Core Components

Let’s Introduce Anxiety Management (LIAM) is a cognitive behaviour therapy (CBT) informed intervention, for anxiety in children and young people, aimed at treating mild-moderate anxiety symptoms in primary and secondary school aged children 8 and 18 years old, particularly those who have been unable to access psychological interventions because they do not meet the severity criteria for a tier 3 Child and Adolescent Mental Health Service (CAMHS). 

LIAM is delivered by a trained practitioner over eight, 1-hour sessions in a one-to-one or group format. CBT is supported by NICE Clinical Guideline 159 as the recommended evidence-based intervention for children and young people suffering from anxiety conditions.

Sessions delivered to children and young people focus on the following topics:

• Session 1 – What is LIAM? (Pre-group session or one to one session)
• Session 2 – What is Anxiety?
• Session 3 – Understanding my Anxiety
• Session 4 – Understanding my Anxiety Trap and Tools
• Session 5 – Anxiety Tools - Body Tools
• Session 6 – Anxiety Tools - Thinking Tools
• Session 7 – Facing Anxiety
• Session 8 – Facing Anxiety Review
• Session 9 – Planning Ahead

Each session is underpinned by a workbook and introduces a range of practical tools for children and young people to practice using such as an anxiety thermometer, anxiety diary, breathing and relaxation tools and a coping ladder. The intervention also asks children and young people to practice using the LIAM anxiety tools in between sessions with help from their parents/carers and has information sheets for parents and carers after each session so they know what was discussed and how they can help their child or young person to develop their skills in coping with anxiety. This part of the intervention recognises the systemic nature of difficulties with anxiety and has the additional intention of encouraging positive changes to the parent / carer’s ways of coping with anxiety.

Resources for practitioners include (1) well-structured session plans split into primary, secondary, group and individual (2) data collection materials and routine outcome measures (ROMs) guidance (3) how to start and end each session plans (4) key messages and what works worksheets (5) audio/video footage (6) workbooks which includes at home activities and information sheet for parents/carers.  

Fidelity

In order to effectively replicate the programme, maintain fidelity and achieve the programme outcomes, all elements of the core programme (content, order and duration of sessions) should be implemented as described in the Practitioner Manual. Support to maintain fidelity is provided with the following resources:

1. Practitioner manuals and materials
2. Session plans and guidance including delivery resources and tools e.g. anxiety thermometers and anxiety diaries, what works messaging and outlines
3. Standardised training, supervision, and reflective logs
4. Evaluation guidance relating to standardised Routine Outcome Measures (ROMs) of anxiety, depression and overall well-being, Experience of Service surveys and workshop evaluations are required to be submitted routinely to the TIPS-EIC team.

 Modifiable Components

All core elements of the LIAM programme are required to be implemented as outlined in the manual, however, practitioners can adjust the number of sessions dependent on the level of support required.  

LIAM exclusions include children or young people who would have significant difficulty understanding the materials discussed in LIAM despite the support of a LIAM practitioner; children or young people who experience moderate to severe levels of anxiety or more complex anxiety presentations (e.g., OCD); children or young people who experience moderate to severe low mood as well as difficulties with anxiety or have current suicidal thinking or have engaged in significant self-harm. 

Let’s Introduce Anxiety Management (LIAM) was developed by NHS Education for Scotland (NES) based in Scotland. Structured implementation support is provided by the NES Training in Psychological Skills - Early Intervention for Children and Young People (TIPS-EIC) team.

Support for Organisation / Practice

Implementation Support

NES provides funding for TIPS-EIC Psychologist posts in regional Health Boards across Scotland. These psychologists deliver training and coaching for LIAM in their respective areas, providing support at a local level for organisations and practitioners implementing LIAM. Support is provided by the NES TIPS-EIC team to local TIPS-EIC Psychologists including regular national meetings to discuss the implementation and continued roll out of LIAM, as well as a collaborative working relationship and email/phone contact as required between TIPS-EIC Psychologists and the Head of Programme for Early Interventions in NES.

Support for collation of all national Routine Outcome Measures (ROM) data collection is also provided from the NES TIPS-EIC team including training and tools. The ROM routine submissions from local sites to the NES TIPS-EIC team are grouped into 3 age bands (8-9 years, 10-11 years and 12-18 years) and use the Revised and Core Child Anxiety and Depression Scale (RCADS); Goal Based Outcomes (GBO); Less than 8 years old: Parent /carer (or teacher) Parent version of the RCADS; Young People’s Clinical Outcomes in Routine Evaluation (YP-CORE) and Experience of Service Questionnaire (ESQ) tools.

Licence Requirements

A licence is not required, however, practitioners must be trained in LIAM prior to implementation and have signed and submitted an Agreement Form to their local TIPS-EIC Team prior to delivering LIAM to children and young people.

Start-up Costs

LIAM is a Scottish Government workforce development funded intervention and as a result there are no direct costs to schools or agencies implementing LIAM through the NES Training in Psychological Skills - Early Intervention for Children and Young People (TIPS-EIC) Team. Funds to cover indirect implementation costs, which include staff time to attend training, coaching and resources for delivery of the intervention, are required.

Building Staff Competency

Qualifications Required

Training in LIAM is designed to be delivered to non-mental health specialists to deliver a structured CBT informed intervention. It is recommended that practitioners delivering LIAM should be qualified professionals from multi-disciplinary agencies that work with children and young people for example, school nurses and education staff as well as staff who work in the third sector. As part of their professional role, is it expected that practitioners will have accessed accredited child protection/safeguarding training.

