“The need for better systematic screening methods and optimized interventions in municipal services is evident”, says Simon-Peter Neumer, lead investigator of the study titled “Echo: Implementation and optimization of an indicated transdiagnostic intervention for children with anxiety and depression”.
High prevelance rates of emotional problems
Children and adolescents in Norway have high prevalence rates of emotional problems. Leaving these children untreated has serious consequences for the individual children, and for society at large.
Norwegian municipalities are responsible for the primary mental health care of children and adolescents. Local municipal service agencies (such as educational- psychological services, school health services, and other first line mental health services) rely on assessments to make decisions regarding impairment, diagnosis, and treatment referrals.
“Improving and standardizing these assessments can help to reduce variations between municipalities to ensure that all children have access to the best mental health care no matter where they live”, says Peter-Simon Neumer.
Assessment and feedback for adaptions of treatment
Echo project gets its name from one of its main functions: to use the standard assessment as a means to give service providers timely feedback about their clients.
For example, when a child meets with a service provider, they will be asked to fill out a mental health assessment electronically. This information will then be passed on directly to the mental health care professional, who will have a snapshot about the level of their client’s psychological distress.
This assessment and feedback (“echo”) can be repeated many times throughout the treatment process, which, in principal, allows for adaptations to the treatment process.
“This process works because the assessments are entered electronically, automatically scored, and the results passed to service providers, almost instantaneously”, explains Peter-Simon Neumer. Furthermore, we need to optimise and tailor promising interventions using new technology. In Echo we will try out a shortened and partial digitalized version of an intervention that may be even better suited to the services. We will also add Virtual reality exposure aiming for even better effects of the intervention.
With good screening instruments, new technology and promising evidence based interventions for these problems, Echo may help to bridge the science-to-service gap and improve overall treatment outcomes.
Evidence-based practices and interventions
Feedback can not only contain information about the client’s symptom levels, but also goals that they have for their own treatment, and also which interventions they have received. Information about the contents of the interventions would also be available for service providers.
“In these ways, Echo will help the service provider to tailor evidence-based practices and interventions (EBP/I) suited to the individual’s needs, and track the development of symptoms of children and adolescents during their contact with first line municipal mental health services”, says Simon-Peter Neumer.
Developing a new, preventive intervention
Developing an integrated evidence-based intervention (EBI) that target multiple, but related, emotional problems (i.e., a transdiagnostic approach), is an important task for research groups involved in the Echo study.
This new intervention is based on the newly developed EMOTION intervention. Results from the EMOTION study were positive and indicate that the intervention can reduce symptoms of anxiety and depression in young people, and that the services would benefit from optimized screening and intervention methods. Through applying e-learning and VR-technology, the aim is to develop an improved and flexible intervention
Echo will be used and tested in close cooperation between users, service providers, and other experts.
40 schools participating
The study will use a randomized design in 40 schools representing different regions, urban, and rural settings in Norwegian municipalities.
The ultimate aim is to disseminate Echo after the study, which can be used to support the use of evidence-based mental health care interventions at a lower cost to society.
BACKGROUND – The research group
The study will continue active collaboration between three regional centers focusing on mental health problems in children in North, Central and Eastern and Southern Norway.
• The Echo system and other study activities will be co-created as part of the research project.
• The collaborating centers have multiple research interests and a common governmental mandate.
• The research group consists of a Lead Investigator for the study Simon-Peter Neumer and local Principal and Co-Investigators responsible for their research sites (Kristin Martinsen, RBUP E/S, Jo Magne Ingul RKBU Central and Frode Adolfsen RKBU North).
• The Lead Investigator and other research and administrative staff will form the Central Research Office (CRO) at RBUP E/S in Oslo.
• Professor Philip Kendall at Temple University, PA, USA, is one of the world’s leading experts in treatment of anxiety in children and will be a member of the international advisory group.
• Other international experts, e.g., Dr. Jörg Richter (psychometrics), Dr. Linda Collins (research designs) have confirmed their participation in the expert group.