Guided self-help digital cognitive behavioural therapy for children and young people with mild to moderate symptoms of anxiety or low mood

Unmet need

3.1 There is a need to improve access to effective mental health treatments. The patient experts noted that it is difficult to get access to mental health care but that it was important for children and young people to have access to treatment as soon as possible. They also noted that there are no options available to them while waiting. The clinical experts agreed that many children and young people are not getting access to the treatment when they need it. The committee concluded that there is an unmet clinical need and access to effective mental health treatments needs to be improved.

Further evidence

3.2 Further evidence should be generated while the technologies are in use to address the immediate unmet need, with appropriate risk management processes in place. The clinical experts stressed the importance of clinical risk management. When questioned, the companies advised that they have risk management and safeguarding systems in place. Also, all these technologies are supported by mental health practitioners that check in with users on a weekly basis. The clinical experts noted that even though risk management is important, many children and young people do not currently get access to any treatment while they are waiting. These guided self-help digital CBT technologies are a way to increase access to treatment with support from a mental health practitioner. The committee concluded that these 5 technologies can be used as a first-line treatment if used with appropriate safeguarding and risk management processes in place while evidence is generated.

Clinical-effectiveness overview

3.3 There is very limited evidence on using all 5 digital CBT technologies for children and young people with mild to moderate symptoms of anxiety or low mood. The evidence base consists of 5 published studies, 2 unpublished studies and 2 conference abstracts. Of these, 7 were single arm designs with no direct comparator, 1 randomised controlled trial design and 1 2-arm non-randomised design. The external assessment group (EAG) noted that the sample sizes across the studies were small so presented a risk of false chance findings and underpowered analyses. The committee concluded that the evidence base is very limited for all 5 technologies. One technology had some higher-level evidence, but none of them were considered to have a stronger evidence base than the others.

Equality considerations

3.4 Neurodivergent children and young people may benefit from these guided self-help digital CBT technologies. The patient experts noted that neurodivergent children and young people are more likely to have significant mental health needs. They look at digital technologies differently and it is important that the technologies meet their needs. They liked the online interaction in place of face-to-face interaction because they do not have to socialise. The committee concluded that this subgroup may benefit from this more remote method of delivering therapy.

3.5 Children and young people with accessibility issues are unlikely to benefit from the guided self-help digital CBT technologies. The clinical experts noted that some children and young people are unable to access digital technologies. They may not have the equipment, internet connection or the privacy needed to complete the intervention. They may also lack experience with computers or electronic devices. These digital technologies are unlikely to improve treatment options for these children and young people. Other treatment options including face-to-face CBT may be more appropriate for these children and young people.

Costs and resource use

3.6 The duration of the intervention and the per user license cost may affect costs. The committee noted that the parameter values in the model were based on very limited data sources, so results are uncertain. Also, the value of information analysis confirmed that further research is needed on the effectiveness of the 5 digital CBT technologies and the health state utilities. Based on the analysis, the key parameters affecting the cost effectiveness is the length of treatment and the per user license cost. It is unknown if the shorter duration with 4 out of 5 technologies will lead to poorer outcomes, or whether the longer duration simply increases costs. The model seemed relatively insensitive to the use of a mental health support worker compared with a clinical psychologist. The committee concluded that more data on these parameters is needed.

Evidence gap overview

3.7 The key evidence gaps relate to the population and key outcomes. The committee concluded that the evidence is very limited, so evidence generation is needed to address these key evidence gaps for all 5 technologies: