JMIR Publications

ABSTRACT

Background:

Self-directed digital mental health services can increase access to evidence-based interventions for child anxiety. However, there has been little comprehensive investigation of real-world dissemination especially utilizing implementation science approaches.

Objective:

To describe and comprehensively assess implementation of the BRAVE Self-Help program for child and adolescent anxiety in Australia over a 10-year period, including implementation strategies during establishment and sustainability phases and implementation-effectiveness outcomes.

Methods:

This study was a large, open implementation-effectiveness trial with Australian child and adolescent participants of the BRAVE Self-Help Program, collected between January 1, 2015, and December 31, 2024. Implementation strategies were reported descriptively across program establishment and sustainability phases. Implementation and effectiveness outcomes were reported across 10 years, in line with the Implementation Outcomes Framework (IOF) and taxonomy of implementation outcomes for digital interventions. Metrics include Adoption, Penetration, Appropriateness, Fidelity, Feasibility, Acceptability and Effectiveness.

Results:

Examples of implementation strategies included targeted promotion and education strategies across academic, professional and community settings, a focus on geographical areas with low service accessibility, provision of easy-to-access resources and support for common challenges, targeting education contexts, and continuous data-driven and user-informed improvement. Over the 10-year period, the BRAVE Self-Help program had 53,726 users, including 28,700 children (mean 9.36, SD 1.40 years) and 25,026 adolescents (mean 14.15, SD 1.62 years). Data revealed a wide variety of user characteristics in terms of age, gender, geographical location, baseline severity, and referral sources (community, health and education settings). Improvement in anxiety symptoms from first to last interaction with the program was observed for participants in general, particularly among those with elevated anxiety at program registration (P <.001, Cohen d=0.54). Of all users completing the registration assessment, 38.72% (20,026/51,721) completed 3 or more of the 10 sessions, with consistent moderate to high satisfaction rates across all sessions.

Conclusions:

This study demonstrated that a self-help digital program for child and adolescent anxiety can be successfully disseminated nationally, and that it is feasible, acceptable and effective for many young people. During a span of 10 years, the BRAVE Self-Help program for child and adolescent anxiety offered evidence-based support to more than 50,000 families. Notably, although progress through sessions was low for some young people, significant improvements can be made in as few as three sessions, and decisions to stop treatment may occur for many reasons, including treatment success.