1
|
Gajaria A, Greenblatt A, Prebeg M, Relihan J, Peter Szatmari, Courtney DB. Talking 'Bout Better outcomes for Adolescent Depression: Youth and Caregiver Perspectives on an Integrated Care Pathway for Depression. Clin Child Psychol Psychiatry 2024; 29:453-465. [PMID: 37394898 DOI: 10.1177/13591045231184916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Depression is a common condition among adolescents, with rates continuing to rise. A gap exists between evidence-based recommendations for the treatment of depression and clinical practice. Integrated Care Pathways (ICPs) can help address this gap, but to date no study has examined how young people and their caregivers experience ICPs and whether these pathways are an acceptable form of care. This study used focus groups with adolescents, caregivers, and service providers to examine experiences of an ICP. METHODS Six individual interviews with service providers, four focus groups with youth, and two focus groups with caregivers were completed. Data was analyzed consistent with Braun & Clarke's Thematic Analysis Framework within an interpretivist paradigm. RESULTS AND CONCLUSION The study demonstrated that ICPs are acceptable to youth and their caregivers and that ICPs facilitate shared decision making between youth/caregivers and care providers. Findings also indicated that youth are willing to engage with ICPs particularly when there is a trusted clinician involved who helps interpret and tailor the ICP to the young person's experience. Further questions include how to best integrate these into the overall system and how to further tailor these pathways to support youth with diagnostic complexity and treatment resistance.
Collapse
Affiliation(s)
- Amy Gajaria
- Margaret and Wallace McCain Centre for Child, Youth, & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrea Greenblatt
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Darren B Courtney
- Margaret and Wallace McCain Centre for Child, Youth, & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
2
|
Courtney DB, Barwick M, Amani B, Greenblatt AT, Aitken M, Krause KR, Andrade BF, Bennett K, Cleverley K, Uliaszek AA, de Oliveira C, Hawke LD, Henderson J, Wang W, Watson P, Gajaria A, Newton AS, Ameis S, Relihan J, Prebeg M, Chen S, Szatmari P. An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial. BMC Psychiatry 2024; 24:193. [PMID: 38459453 PMCID: PMC10921633 DOI: 10.1186/s12888-023-05297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/22/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information 'Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. METHODS AND ANALYSIS We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13-18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale-Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. ETHICS AND DISSEMINATION Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.
Collapse
Affiliation(s)
- Darren B Courtney
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada.
| | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Bahar Amani
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Andrea T Greenblatt
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Karolin R Krause
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Brendan F Andrade
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence, and Impact (Formerly Clinical Epidemiology and Biostatistics), McMaster University, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Priya Watson
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Amy Gajaria
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Ameis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Jacqueline Relihan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
3
|
Sarakbi D, Groll D, Tranmer J, Kessler R, Sears K. Supporting Quality Integrated Care for Adolescent Depression in Primary Care: A Learning System Approach. Int J Integr Care 2024; 24:6. [PMID: 38312480 PMCID: PMC10836164 DOI: 10.5334/ijic.7685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Background Quality integrated care, which involves primary care and mental health clinicians working together, can help identify and treat adolescent depression early. We explored systemic barriers to quality integrated care at the provincial level in Ontario, Canada using a learning system approach. Methods Two Ontario Health Teams (OHTs), regional networks designed to support integrated care, completed the Practice Integration Profile (PIP) and participated in focus groups. Results The OHTs had a median PIP score of 69 out of 100. Among the PIP domains, the lowest median score was case identification (50), and the highest one was workspace (100). The focus groups generated 180 statements mapped to the PIP domains. Workflow had the highest number of coded statements (59, 32.8%). Discussion While the primary care practices included mental health clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care pathway for adolescent depression. These include limited access to mental health expertise for assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants as the first line of treatment due to their accessibility rather than evidence-based guidelines. Conclusion Primary care practices, within regional networks such as OHTs, can form learning systems to continuously identify the strategies needed to support quality integrated care for adolescent depression based on real-world data.
