Providing an indicated preventive intervention for children with symptoms of anxiety and depression: A study of effectiveness, implementation factors, and program fidelity

Background - Anxiety and depression are the most prevalent disorders among children and adolescents, and the consequences could be life damaging if these problems are ignored. However, implementing psychosocial interventions in real-life settings to prevent these issues is challenging and complex procedure. The main goals of this thesis were to investigate the effectiveness of the EMOTION: “Coping Kids” Managing Anxiety and Depression program and examine the factors closely related to the implementation and treatment fidelity of this new transdiagnostic intervention. Method - This multi-method national clustered randomized controlled trial (RCT) included 36 schools from three regions in Norway. Professionals (N = 68) employed in different municipal services (e.g., school mental health services) delivered the group-based EMOTION intervention to children (N = 266) with elevated symptoms of anxiety and depression. The control condition consisted of N = 443 children. Further, twelve of the group leaders were interviewed, and 239 video records were scored to assess the group leaders’ adherence and competence during delivery of the program. Results - The mixed models-analyses indicated a significant symptom reduction of self-reported anxious and depressive symptoms compared to the control group. Parents reported a significant reduction in depressive symptoms, but not for anxiousness. Findings from the mixed methods study of the group leaders showed that although the group leaders were positive and found the intervention suitable within the service setting, there were potential barriers related to time, lack of support from leaders and the importance of collaborating with the schools. Furthermore, we were not able to replicate the factor structure of the instrument assessing the adherence and competence (treatment fidelity) of the group leaders. Conclusion - The EMOTION program show promising results regarding symptom reduction for anxiousness and sadness, however, focusing on key implementation factors is important for the continued use of the program. Particularly factors related to organizational leadership support and resources, as well as collaborating with the schools needs to be addressed. More research regarding program fidelity is also warranted