1 Recommendations

1.1 Four guided self-help digital cognitive behavioural therapy (CBT) technologies can be used as an initial treatment option for children and young people (aged 5 to 18) with mild to moderate symptoms of anxiety or low mood, while evidence is being generated. These technologies can be used once they have Digital Technology Assessment Criteria (DTAC) approval from NHS England. The technologies are:

  • Lumi Nova (BfB labs)

  • Online Social anxiety Cognitive therapy for Adolescents (OSCA)

  • Online Support and Intervention for child anxiety (OSI)

  • Space from anxiety for teens, space from low mood for teens, space from low mood and anxiety for teens (Silvercloud).

Potential benefits of early access

  • Access: Guided self-help digital cognitive behavioural therapy (CBT) technologies provide another treatment option for children and young people including those who may not be able to access current treatment or are on a waiting list and so not currently having treatment.

  • Clinical benefit: Early evidence suggests that digital CBT technologies may improve symptoms of anxiety for children and young people with mild to moderate symptoms of anxiety or low mood.

  • Resources: Earlier treatment could reduce the demand on other treatment options such as face-to-face CBT and potentially prevent progression to more severe symptoms which could be more costly to treat.

  • Equality: Because these technologies can be used remotely, they may be preferred by some children and young people compared with face-to-face interactions with adults. This may especially benefit neurodivergent children and young people.

Managing the risk of early access

  • Clinical assessment: An initial assessment with a healthcare professional is needed before using these technologies to make sure they are suitable. This can take place in a range of settings including school mental health support teams, single point of access teams, voluntary sector teams and children and young people's mental health services.

  • Clinical support: Children and young people will have regular support from a healthcare professional and safeguarding and risk management processes must be in place. This means that if the treatment is not working and symptoms are getting worse, it will be identified quickly, lowering the risks.

  • Individual choice: These technologies can be used as an initial treatment option. Children and young people may choose to wait for other treatment options including face-to-face CBT. They may also have further treatment such as face-to-face CBT after using these technologies.

  • Care pathway: This guidance has assessed the use of the technologies as an initial treatment option to address an unmet need and increase access to effective mental health treatments. Their use elsewhere in the care pathway should be based on individual clinical assessment.

  • Costs: Early results from the economic modelling show that the technologies could be cost effective. This guidance will be reviewed within 4 years and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.

1.2 Further evidence should be generated on:

  • symptom severity

  • impairment measures

  • health-related quality of life

  • level of user engagement

  • rates and reasons for stopping treatment.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.