Collapse
Affiliation(s)
- Diana Sarakbi
- Health Quality Programs, Queen’s University, Ontario, Canada
| | - Dianne Groll
- Department of Psychiatry and Psychology, Queen’s University, Ontario, Canada
| | - Joan Tranmer
- School of Nursing and Department of Public Health Sciences, Queen’s University, Ontario, Canada
| | - Rodger Kessler
- Department of Family Medicine, University of Colorado, Colorado, United States
| | - Kim Sears
- School of Nursing and Health Quality Programs, Queen’s University, Ontario, Canada
| |
Collapse
|
4
|
Aitken M, Sagar A, Courtney D, Szatmari P. Development, reach, acceptability and associated clinical changes of a group intervention to improve caregiver-adolescent relationships in the context of adolescent depression. JCPP ADVANCES 2023; 3:e12168. [PMID: 38054062 PMCID: PMC10694543 DOI: 10.1002/jcv2.12168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/27/2023] [Indexed: 12/07/2023] Open
Abstract
Background Adolescents with depression often experience relationship problems with their caregivers, which predict poorer treatment outcomes. Personalising interventions by targeting factors associated with poor treatment outcomes may enhance the effectiveness of interventions. We report the development and initial evaluation of an intervention designed to target caregiver-adolescent relationship problems in the context of adolescent depression. Methods Following a literature search to identify established caregiver interventions, we developed a new group intervention for caregivers through an iterative process including six rounds of the group with n = 53 caregivers of adolescents age 13-18 in the context of an integrated care pathway for adolescent depression. Caregivers rated their family functioning at the beginning and end of the program and provided anonymous satisfaction ratings. Enrolment and attendance data were examined. Youth with lived experience of depression and their caregivers provided input that was incorporated in the final version of the intervention. Results The final intervention consists of 8 weekly, 1.5 h group sessions, delivered face-to-face, addressing: psychoeducation, the cognitive-behavioural model and caregiving, positive caregiving, listening and validation, expressing emotions effectively, and problem solving. Reach (56%), attendance (M = 63%, SD = 31%), and satisfaction (M = 92%; SD = 7%) supported the feasibility of the program. Caregivers reported significant improvements in family functioning, t(21) = 2.68, p = .014, d z = 0.56 [95% CI 0.11-1.0]. Discussion A group intervention is acceptable to caregivers of adolescents with depression and may be associated with improved family functioning. Further research is needed, including a randomised controlled trial to test effects of the intervention on various dimensions of the caregiver-youth relationship and on youth depression outcomes.
Collapse
Affiliation(s)
- Madison Aitken
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Ameeta Sagar
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Darren Courtney
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Peter Szatmari
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatryHospital for Sick ChildrenTorontoOntarioCanada
| |
Collapse
|
5
|
Henderson J, Courey L, Relihan J, Darnay K, Szatmari P, Cleverley K, Cheung A, Hawke LD. Youth and family members make meaningful contributions to a randomized-controlled trial: YouthCan IMPACT. Early Interv Psychiatry 2022; 16:670-677. [PMID: 34725926 PMCID: PMC9544385 DOI: 10.1111/eip.13232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/02/2021] [Accepted: 10/19/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND There are growing calls to engage service users in research about issues relevant to them. Youth and family members can make meaningful contributions to research projects, improving quality and relevance. However, more information is needed on the contributions that youth and family members can make to various study designs. OBJECTIVE This paper describes the contributions that youth and family members have made to a multi-site pragmatic randomized-controlled trial, YouthCan IMPACT, and the way project-based engagement learnings accelerated change at the institutional level and beyond. RESULTS Youth and family members were full members of the project team, including the project's core governance and working groups. They contributed to project leadership, as funding co-applicants and as equal members of the governance team. They were also engaged in study design. Youth defined the primary outcome measure and contributed to decisions on all secondary measures. The service pathway was co-designed with youth and family members; for example, they guided the inclusion of peer support and a family member intervention as core service components. Study implementation contributions included ensuring a youth- and family-friendly research process and training research staff on working with youth and family members. Knowledge translation activities have included youth and family members as co-presenters and manuscript co-authors. The learnings from this trial have been leveraged to expand youth and family engagement at the institution and beyond. CONCLUSIONS Youth and family members make substantial contributions to complex research projects, including randomized-controlled trials, thereby improving project design, study implementation, associated interventions, and knowledge translation.
