10 Years of BRAVE Self-Help Service Delivery for Child and Adolescent Anxiety in Australia: Open...

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

This study aimed to describe and comprehensively assess the 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.

This study was a large, open implementation-effectiveness trial involving Australian child and adolescent participants in the BRAVE Self-Help Program, conducted 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 included adoption, penetration, appropriateness, fidelity, feasibility, acceptability, and effectiveness.

Over the 10-year period, the BRAVE Self-Help program had 53,726 users, including 28,700 children (mean age 9.36, SD 1.40 years) and 25,026 adolescents (mean age 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.

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 could be made in as few as 3 sessions, and decisions to stop treatment occurred for many reasons, including treatment success.