Helping anxious children by empowering their parents

Anxiety disorders are the most common mental health condition in childhood – and one of the most undertreated. Nearly one in 15 children in England lives with anxiety severe enough to affect their schooling, friendships, and family life. Yet overstretched NHS services mean most never receive timely, evidence-based help. The consequences ripple outward: untreated childhood anxiety costs society up to £4,040 per child each year in lost potential, family strain, and escalating need for specialist support later in life.

The gap between need and provision demanded a fundamentally different approach – one that could reach more families without requiring more clinicians.

Our approach and partners

Researchers at the University of Oxford's Department of Experimental Psychology, with support from the NIHR ARC Oxford and Thames Valley and the NIHR Oxford Health Biomedical Research Centre, developed Online Support and Intervention (OSI) – a digital programme that equips parents to deliver proven cognitive behavioural therapy techniques to their anxious child, with light-touch therapist support.

OSI guides parents through seven online modules covering strategies such as promoting independence, testing fears, and problem-solving. Brief weekly check-ins with a children's wellbeing practitioner keep families on track. An optional game app helps motivate children to try new strategies with their parent or carer.

The programme was tested in a large trial across 34 child and adolescent mental health services in England and Northern Ireland, involving 444 families with children aged 5–12. Oxford Health NHS Foundation Trust, the ARC OxTV's host organisation, was centrally involved in both the research and subsequent implementation.

What we found – and why it matters

1. Same outcomes, dramatically less clinician time. Children receiving OSI showed the same reductions in anxiety and improvements in daily functioning as those receiving traditional face-to-face therapy – but therapists spent 40% less time per case (182 minutes on average, compared to 307 minutes for usual care).
2. Families and therapists valued the approach. Parents found the programme flexible and empowering, fitting around school and work. Many reported gaining lifelong skills to support their child's mental health. Therapists saw OSI as a practical route to reducing growing waiting lists without compromising care quality.
3. The economics stack up. A comprehensive economic evaluation, published in The Lancet Psychiatry, confirmed OSI is cost-effective – providing the evidence base needed to justify NHS-wide rollout and international expansion.
4. NICE recommended OSI for NHS use in February 2023 through its first-ever Early Value Assessment of digital mental health technologies for children and young people.

Following the NICE recommendation, digital health company Koa Health licensed OSI through Oxford University Innovation and is now supporting its delivery across the NHS. Over 1,000 families have used the programme, and more than 20 NHS areas – from Manchester to West Sussex – have committed to adopting it.

What this means

For families, OSI replaces months on a waiting list with timely, accessible support that fits around daily life. For NHS services under severe pressure, it transforms the economics of children's mental healthcare – enabling the same workforce to treat substantially more children within existing resources.

ARC OxTV funding played a specific bridging role: it kept OSI available to families after clinical trials ended and before the commercial licence with Koa Health was in place, preventing a gap in access during a critical transition.

What needs to happen next

OSI has secured £7 million in Wellcome funding to adapt and test the programme across five countries – Japan, Chile, Pakistan, the Philippines, and Thailand – reaching 1,600 children. Adaptation for Chilean families, supported by the Inter-American Development Bank, is already underway.

In the UK, two school-based trials are now testing whether OSI can prevent anxiety disorders before they take hold. Oxford researchers are also adapting the programme for children with autism, selective mutism, and obsessive-compulsive disorder.

Wider adoption depends on local NHS services committing resources to embed OSI in routine practice, and on continued investment in the workforce training needed to support delivery at scale.

Lessons for future research

OSI's journey illustrates how applied research collaborations can accelerate the path from evidence to practice. ARC OxTV's bridging funding – maintaining access between a trial ending and a commercial partner beginning delivery – addressed a gap that frequently stalls implementation of promising interventions. This model of transitional support deserves wider replication across the NIHR infrastructure.