Collapse
Affiliation(s)
- Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Jacqueline Relihan
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
| | - Karleigh Darnay
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
| | - Peter Szatmari
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Ruiz-Íñiguez R, Carralero-Montero A, Martínez-González A, Méndez-Parra E, Valdés-Díaz Y, Sempere J. Interfamily Therapy, a multifamily therapy model settled in infant-juvenile mental health services of Havana (Cuba): A qualitative study from participants' perspectives. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:843-863. [PMID: 34291840 DOI: 10.1111/jmft.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Interfamily therapy (IFT) is a specific model for multifamily therapy (MFT) of recent expansion in Latin American and European countries. In IFT a multifamily group becomes a community of learning where professionals and family members establish collaborative relationships and participate in dialogues. This study used a qualitative phenomenological approach to explore the participants' perspective of 14 members and ex-members of two IFT groups conducted in Infant-Juvenile Mental Health Centers in Havana (Cuba). In this study IFT was well accepted and effective, and it was perceived as beneficial due to its positive influence for participants, with benefits on a personal, family and social level. In addition, participants articulated a series of therapeutic elements of IFT that were essential to promote these benefits. In conclusion, IFT seems to be a useful therapeutic model in the treatment of children, adolescents and their families in a Cuban psychiatric setting.
Collapse
|
7
|
Du L, Chen YM, Jin X, Yuan W, Wang JS. Critical appraisal of clinical practice guidelines for depression in children and adolescents: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e22384. [PMID: 32957419 PMCID: PMC7505307 DOI: 10.1097/md.0000000000022384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression as a clinically significant and growing public health issue is the third leading cause of disability. Adolescent-onset depression has been associated with psychiatric, anxiety disorders, suicidality, medical comorbidities, and an elevated risk of major depressive disorder episodes later in life. How to effectively identify, prevent, and treat depression has become one of the key points of discussion among medical institutions/departments. With the importance of depression being emphasized, countries/organizations around the world have developed guidelines for clinical practice related to depression for different groups of people to guide medical staff to implement scientific, effective, and standardized depression management. However, the quality of such guidelines is not yet clear, which is not conducive to the selection of medical staff and affects clinical application to a certain extent. This study aims to evaluate the rigor of the development of clinical practice guidelines (CPGs) for depression in children and adolescents and will identify, in these documents, the recommendations for depression in children and adolescents. METHODS Electronic databases and specific databases of CPGs will be searched. Study selection and data extraction will be performed independently by 2 reviewers. The AGREE II Instrument and RIGHT checklist will be used to assess the methodological quality and reporting quality of included CPGs about depression in children and adolescents. We will also analyze consistency and inconsistency of the recommendations in CPGs, including assessment, diagnosis, screening, treatment, and management. Bubble charts will be used to show the differences in methodological and reporting quality. Subgroup analysis will be conducted according to the result of evaluation. Excel and Endnote X9 will be used. RESULTS Using the search drafts of electronic databases, we included 6 CPGs. The results of our study will be published in a peer-reviewed journal. CONCLUSIONS Our study will provide systematic evidence for existing CPGs for depression in children and adolescents and provide a guidance for CPGs users. PROTOCOL REGISTRATION INPLASY202080002.
Collapse
Affiliation(s)
- Li Du
- The Third People's Hospital of Lanzhou city, Lanzhou, Gansu
| | - Ya-Min Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University
| | - Xiu Jin
- Department of General Surgery
| | - Wei Yuan
- Department of Cardiovascular Medicine, the First Hospital of Lanzhou University
| | - Jian-Shu Wang
- Department of bone and soft tissue oncology, Gansu Provincial Cancer Hospital, Lanzhou, China
| |
Collapse
|