Stepped versus stratified care for pediatric anxiety disorders

Research problem and specific questionsAnxiety disorders (ADs) affect up to 20-30% of children and adolescents and are the number one contributor to disability in Swedish children.

ADs can be treated effectively using cognitive-behavioral therapy (CBT), but child and adolescent mental health services (CAMHS) struggle to provide care in a timely and evidence-driven way. Pressing problems are insufficient CBT capacity and unclarities about how to best allocate existing resources.

To improve access to CBT, the PI has led a 10-year research program developing and evaluating internet-delivered CBT (ICBT) for pediatric ADs and other problems.

Swedish health authorities are now moving to implement ICBT programs, but there is insufficient evidence to guide implementation.

This project will contrast two treatment allocation models: stepped care, where all patients start with ICBT vs stratified care, where patients are matched to treatment according to individual characteristics.

The project is conducted as a parallel-group non-commercial randomized controlled trial (RCT) with an internal pilot and will answer the following question:Which service delivery model, stepped or stratified care, is most efficacious, cost-effective, and least prone to unequal outcomes for pediatric ADs?Data and methodWe will recruit and randomize treatment-seeking youth with ADs (aged 9-17) to stepped or stratified care.

Primary outcomes are reduction in anxiety severity and cost-effectiveness.

The study will be conducted within CAMHS Skåne, which receives >2000 pediatric AD referrals per year.Plan for project realizationThe project group has 20-years of experience carrying out high quality RCTs.

The project will be conducted in regular health care and is partly funded by CAMHS Skåne and strategical regional funding.

A pilot trial will be conducted to secure feasibility, improve acceptability, and inform power calculation for the RCT.RelevanceWithout adequate treatment, pediatric ADs have lifelong detrimental effects.

Effective treatments are available, but evidence-based care does not reach 90% of affected youth and existing resources are allocated without sufficient evidence-based knowledge.

This project will conduct the largest clinical RCT to date in the field of pediatric mental health with the aim to improve access to high quality care for pediatric ADs while at the same time reducing waiting-list time, patient burden, and overall healthcare costs.