Can school-based mental health programmes reduce anxiety in children? Results from a UK randomised controlled trial evaluating the FRIENDS cognitive behaviour therapy programme

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Schools provide a natural and convenient location for delivering universal emotional health prevention programmes for children. Universal programmes are non-stigmatising, can be more readily accommodated within school timetables and provide opportunities for symptom reduction and primary prevention. However before such programmes are widely adopted appropriately sized implementation trials are required to determine whether these programmes are effective when delivered under everyday conditions. Preventing Anxiety in Children through Education in Schools (PACES) is a three armed cluster randomised controlled trial conducted in UK primary schools. The study evaluated the effectiveness of a universally provided anxiety prevention programme (FRIENDS) delivered by school and health staff compared with usual school provision. FRIENDS is a cognitive behaviour therapy programme designed to teach children skills to counter the cognitive, emotional and behavioural aspects of anxiety. 45 schools were enrolled, 41 consented to participate with 1 withdrawing after randomisation. The remaining 40 schools had 1448 eligible participants i.e. children aged 9-10 attending school. A total of 1362 (94%) consented to participate, 1339 (98%) completed baseline assessment with 1257 (92%) completing 12 month assessments. Our primary outcome was anxiety assessed by the Revised Child Anxiety and Depression Scale (RCADS). At 12 months there was a difference in adjusted mean child-reported RCADS scores for health-led versus school-led FRIENDS (19·49 [SD 14·81vs 22·86 [15·24]; adjusted difference –3·91, 95% CI –6·48 to –1·35; p=0·0004) and health-led FRIENDS versus usual school provision (19·49 [14·81] vs 22·48 [15·74]; –2·66, –5·22 to –0·09; p=0·043). Our results suggest that universal anxiety prevention programmes can be effective when used in schools. However, programme effectiveness varies depending on who delivers them. References: Stallard P, Skryabina E, Taylor G, Phillips R, Daniels H, Anderson R & Simpson N. Classroom-based cognitive behaviour therapy (FRIENDS): a cluster randomised controlled trial to Prevent Anxiety in Children through Education in Schools (PACES). Lancet Psychiatry 2014: 1 (3); 185-192. doi:10.1016/S2215-0366(14)70244-5Stallard P, Taylor G, Anderson R, Daniels H, Simpson N, Phillips R & Skryabina E. School based intervention to reduce anxiety in children: study protocol for a randomised controlled trial (PACES). TRIALS. 2012, 13:227. doi: 10.1186/1745-6215-13-227.

Poster First Author: 
Paul Stallard
Conference Presented At: 
IAYMH 2015
Poster Date: 
October, 2015
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