A Way through the woods: Development of an integrated care pathway for adolescents with depression

Depression in adolescents is common and debilitating. Treatment approaches vary widely across clinics and may not reflect evidence-based care. Integrated care pathways (ICPs) are implementation tools to facilitate bridging the gap between rigorous but often complex clinical practice guidelines and what is actually practiced. We describe the development of an ICP for the treatment of Adolescents with Major Depressive Disorder (MDD-A) based on the best-available clinical practice guidelines and derived in collaboration with clinicians, administrators, youth partners and caregivers.

With clinician and health service manager input, we took the recommendations from a high quality clinical practice guideline (the National Institute of Health and Care Excellence Clinical Practice Guideline for Depression in Children and Young People) and translated them into an ICP. Feedback from youth partners and clinicians was iteratively incorporated into the current version of the pathway using a collaborative approach.

The current iteration of the pathway at a Canadian tertiary care teaching hospital is described. All youth (and caregivers, if applicable) are offered a multi-family psychoeducation session, a 16-session Group Cognitive Behaviour Therapy and team reviews every 4 weeks that include measurement-based care. Conditional branches of the pathway include a medication algorithm and an 8-session group for caregivers.

The resulting ICP provides a tool to facilitate bridging the gap between evidence and clinical practice.