Psychological Stepped Care for Anxious Adolescents in Community Mental Health Services: An Effectiveness Trial

Anxiety disorders are the most common mental disorder in childhood affecting up to 10% of youth, and are associated with significant burden on individuals, families, schools, communities and the economy. Delivery of mental health services to treat adolescents is costly with many barriers to accessing evidence-based treatment. Primary Health Networks are encouraged to implement stepped care approaches to mental health treatment to increase service-efficiency. However, few scientific evaluations of stepped care models have been conducted. Our team are the first to demonstrate the efficiency of stepped care for anxious adolescents in a university clinic. This project partners with Northern Sydney Local Health District (NSLHD) community mental health services (headspace and Child & Youth Mental Health Services [CYMHS]) to evaluate in a pilot randomised controlled trial, the service-efficiency and efficacy of implementing evidence based psychosocial treatments for adolescent anxiety using a stepped care approach. Adolescents will receive either treatment as usual or stepped care consisting of an internet intervention [step 1], and then if required, additional face-to-face evidence-based therapy [step 2]. The superiority of stepped care on service-efficiency and treatment effectiveness will be compared in two headspace and two CYMHS sites. The results will provide preliminary evidence for stepped care approaches in community mental health that can be used to further evaluate translation of stepped care on a larger scale.