Title: Scientific Title: Interpersonal Counselling for Adolescent Depression delivered by Youth Mental Health Workers without Core Professional Training: A Feasibility Randomised Controlled Trial_x000D_ Public Title: ICALM (Interpersonal Counselling for Adolescent Low Mood)
Funder: Department of Health and Social Care

Abstract: The mental health of young people is a growing concern. Up to 20% of young people will have experienced depression by the age of 18. Symptoms of depression include sad or irritable mood, loss of interest in activities, decreased energy, low self-esteem, excessive guilt, poor concentration, changes in appetite and disturbed sleep. Young people with depression, even when this depression is mild, experience serious social and educational difficulties and are at greater risk of suicide than their peers. Therefore, it is important that effective treatments are available to all young people who seek help for depressive symptoms. _x000D_ _x000D_ Most young people with depression do not have severe enough symptoms to be treated by specialist NHS child and adolescent mental health services (CAMHS). They therefore receive support from staff members with no formal training in treating mental health problems, working in services such as local authority teams and charities. Training these staff members to deliver evidence-based treatment would considerably expand the therapy workforce, making treatment for depression available to more young people. However, there is currently very little information to guide policy decisions about which interventions these staff members, who are not qualified mental health professionals, should be trained to deliver._x000D_ _x000D_ Interpersonal Counselling (IPC) is a talking therapy for depression designed to be provided by staff who are not qualified mental health professionals. A version of IPC designed to suit young people (IPC for Adolescents: IPC-A) has been developed and early work suggests that young people who receive IPC-A like it and experience improvements in their depressive symptoms. However, we don’t know whether IPC-A is better at reducing depression symptoms than the normal support provided by non-specialist services, so want to do a study to find out. Before we can do this, we need to run a smaller ‘feasibility’ study to answer questions about whether a larger study would be possible. _x000D_ _x000D_ The feasibility study will involve training local authority and charity staff members (without formal mental health qualifications) as IPC-A therapists. The training will involve two full-day workshops, followed by delivering IPC-A to young people under close supervision. Training and supervision will be provided by experienced mental health professionals. Young people aged 12-18 years seeking help for symptoms of depression will be invited to take part in the research and, if they consent, will be screened to ensure the study is suitable for them. _x000D_ _x000D_ Young people who consent will be randomly allocated to receive either IPC-A or the support young people currently receive (“treatment as usual”) because, in the future trial, we will need to do this to test in a fair and unbiased way whether IPC-A is better than the support young people currently receive. All participants will be invited to meet with a researcher to answer questions about their mental health and relationships, and will be asked to complete questionnaires regularly during the study. Some participants will also be invited to take part in interviews to help us understand their experience of taking part. The results of the study will be shared with young people, participating services and commissioners, and will be used to design a future study testing whether IPC-A delivered by this staff group is better than usual support at reducing young people’s depressive symptoms.

Lay abstract: Background: Depression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes. To meet demand for treatment for adolescent depression, there is a need for evidence-based interventions suitable for delivery outside of specialist Child and Adolescent Mental Health Services (CAMHS). Interpersonal Counselling for Adolescents (IPC-A) is a brief manualised intervention for adolescent depression suitable for delivery by staff who are not qualified health professionals following participation in a brief training course. While initial piloting within local authority services has generated promising results, the effectiveness and cost-effectiveness of IPC-A has yet to be established._x000D_ _x000D_ Aim: To assess the feasibility of a randomised controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of IPC-A delivered by staff without core professional training in comparison to current provision. _x000D_ _x000D_ Intervention: Interpersonal Counselling (IPC) is an up to six session manualised psychological intervention, derived from Interpersonal Psychotherapy. IPC is focused on the client’s current depressive symptoms and interpersonal relationships, with a focus on one of four domains: grief, relationship disputes, big changes and loneliness & isolation. The therapist works with the clients to identify effective strategies to deal with their interpersonal problems. IPC-A is an adapted form of IPC designed to suit the needs of young people._x000D_ _x000D_ Design: Feasibility RCT with process evaluation using ethnographic methodology. Eligible young people (n=60) will be randomised in a 1:1 ratio to receive either IPC-A or treatment as usual (TAU). Participants will be assessed pre-randomisation (baseline) and followed up at 5, 10 and 23 weeks post-randomisation. A parallel process evaluation will generate understanding of intervention implementation across services and explore the acceptability of the intervention from the perspective of young people and other key stakeholders._x000D_ _x000D_ Participants: Young people aged 12-18 years presenting to non-specialist services with symptoms of depression. _x000D_ _x000D_ Outputs and anticipated impact: The primary output of this feasibility trial will be the design of the subsequent full-scale trial. If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority RCT of the effectiveness and cost-effectiveness of IPC-A in comparison to TAU for adolescents presenting to non-specialist services with depressive symptoms. If satisfactory solutions to any problems encountered cannot be identified, alternative research designs will be considered. If proven effective, an IPC-A training programme could be implemented nationally. This would facilitate rapid expansion of the therapy workforce, increasing access to evidence-based treatment for adolescent depression. _x000D_ _x000D_ Delivery timeline: The project will be conducted over 24 months. Training of identified staff members to deliver IPC-A will begin before the project begins and be completed during Months 1 – 3. Recruitment will take place Months 4 – 15. Follow-up assessments will be completed in Month 21. Month 22 – 24 will be dedicated to data cleaning, analysis and dissemination.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH