Article Text

Original research
School-based screening for childhood anxiety problems and intervention delivery: a codesign approach
  1. Victoria Williamson1,2,3,
  2. Michael Larkin4,
  3. Tessa Reardon2,3,
  4. Samantha Pearcey2,
  5. Roberta Button2,3,
  6. Iheoma Green2,3,
  7. Claire Hill3,
  8. Paul Stallard5,
  9. Susan H Spence6,
  10. Maria Breen7,
  11. Ian Mcdonald8,
  12. Obioha Ukoumunne9,
  13. Tamsin Ford10,
  14. Mara Violato11,
  15. Falko Sniehotta12,
  16. Jason Stainer13,
  17. Alastair Gray11,
  18. Paul Brown14,
  19. Michelle Sancho15,
  20. Fran Morgan16,
  21. Bec Jasper16,
  22. Cathy Creswell2,3
  1. 1Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
  2. 2Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
  3. 3School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
  4. 4Institute for Neurodevelopment and Health, Department of Psychology, Aston University, Birmingham, UK
  5. 5University of Bath, Claverton Down, Bath, UK
  6. 6Australian Institute of Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
  7. 7Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
  8. 8Charlie Waller Memorial Trust, Thatcham, UK
  9. 9NIHR ARC South West Peninsula, University of Exeter, Heavitree Rd, Exeter, UK
  10. 10Department of Psychiatry, University of Cambridge, Cambridge, UK
  11. 11Nuffield Department of Population Health, University of Oxford, Oxford, UK
  12. 12Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  13. 13Stanley Primary School, Teddington, UK
  14. 14Bransgore C Of E Primary School, Bransgore, UK
  15. 15West Berkshire Council, Council Offices, Newbury, UK
  16. 16Square Peg (Team Square Peg CIC), London, UK
  1. Correspondence to Dr Michael Larkin; m.larkin{at}


Objectives A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems.

Design Codesign.

Setting UK primary schools.

Participants Data were collected from year 4 children (aged 8–9 years), parents, school staff and mental health practitioners.

Results We report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback.

Conclusions We reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.

  • education & training (see Medical Education & Training)
  • mental health
  • paediatrics

Data availability statement

No data are available.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors All authors contributed to the study design, contributed towards the write up of the manuscript and read and approved the manuscript prior to submission. VW, ML, TR, CC, RB, IG and SP contributed towards data collection and data analysis.

  • Funding This paper represents independent research funded by the National Institute for Health Research (NIHR) (CC) and hosted by Oxford Health NHS Foundation Trust. CC and MV acknowledge support from the Oxford and Thames Valley NIHR Applied Research Collaboration (ARC). MV was partly supported by the NIHR Oxford Biomedical Research Centre. OU was supported by the NIHR ARC for Leadership in Applied Health Research and Care for the South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Method section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.