BMC Psychiatry (Mar 2024)

An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial

  • Darren B. Courtney,
  • Melanie Barwick,
  • Bahar Amani,
  • Andrea T. Greenblatt,
  • Madison Aitken,
  • Karolin R. Krause,
  • Brendan F. Andrade,
  • Kathryn Bennett,
  • Kristin Cleverley,
  • Amanda A. Uliaszek,
  • Claire de Oliveira,
  • Lisa D. Hawke,
  • Jo Henderson,
  • Wei Wang,
  • Priya Watson,
  • Amy Gajaria,
  • Amanda S. Newton,
  • Stephanie Ameis,
  • Jacqueline Relihan,
  • Matthew Prebeg,
  • Sheng Chen,
  • Peter Szatmari

DOI
https://doi.org/10.1186/s12888-023-05297-4
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 14

Abstract

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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.

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