Youth Partners in Care: Depression and Quality Improvement

Study Overview
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Brief Summary
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This randomized effectiveness trial evaluates a quality improvement intervention aimed at providing access to evidence-based depression treatments (particularly cognitive-behavior therapy for depression and or pharmacotherapy) through primary care for youth ages 13-21, as compared to enhanced usual care. The major hypothesis is that the quality improvement intervention will be associated with improved outcomes, relative to enhanced usual care.

Official Title
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Youth Partners in Care: Depression & Quality Improvement

Conditions
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Depression

Intervention / Treatment
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* Other: Quality Improvement (QI) for depression
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Met either of two criteria: 1) endorsed stem items for major depression or dysthymia from the 12-month Composite International Diagnostic Interview(CIDI-12,2.1) modified slightly to conform to diagnostic criteria for adolescents, 1-week or more of past-month depressive symptoms, and a total Center for Epidemiological Studies- Depression Scale(CES-D)40 score ≥ 16, or 2) CES-D score ≥ 24. Age 13-21 Presented at primary care clinic Exclusion Criteria: not English-speaking provider not in study sibling already in study completed eligibility screener previously

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Usual Care<br>Patients received usual care through primary care, enhanced by provider education regarding depression evaluation and management (1-2 hour training, plus study manual) | Other: Usual Care<br>* Usual care enhanced by provider education regarding depression evaluation and management<br>|
| Experimental: Quality Improvement for Depression<br>Major intervention components included a) expert leader teams who planned and implemented the intervention at each clinic, b) care managers who supported primary care clinicians with depression evaluation and management, c) access to cognitive-behavior therapy for depression within each primary care clinic, and d) patient and provider choice regarding treatment modality. | Other: Quality Improvement (QI) for depression<br>* Major intervention components included a) expert leader teams who planned and implemented the intervention at each clinic, b) care managers who supported primary care clinicians with depression evaluation and management, c) access to cognitive-behavior therapy for depression within each primary care clinic, and d) patient and provider choice regarding treatment modality.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-reported depressive symptoms on the CES-D (Center for Epidemiologic Studies Depression Scale) |  | 6-months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mental health related quality of life as assessed using self-report on the Medical Outcomes Study Short Form 12 Health Survey. |  | 6 months, with follow up at 12 and 18 months | 
| satisfaction with care |  | 6 months with follow up at 12 and 18 months | 
| Rates of mental health care, counseling/psychotherapy, and medication treatment. | Youth self report on the study version of the Service Assessment for Children & Adolescents provided measures of rates of mental health care(dichotomous indicator of whether any mental health treatment received), counseling/psychotherapy (dichotomous indicator of whether counseling/psychotherapy was received, number of counseling/psychotherapy sessions), and medication treatment (dichotomous indicator of whether youth received any medication treatment for mental health problems). These measures were obtained using . | 6-months with follow-up at 12 and 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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depression, quality improvement, treatment, adolescents