Improving accessibility of cognitive behavioural therapy for children and adolescents: Review of evidence and future directions

Background: Despite great progress in Cognitive Behavioural Therapies (CBTs) for children and adolescents over the last two decades, as many as four out of five young people who could benefit from therapy are not accessing it. The demand on available services, the stigma of mental health difficulties, costs and time demands of treatment, and geographic isolation are some of the many barriers to effective treatments. Method: The aim of this narrative review is to explore the literature on alternative formats of delivery that have the potential to reach more young people by lessening the barriers to access. Group delivery, intensive and brief formats, electronic and remote formats, and preventive approaches are considered with relevant literature in each area explored. Results: There is a substantial body of evidence, including some large-scale controlled trials, to support the group delivery of CBTs for children and adolescents. Preventive approaches also show great promise with some positive results from controlled trials. Intensive and brief delivery formats are emerging as an area of promise but to date they have not been the subject of large-scale controlled trials. Similarly, there is emerging evidence of the effectiveness of electronic CBT formats. Although each of these areas has been progressing, no direct comparison between these alternative approaches were found. Conclusions: Although evidence is developing for alternative formats of delivery that can be effective as well as reducing the barriers to accessing them, there remains a relative paucity of large-scale and controlled studies except those involving standard delivery formats. Further research validating alterative formats, their relative effectiveness and their impact on reach is necessary.