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Background & Publications

Background

Fears, worries and anxiety are a normal part of childhood, but for some children anxiety has a negative impact on their day-to-day lives. These children may benefit from support or intervention to help them manage and overcome their difficulties with anxiety. 

Psychological treatments work well for children with anxiety difficulties, but very few children access these treatments. Families can struggle to identify anxiety-related difficulties in their children, they may be unsure if and where to seek support, and they often face long waiting times for treatment. iCATS aims to reduce these barriers and help ensure more children with anxiety problems receive effective support when they need it.  

Researchers, parents, children, school staff and mental health practitioners have all come together to develop and test iCATS-i2i. Each of the stages involved in this process are outlined below. The publications associated with each stage are included in a separate section at the bottom of this page.

  1. Development of a short child anxiety questionnaire

This study involved 19 schools across England. Children in Years 4-6, their parents, and teachers completed questionnaires about the child’s fear and worries, and families also took part in interviews. 

Using this information, we developed a two-question parent-report measure to help identify children who may be experiencing anxiety. This measure is now used in iCATS-i2i. 

2. Co-design of iCATS-i2i procedures 

As part of this stage, we worked with parents, children, school staff and other key stakeholders to develop the iCATS-i2i procedure – a new way of identifying and supporting children with anxiety problems through schools.

3. Feasibility study

This study involved working with 6 schools to try out the co-designed procedures that were developed in Study 2. We wanted to check that the procedures worked well for all involved, and identify any changes that were needed before proceeding to Study 5. 

4. Economic impact of elevated child anxiety

Alongside testing the iCATS-i2i procedures, our team conducted a literature review to investigate the longer-term impacts and economic costs of child anxiety problems.  

5. Cluster Randomised Controlled Trial

The iCATS-i2i programme was evaluated in a large trial involving Year 4 classes across 84 primary schools across England.

More than 4500 children and 1500 parents/carers took part in our study!

The trial showed that delivering iCATS-i2i reduced child anxiety problems compared to usual school provision. There were also benefits for children with anxiety problems across wider parent- and teacher-reported outcomes, up to 2 years later. 

6. Adapting for delivery in routine practice

Beyond the research trial, we aimed to identify what changes we could make to help ensure the programme works well in practice – when delivered by Mental Health Support Teams (MHSTs) working with schools. 

To do this we spoke to MHST staff, primary school staff, and parents/carers during research interviews, follow-up discussions and additional consultations.  

7. Improving access for families living on low incomes

To make sure iCATS-i2i is as accessible as possible, we are planning a follow-up project to tailor strategies to increase participation among families living on low incomes. This is because the main research trial found that participation in screening and OSI was lower in schools with high compared to lower levels of deprivation. This study will involve us speaking to families living on low incomes and practitioners who support these families. 

8. Implementation study

We are planning to work with a small number of MHSTs to test the routine delivery of iCATS-i2i in schools.

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Publications

Please see below for the research papers published by the iCATS team:

1. Development of a short child anxiety questionnaire

2. Co-design iCATS-i2i procedures

3. Feasibility Study

4. Economic impact of elevated child anxiety

5. Cluster Randomised Controlled Trial

6. Adapting for delivery in routine practice

  • Qualitative study – publication forthcoming 
  • Adaptations paper – publication forthcoming