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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
An Evaluation of Stepped Care for Child Anxiety
Scientific title
A Randomised Controlled Trial of Standard Care versus Stepped Care for Children and Adolescents with Anxiety Disorders
Secondary ID [1] 280204 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Anxiety 286144 0
Condition category
Condition code
Mental Health 286338 286338 0 0

Study type
Description of intervention(s) / exposure
Stepped Care: consist of 3 treatment steps. Participants and their parents in this condition will first receive the least intensive intervention followed by more intensive interventions if required. Step 1 will involve completion of the validated self-help program Helping your Anxious Child (primary school participants) or Cool Teens (high school participants). The program will be available in both online and workbook formats and consists of 10 modules each taking 30-90 minutes to complete. A period of 12 weeks is allocated for completion of the self-help program during which time families will receive 4, 30 minute contacts with a CBT therapist (by telephone or email self-selected by families). Based on our previous work, scheduled sessions will involve checking of progress, motivational prompts, and assistance with difficulties Therapists will also be available for client-initiated contact between sessions. Step 2 will involve the same program and treatment length as offered in standard care. Step 3 will involve an intensive intervention for treatment non-responders. This is a 12x 50 minute session individual program, held weekly over a 12 week period, for children/adolescents and their primary caregiver with content based on a functional assessment of barriers and limitations to the previous treatment. It continues skills from the Cool Kids program in a more intensive fashion, incorporates motivational features and has a strong focus on parenting factors and parent-child interaction. Sessions in step 3 are conducted by clinical psychologists or clinical psychology interns.
Intervention code [1] 284533 0
Treatment: Other
Intervention code [2] 284534 0
Comparator / control treatment
Standard Care: 10x 50 minute individual sessions attended by the child/adolescent and their primary caregiver over a 12 week period. Treatment is implemented by psychologists, clinical psychologists and psychology interns using the manualised Cool Kids Anxiety Management Program.
Control group

Primary outcome [1] 286804 0
Changes in diagnostic status and severity according to the Anxiety Disorders Interview Schedule
Timepoint [1] 286804 0
Pre treatment compared to one year after randomisation
Secondary outcome [1] 296699 0
Changes on self and primary caregiver report measure:
Spence Children's Anxiety Scale
Timepoint [1] 296699 0
Pre treatment compared to 14, 27, 40 and 52 weeks after randomisation
Secondary outcome [2] 296737 0
Changes on self and primary caregiver report measure:
Short Mood and Feelings Questionnaire
Timepoint [2] 296737 0
Pre treatment compared to 14, 27, 40 and 52 weeks after randomisation
Secondary outcome [3] 296738 0
Changes on self and primary caregiver report measure:
Strengths and Difficulties Questionnaire
Timepoint [3] 296738 0
Pre treatment compared to 14, 27, 40 and 52 weeks after randomisation
Secondary outcome [4] 296739 0
Changes on self and primary caregiver report measure:
Diagnostic Interview Schedule for Children IV
Timepoint [4] 296739 0
Pre treatment compared to 14, 27, 40 and 52 weeks after randomisation
Secondary outcome [5] 296741 0
Changes on self and primary caregiver report measure:
Child Anxiety Life Interference Scale
Timepoint [5] 296741 0
Pre treatment compared to 14, 27, 40 and 52 weeks after randomisation
Secondary outcome [6] 296742 0
Self and primary caregiver report of resource use since last assessment
Timepoint [6] 296742 0
Pre treatment, 14, 27, 40 and 52 weeks after randomisation

Key inclusion criteria
Primary Anxiety Disorder in Child/Adolescent
(No criteria for parents)
Minimum age
7 Years
Maximum age
17 Years
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Life-threatening suicidal ideation or self harm
At risk due to abuse or neglect
Current psychological treatment elsewhere
Significant intellectual impairment
Unmanaged psychotic symptoms

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation concealment involves contacting the holder of the allocation schedule
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation by using a randomization table created by a computer software
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?

Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)

Funding & Sponsors
Funding source category [1] 284955 0
Government body
Name [1] 284955 0
National Health and Medical Research Council
Address [1] 284955 0
Level 1
16 Marcus Clarke Street
Canberra ACT 2601
Country [1] 284955 0
Primary sponsor type
Macquarie University
Balaclava Rd
Macquarie University
NSW 2109
Secondary sponsor category [1] 283826 0
Name [1] 283826 0
Address [1] 283826 0
Country [1] 283826 0

Ethics approval
Ethics application status
Ethics committee name [1] 286965 0
Macquarie University Human Research Ethics Committee
Ethics committee address [1] 286965 0
Macquarie University.
Sydney. NSW 2109.
Ethics committee country [1] 286965 0
Date submitted for ethics approval [1] 286965 0
Approval date [1] 286965 0
Ethics approval number [1] 286965 0
Ethics committee name [2] 294700 0
Departmental Ethics Committee - Dept of Health & Aging
Ethics committee address [2] 294700 0
GPO Box 9848
Canberra. ACT. 2601
Ethics committee country [2] 294700 0
Date submitted for ethics approval [2] 294700 0
Approval date [2] 294700 0
Ethics approval number [2] 294700 0

Brief summary
The aim of the current study is to evaluate a stepped care model of the delivery of treatment to young people with anxiety disorders. Our clinic will function as a "microsystem" to evaluate the cost-effectiveness of moving from the current gold standard one-size-fits-all model of treatment delivery to a stepped care framework. By introducing both low-intensity and high intensity steps into the stepped care approach, we predict that the stepped care model will result in both 1) greater efficacy (reductions in diagnoses, symptoms, and life impairment) and 2) improved cost effectiveness than traditional treatment.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 33969 0
Prof Ronald Rapee
Address 33969 0
Dept of Psychology
Macquarie University
Sydney. NSW. 2109
Country 33969 0
Phone 33969 0
61 2 9850 8032
Fax 33969 0
Email 33969 0
Contact person for public queries
Name 17216 0
Dr Heidi Lyneham
Address 17216 0
Department of Psychology
Macquarie University
North Ryde
NSW 2109
Country 17216 0
Phone 17216 0
Fax 17216 0
Email 17216 0
Contact person for scientific queries
Name 8144 0
Prof Ron Rapee
Address 8144 0
Department of Psychology
Macquarie University
North Ryde
NSW 2109
Country 8144 0
Phone 8144 0
Fax 8144 0
Email 8144 0

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary