Social security disability assessors are required to objectively quantify disability with regards to potential ability to work. Difficulties arise when assessments need to be performed in the absence of objective medical data relying solely on self-report regarding subjective health complaints. In such cases, validity tests provide a useful tool during an assessment. This case report illustrates this through the outcomes of 3 disability assessments.
Abstract • Background :In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children’s mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely, and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures have been relaxed. Anxiety problems are a common reason for referral to CAMHS, children with pre-existing anxiety problems are particularly vulnerable in the context of COVID-19, and there were concerns about increases in childhood anxiety as schools reopened. The proposed research will evaluate the clinical and cost-effectiveness of a brief online parent-led cognitive behavioural treatment (CBT) delivered by the OSI (Online Support and Intervention for child anxiety) platform with remote support from a CAMHS therapist compared to 'COVID-19 treatment as usual’ (C-TAU) in CAMHS and other children’s mental health services throughout the COVID-19 pandemic. • Methods :We will conduct a two arm, multi-site, randomised controlled non-inferiority trial to evaluate the clinical and cost-effectiveness of OSI with therapist support compared to CAMHS and other child mental health services 'COVID-19 treatment as usual' (C-TAU) during the COVID-19 outbreak and to explore parent and therapists' experiences. • Discussion :If non-inferiority is shown, the research will provide:1) a solution for efficient psychological treatment for child anxiety disorders while social distancing (for the COVID-19 context and future pandemics); 2) an efficient means of treatment delivery as ‘normal service’ resumes to enable CAMHS to cope with the anticipated increase in referrals; as well as 3) a demonstration of rapid, high quality evaluation and application of online interventions within NHS CAMHS to drive forward much-needed further digital innovation and evaluation in CAMHS settings. The primary beneficiaries will be children with anxiety disorders and their families, NHS CAMHS teams, and commissioners who will access a potentially effective, cost-effective, and efficient treatment for child anxiety problems. • Trial registration : This trial was registered prospectively on the ISRCTN: ISRCTN12890382 (date of registration 23/10/2020). https://doi.org/10.1186/ISRCTN12890382
BackgroundAnxiety problems are common in children, yet few affected children access evidence-based treatment. Digitally augmented psychological therapies bring potential to increase availability of effective help for children with mental health problems. This study aimed to establish whether therapist-supported, digitally augmented, parent-led cognitive behavioural therapy (CBT) could increase the efficiency of treatment without compromising clinical effectiveness and acceptability.MethodsWe conducted a pragmatic, unblinded, two-arm, multisite, randomised controlled non-inferiority trial to evaluate the clinical effectiveness and cost-effectiveness of therapist-supported, parent-led CBT using the Online Support and Intervention (OSI) for child anxiety platform compared with treatment as usual for child (aged 5–12 years) anxiety problems in 34 Child and Adolescent Mental Health Services in England and Northern Ireland. We examined acceptability of OSI plus therapist support via qualitative interviews. Participants were randomly assigned (1:1) to OSI plus therapist support or treatment as usual, minimised by child age, gender, service type, and baseline child anxiety interference. Outcomes were assessed at week 14 and week 26 after randomisation. The primary clinical outcome was parent-reported interference caused by child anxiety at week 26 assessment, using the Child Anxiety Impact Scale–parent report (CAIS-P). The primary measure of health economic effect was quality-adjusted life-years (QALYs). Outcome analyses were conducted blind in the intention-to-treat (ITT) population with a standardised non-inferiority margin of 0·33 for clinical analyses. The trial was registered with ISRCTN, 12890382.FindingsBetween Dec 5, 2020, and Aug 3, 2022, 706 families (706 children and their parents or carers) were referred to the study information. 444 families were enrolled. Parents reported 255 (58%) child participants' gender to be female, 184 (41%) male, three (<1%) other, and one (<1%) preferred not to report their child's gender. 400 (90%) children were White and the mean age was 9·20 years (SD 1·79). 85% of families for whom clinicians provided information in the treatment as usual group received CBT. OSI plus therapist support was non-inferior for parent-reported anxiety interference on the CAIS-P (SMD 0·01, 95% CI –0·15 to 0·17; p<0·0001) and all secondary outcomes. The mean difference in QALYs across trial arms approximated to zero, and OSI plus therapist support was associated with lower costs than treatment as usual. OSI plus therapist support was likely to be cost effective under certain scenarios, but uncertainty was high. OSI plus therapist support acceptability was good. No serious adverse events were reported.InterpretationDigitally augmented intervention brought promising savings without compromising outcomes and as such presents a valuable tool for increasing access to psychological therapies and meeting the demand for treatment of child anxiety problems.FundingDepartment for Health and Social Care and United Kingdom Research and Innovation Research Grant, National Institute for Health and Care (NIHR) Research Policy Research Programme, Oxford and Thames Valley NIHR Applied Research Collaboration, Oxford Health NIHR Biomedical Research Centre.
Previous cross-cultural research into social support has attributed national variations in social support to assumed cultural values but has rarely measured these values at an individual level. This study investigates the relationship between support offered and individualism among 186 government workers in Indonesia and the United Kingdom. Indonesian respondents were more willing to offer support to strangers than their British counterparts, but individualism was a significant predictor of (lesser) support provision only in Britain. In addition, female respondents in Britain, and older respondents in Indonesia, offered higher levels of support. These findings underline the difficulties for individual-level measures of culture in accounting for cultural-level differences and are discussed in the light of further emic and etic factors likely to be significant for an understanding of support provision in these two cultures.
Abstract The child anxiety impact scale-parent version (CAIS-P) is a useful measure to assess the impact of anxiety on a child’s daily life; however, a Japanese version of the CAIS-P has not been developed, and whether the CAIS-P can be utilized in Eastern countries remains unascertained. The purpose of this study was to develop a Japanese version of the CAIS-P and examine its reliability and validity. Parents of 400 children (aged 7 to 15 years) from the Japanese community completed the CAIS-P. A confirmatory factor analysis indicated that the factor structure of the original CAIS-P, consisting of school activity, social activity, and home/family activity factors, provided a good fit for the Japanese version of the CAIS-P. Estimated Spearman’s correlation coefficients showed moderate correlations between the total and factor scores of the CAIS-P, anxiety symptoms (Spence Child Anxiety Scale-parent version), and depressive symptoms (Child Depression Inventory). Furthermore, the item response theory model revealed that each factor of the CAIS-P is a high information reliable measure for children with high trait anxiety. These results provide support for the Japanese version of the CAIS-P’s factorial validity, convergent validity, and reliability and its potential for application in child anxiety research in Japan.
Background: Digitally augmented psychological therapies bring potential to increase availability of effective help for children with mental health problems.Methods: We did a two-arm, multi-site, randomised controlled non-inferiority trial to evaluate the effectiveness of therapist supported online parent-led Cognitive Behaviour Therapy (OSI+TS) compared to treatment as usual for child anxiety problems in routine child mental health services (C-TAU) in 34 organisations in England and Northern Ireland. We examined acceptability of OSI+TS via qualitative interviews with parents and therapists. Children aged 5 to 12 years who were offered treatment for child anxiety problems were eligible. Participants were randomly assigned (1:1) to either OSI+TS or C-TAU, with minimisation by child age, gender, service type, and baseline child anxiety interference, including permuted block size. Outcomes were assessed 14 and 26 weeks after randomisation. The primary outcome was parent-reported interference caused by child anxiety. Outcome analyses were conducted blind in the intention-to-treat population. The trial is registered with the ISRCTN registry 12890382.Findings: Between December 5, 2020 and August 3, 2022, 706 families were referred to study information. 444 were enrolled. 255 (58%) participants were girls, 184 (41%) were boys. 400 (90%) were White. Mean age was 9·20 years (SD 1·79). 222 participants were randomly assigned to OSI+TS and 222 to C-TAU. 85% of C-TAU families received Cognitive Behaviour Therapy. At 26 weeks OSI+TS was non-inferior for parent reported anxiety interference (SMD= 0·01 (95% CI -0·15 to 0·17), p < 0·0001) and all secondary outcomes. Therapist time for treatment delivery averaged 185·93 minutes (SD = 98·12) for OSI+TS compared to 308·57 (SD=173·02) for C-TAU. OSI+TS acceptability was good. No serious adverse events were reported.Interpretation: The therapist supported online intervention brought substantial savings in therapist time without compromising outcomes for children being treated for anxiety problems in routine child mental health services.Trial Registration: he trial is registered with the ISRCTN registry 12890382.Funding: Department for Health and Social Care/ United Kingdom Research and Innovation Research Grant (managed by the Medical Research Council), National Institute of Health Research Policy Research Programme, Oxford and Thames Valley National Institute of Health Research Applied Research Collaboration, Oxford Health NIHR Biomedical Research Centre.Declaration of Interest: The Online Support and Intervention (OSI) intervention is based on underpinning evaluations of a book‐based treatment approach for child anxiety disorders. No investigators receive any financial reward for the use of OSI; however, CC receives royalties for the sale of a parent book and a therapist book that some of the underpinning work is based on.Ethical Approval: This study was approved on 04/09/2020 by London ‐ City & East Research Ethics Committee (Bristol Research Ethics Committee Centre, Whitefriars, Level 3 Block B, Lewins Mead, Bristol, BS1 2NT, UK; +44 (0)207 104 8214; cityandeast. rec@hra.nhs.uk), ref: 20/HRA/4431.
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