Reaching more young people with mental health difficulties: An evaluation of delivering a group-based CBT intervention for children and adolescents in an intensive format

Abstract

Aim. A clear need exists for finding alternative delivery formats of psychological treatments that are more transportable and which break down some of the barriers to engagement (Elkins, McHugh, Santucci, & Barlow, 2011) that are stopping as many as four out of five young people who could benefit from therapy from accessing it (Cobham, 2012). Group delivery and intensive formats have the potential to reduce some of the barriers to engagement. The aim of this study was to compare an Intensive 2-week group delivery of the FRIENDS programs to a Standard 10 week group delivery.

Method. In this open effectiveness trial, 260 children and their families participating in the FRIENDS groups at a private community based psychology clinic situated in Brisbane, Australia, agreed to participate in the research. Families self selected Intensive 2-week delivery or standard 10-week delivery and were routed into Fun FRIENDS for 4-7 year olds, FRIENDS for Life for 8-11 year olds, and My FRIENDS Youth for 12 to 15 year olds. All of the caregivers were invited to attend family sessions and the Adult Resilience group. Surveys delivered online were sent both before and after the group.

Results. Mixed model results showed significant (p<0.01) outcomes for all formats from baseline to post for the Spence Anxiety Scales (SAS), the Child Depression Inventory (CDI-P), the Strengths & Difficulties Questionnaire (SDQ), and the Devereux Student Strengths Assessment (DESSA), with non-significant interactions (p>0.05) comparing Time to the format in which it was delivered, Standard or Intensive, across all these measures. Effect sizes (Cohen’s D) across total symptom scales on the SAS, CDI-P, and SDQ, for both Standard and Intensive all showed small decreases at Post intervention (d = -0.21 – -0.49). Then at 12 month Follow up, further improvements were observed across both formats with Standard still showing small reductions from baseline (d = -0.34 – -0.47), and Intensive showing medium to large reductions (d = -0.57 – -0.90) from baseline across all measures. As well as the decreases noted in symptom scales, strengths measured by the DESSA increased for both formats from baseline to post (d = 0.38 – 0.40), with this rising to large increases in total strengths score at 12 month Follow up (d = 2.25 – 2.52).

Conclusions. Results indicate that both Standard and Intensive delivery of the FRIENDS programs were effective at reducing symptoms of anxiety and depression, as well as conduct, hyperactivity, and peer problems. Whilst also increasing strengths in self-management and awareness, social awareness and relationship skills, personal responsibility, decision making, and optimistic thinking. These changes in measures especially at follow up, with no statistical difference between formats, suggests that Intensive delivery is potentially as effective as Standard delivery and may provide another way of increasing the reach of CBT based interventions. Conclusions are limited by non-randomisation, dropout, and not having a measure of reach. Show more