%0 Clinical Trial Protocol
%T An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial.
%A Courtney DB
%A Barwick M
%A Amani B
%A Greenblatt AT
%A Aitken M
%A Krause KR
%A Andrade BF
%A Bennett K
%A Cleverley K
%A Uliaszek AA
%A de Oliveira C
%A Hawke LD
%A Henderson J
%A Wang W
%A Watson P
%A Gajaria A
%A Newton AS
%A Ameis S
%A Relihan J
%A Prebeg M
%A Chen S
%A Szatmari P
%J BMC Psychiatry
%V 24
%N 1
%D 2024 Mar 8
%M 38459453
%F 4.144
%R 10.1186/s12888-023-05297-4
%X BACKGROUND: 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: 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.
BACKGROUND: 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.