorders are common and have a greater economic burden than any other mental health condition. Half of all anxiety disorders emerge by 11 years of age, and 6.5% of children are affected at any time. Effective psychological treatments for childhood anxiety disorders exist, yet very few children access them. Families face a range of barriers, particularly problems with identification of anxiety disorders and access to prompt support. Aim 1: Establish an assessment system for universal screening of anxiety problems in children. Objective: To establish and optimise an assessment system to identify children with anxiety disorders with sufficient accuracy. Methods: Children, parents and teachers will complete questionnaires (test) and children and parents will be administered diagnostic interviews (reference standard), in order to identify the best questionnaire items/reporters to identify child anxiety disorders. Aim 2: Develop the pathway from 'universal screening' for problematic child anxiety to brief intervention Objective: To develop procedures and materials that are practical, acceptable, secure and maximise engagement. Methods: Children, parents, school staff and other key stakeholders will participate in co-design procedures to iteratively develop the pathway procedures. Aim 3: Test the feasibility of the pathway Objective: To ensure the pathway is acceptable, that there are no unacceptable impacts, that trial recruitment and retention targets are feasible, and proposed clinical and economic measures are relevant and meaningful. Methods: A single arm feasibility study. Aim 4: Model the economic impact of elevated child anxiety Objective: To establish the short/medium-term mental health outcomes and economic burden of elevated child anxiety in order to model longer-term economic benefits/costs in WP5 Methods: (i) Pragmatic literature review; (ii) Analysis of existing UK cohort studies to identify the social, health and economic consequences of childhood anxiety problems. Aim 5: Evaluate the pathway from universal screening to brief intervention for children with anxiety problems Objective: To compare outcomes for children who score above the anxiety assessment system cut-off scores in schools which have received usual school practice + the pathway (intervention arm) versus usual school practice + assessment only (control arm). Estimate the cost-effectiveness of usual school practice + the pathway versus usual school practice +assessment only, extrapolating results beyond the trial duration. Evaluate experiences of the pathway. Methods: Cluster randomised controlled trial, including clinical, educational and health economic outcomes, and evaluations of participant experiences. Timelines for delivery We will work closely with stakeholders to ensure that the pathway is in a form that can be directly incorporated into schools on completion of the project if indicated. Anticipated Impact If effective, this pathway will provide schools/ mental health practitioners with resources and procedures to support identification and early intervention for child anxiety problems, and will set out a model for identification and access to good quality care that can be expanded to other common mental health conditions in children.
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