University of Oxford’s Prof. Cathy Creswell on ‘making the most of parents and digital to increase the access to psychological therapies’.
Prof. Creswell’s session opened with a stark statistic: despite children and young people accounting for 30% of the population of England only 8% of mental health (and 1% of overall health) spend is on their mental health. Coupled with the NAO projection that two-fifths of children and young people with a diagnosable condition would access support, there is an imperative to improve response to such needs.
As Professor of Developmental Psychology at the University of Oxford, Cathy is a clinical psychologist with a particular interest in the development and treatment of common mental health problems in children and young people. Her work predominantly focuses on improving outcomes from psychological interventions for mental health problems in children, and making them more accessible to those that need them. She has a specific focus on anxiety problems – the most commonly known referral reason for children and young people. Indeed, the worldwide peak onset age for anxiety and fear-related disorders is just 5.5 years old. (Solmi et al., 2022)
“Parents are the most important agents of change we can access in helping children to overcome difficulties with anxiety.”
– Prof. Cathy Creswell
Mindful of well-documented pressures on healthcare systems, she took the audience through the development of parent-led cognitive behavioural therapy intervention for children with anxiety disorders. Unlike conventional interventions, with parent-led CBT the child does not attend appointments. Instead, therapists works with the parent to teach and empower them with CBT tools and techniques which can be passed onto their children. The intervention, she said “is about helping parents to create opportunities for their children to test their fears, and it is structured around promoting curiosity”. Trials found it to be clinically effective at treating anxiety disorders, and strikingly, patient outcomes were the same regardless of whether the CBT trainers were experienced or novice therapists (Thirlwall et al., 2013).
Prof. Creswell took the audience through further studies in which the intervention was adapted into an online course with additional support from CBT therapists – Online Support and Intervention for Child Anxiety (OSI) – to make it more accessible to users, as well as featuring some gamified elements for the children themselves (Hill et al., 2022). Whilst clinical effectiveness was maintained and comparable with treatment(s) as usual, crucially the online iteration required only 59% of the therapists’ time compared to treatment as usual.
Demonstrating time and economic efficiency are vital when considering adoption of novel interventions, she said. To ensure this, co-production was key with the involvement of children, parents and clinical users to help ensure an intervention which ultimately reduces clinician time without impacting outcomes, can be delivered by a range of practitioners and build staff skills, and one which families find it appropriate, accessible and easy to use (Creswell et al., 2024. Currently, she and colleagues are examining the ongoing use of OSI ‘in the wild’ outside the parameters of a trial (OSI-GROWS).
Whilst OSI focuses on anxiety disorders, Cathy referenced comparable work in the US and Norway on parent-led, therapist-assisted CBT for children who had experienced trauma and delivered as part of a stepped-care approach (Salloum et al., 2024), and echoed the statement that such interventions are particularly appropriate for children whose parents may not wish to leave and entrust them to unknown adults as a result of their past experiences.
UKPTS Bites is a series of short, free, online lunchtime sessions on topics related to PTSD, trauma and beyond. It is hosted in partnership with the ESTSS. More details on upcoming sessions can be found on our events page.