Training Requirements

LIAM has four core components to its training and practitioner competence development, these are:

1. An online e-learning module for universal delivery
2. Half day awareness raising workshop to support settings where LIAM will be delivered, e.g., for all school staff in advance of a LIAM implementation
3. A two-day training course, for selected staff, introducing the techniques to deliver the intervention
4. On the job follow-up coaching

The half-day awareness raising workshop contains CBT informed information about anxiety and how to help children and young people to manage their anxiety as well as the LIAM approach and when it should be offered to a children or young people.

Prior to delivery of LIAM practitioners must complete an online anxiety e-learning training before attending a two-day training. Training equips participants to deliver psychologically informed practices and interventions to children and young people who have elevated levels of distress but who would not meet the criteria for a referral to CAMHS. The two-day training programme, delivered by the TIPS-EIC Psychologists, ensures that practitioners deliver this intervention with fidelity. Day 1 comprises an introduction to LIAM followed by sessions 1 to 5 which focus on Understanding Anxiety and Anxiety Tools; Day 2 looks at sessions 6 to 9 and Anxiety Tools, Facing Anxiety and Planning as well as a preview of skills coaching and case review, paperwork, and an introduction to LIAM routine outcome measures (ROMs). After the two-day training, each practitioner receives a certificate of completion.

Supervision Requirements

LIAM practitioners, post training, will receive regular (weekly/fortnightly/monthly) on-the-job follow-up coaching with the TIPS-EIC Psychologist. The coaching sessions are a structured review of practice and provide feedback, they provide practitioners with support to effectively deliver LIAM with fidelity to the CBT model. The coaching model is underpinned by the principles of implementation science which promotes on the job support to embed new skills into practice.

Theory of Change

Let’s Introduce Anxiety Management (LIAM) is based on cognitive behavioural therapy (CBT) and underpinned by supportive relationships. LIAM aims to improve the immediate and long-term effects for children and young people suffering from mild and moderate anxiety and its impact on their thoughts, body and actions enabling them to understand and manage their symptoms to lead positive lives. This intervention seeks to increase self-esteem and improve coping abilities, applying anxiety tools.

Values

LIAM is a structured, time limited CBT informed intervention for children and young people, that can be delivered in community settings. It takes an early intervention approach to managing anxiety in children and young people. It uses routine outcome measures to inform progress for the practitioner and young person, and to ensure safety and fidelity to the model. LIAM is delivered within the context of ongoing skills coaching to support practitioners. 

• Does providing a structured CBT informed early intervention to manage anxiety in children and young people fit with your organisation’s values?
• Does using routine outcome measures fit with the values of your service?
• Does your organisation value ongoing skills coaching?

Priorities

LIAM seeks to take an early intervention approach to improving anxiety and the overall wellbeing of children and young people, including equipping them with coping strategies and tools to manage their anxiety symptoms that affects their everyday lives.

• Is taking an early intervention CBT based approach to reducing anxiety and improving overall wellbeing in children and young people a priority for your organisation?

Existing Initiatives

• Does your service already provide interventions aimed at improving children and young people’s anxiety and overall well-being in the community setting?
• Are the existing initiatives effective? Do they fit your current and anticipated future requirements?

Workforce

One practitioner, a qualified professional from a multi-disciplinary agency that works with children and young people e.g., school setting, is required to be trained to deliver this intervention to primary and secondary school aged children (8 - 18 years).  In addition to time to attend training, attendance at weekly/fortnightly/monthly skills coaching sessions and completion of paperwork is required.

• Does your organisation have practitioners who are available and interested in learning and delivering this programme?
• Can your organisation support the time commitment required for practitioner training, delivery of the intervention and attendance at coaching sessions?

Technology Support

Access to technology to enable the participation in the eLearning module is required for practitioners (device and internet access). Technology is not required to deliver the intervention.

• Do you have the technology to support practitioners to access online e-learning modules as part of LIAM training?

Administrative Support

Administrative support is required to receive referrals and co-ordinate / schedule client sessions, collect and input evaluation data including ROMs and participant feedback and printing off materials. Access to a quiet private space is required to deliver the intervention.  

• Do your current administrative procedures support your practitioners to implement a programme?

Financial Support

Training and implementation support for LIAM in Scotland is provided through the TIPS-EIC team at NES and affiliated Psychologist throughout the country. This is a Scottish Government funded initiative and therefore there are no direct costs for agencies.  Indirect costs of implementing this intervention will be borne by the implementing agency such as staff time to attend training, coaching and delivering the intervention.

• Do you have the finances available to support any indirect costs associated with delivering this programme?

Comparable Population

LIAM has been developed as an intervention strategy for children and young people aged 8 - 18 years in the community setting, who suffer from mild to moderate symptoms of anxiety that are not severe enough to access tier 3 CAMHS psychological interventions.

Evidence for the effectiveness of LIAM includes children and young people aged 8 - 17 years, from across 8 health boards in Scotland; NHS Ayrshire & Arran, Borders, Forth Valley, Greater Glasgow and Clyde, Lanarkshire, Grampian, Fife and Lothian.

• Is this comparable to the population you serve?

Desired Outcome

LIAM aims to improve the immediate and long-term effects for children and young people who are affected by mild to moderate anxiety and its impact on their thoughts, body and actions enabling them to understand and manage their anxiety and to lead positive lives.   This evidence-based intervention teaches children and young people healthy ways to understand and cope with their anxiety as well as supporting their parents to learn and about and manage their own anxiety levels so they can best support their children and young people.

Research has identified in children across Scotland that LIAM has demonstrated significant improvements in anxiety, depression and overall well-being and can be delivered by staff who do not have a therapeutic background by engaging in training and follow-up coaching sessions with a LIAM expert.

• Is improving anxiety, depression and overall wellbeing of children and young people in the community a desired outcome for your service?
• Does your organisation have other initiatives in place that already effectively and efficiency address the above outcomes?