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Background: Difficulties identifying anxiety disorders in primary‐school aged children present significant barriers to timely access to support and intervention. This study aimed to develop a brief assessment tool that can identify children with anxiety disorders in community settings, with a high level of sensitivity and specificity. Methods: Children (aged 8–11 years), and their parents/carers and teachers from 19 primary/junior schools in England each completed a pool of questionnaire items that assessed child anxiety symptoms and associated impact. Diagnostic assessments (Anxiety Disorder Interview Schedule for Children: Child and Parent interviews) were administered by independent assessors to determine the presence/absence of anxiety disorders in children. We created alternative candidate brief child‐, parent‐, teacher‐report questionnaires consisting of the ‘best’ items selected from the wider pool of completed items. We used exploratory factor analysis to reduce the item pool, and multivariable backward elimination logistic regression to identify items that were the strongest predictors of the presence/absence of an anxiety disorder. Results: Parents/carers of 646 children provided consent; child/parent/teacher‐report questionnaires were collected for 582/646/565 children respectively; and diagnostic outcome data were collected for 463 children. None of the brief child‐ nor teacher‐report questionnaires achieved acceptable sensitivity/specificity (

Objectives: A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems. Design: Codesign. Setting: UK primary schools. Participants: Data were collected from year 4 children (aged 8–9 years), parents, school staff and mental health practitioners. Results: We report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback. Conclusions: We reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.

INTRODUCTION: Anxiety difficulties are among the most common mental health problems in childhood. Despite this, few children access evidence-based interventions, and school may be an ideal setting to improve children's access to treatment. This article describes the design, methods and expected data collection of the Identifying Child Anxiety Through Schools - Identification to Intervention (iCATS i2i) study, which aims to develop acceptable school-based procedures to identify and support child anxiety difficulties. METHODS AND ANALYSIS: iCATS i2i will use a mixed-methods approach to codesign and deliver a set of procedures-or 'pathway'-to improve access to evidence-based intervention for child anxiety difficulties through primary schools in England. The study will consist of four stages, initially involving in-depth interviews with parents, children, school staff and stakeholders (stage 1) to inform the development of the pathway. The pathway will then be administered in two primary schools, including screening, feedback to parents and the offer of treatment where indicated (stage 2), with participating children, parents and school staff invited to provide feedback on their experience (stages 3 and 4). Data will be analysed using Template Analysis. ETHICS AND DISSEMINATION: The iCATS i2i study was approved by the University of Oxford's Research Ethics Committee (REF R64620/RE001). It is expected that this codesign study will lead on to a future feasibility study and, if indicated, a randomised controlled trial. The findings will be disseminated in several ways, including via lay summary report, publication in academic journals and presentation at conferences. By providing information on child, parent, school staff and other stakeholder's experiences, we anticipate that the findings will inform the development of an acceptable evidence-based pathway for identification and intervention for children with anxiety difficulties in primary schools and may also inform broa