An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation,...

Area of Science:

• Child and Adolescent Psychiatry
• Mental Health Services Research
• Implementation Science

Background:

• Adolescent depression is a significant public health concern requiring effective, evidence-based interventions.
• Current community mental health settings often lack integrated care pathways for managing adolescent depression.
• The CARIBOU-2 (Care for Adolescents who Receive Information 'Bout OUtcomes, 2nd iteration) pathway was developed to address this gap.

Purpose of the Study:

• To test the clinical and implementation effectiveness of the CARIBOU-2 pathway compared to treatment-as-usual (TAU).
• To evaluate the CARIBOU-2 pathway's impact on reducing depressive symptoms in adolescents.
• To assess the feasibility and cost-effectiveness of implementing the CARIBOU-2 pathway in community mental health settings.

Main Methods:

• A Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial design.
• Inclusion of 300 adolescents (aged 13-18 years) with depressive symptoms across six community mental health agencies.
• Primary outcome: rate of change in depressive symptoms (Childhood Depression Rating Scale-Revised) over 24 weeks, analyzed using generalized mixed effects modeling.

Main Results:

• The study hypothesizes a greater rate of reduction in depressive symptoms for adolescents receiving the CARIBOU-2 intervention compared to TAU.
• Implementation outcomes, including clinician fidelity and cost-effectiveness, will be examined.
• Preliminary data analysis is pending.

Conclusions:

• If hypotheses are supported, the CARIBOU-2 pathway could offer a more effective model for adolescent depression care.
• Systematic implementation of CARIBOU-2 in other community mental health agencies is indicated if effective.
• This research contributes to advancing evidence-based practices in adolescent mental health services.