Depressive disorders among adolescents managed in a child and adolescent mental health service.

OBJECTIVE: The aims were to describe the prevalence and treatment of depressive disorders among case-managed adolescents attending a regional Child and Adolescent Mental Health Service (CAMHS). METHOD: An observational study was conducted in a regional CAMHS over a 3-month period. Clinicians recorded treatment of their case-managed adolescents aged 12-18 years at the end of each calendar month. The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) and Children's Global Assessment Scale (CGAS) were collected at the beginning of the study period or at entry into the service, and repeated at discharge from the service or at the conclusion of the study period. Adolescents also completed the Reynold's Adolescent Depression Scale, 2nd edition. RESULTS: Depressive disorders were the most common clinician diagnosis reported (22%). There was no statistically significant difference in treatment for depressed compared to non-depressed adolescents. There was a statistically significant improvement in both the HoNOSCA scores (p <0.001) and CGAS scores (p <0.001) for the whole sample. CONCLUSION: Treatment appeared to be the same in type for depressed compared to non-depressed adolescents case managed within CAMHS.

Treatment content in child and adolescent mental health services: development of the treatment recording sheet.

This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.

Harnessing the social capital of rural communities for youth mental health: an asset-based community development framework.

In Australia, we are facing a period of mental health reform with the establishment of federally funded community youth services in rural areas of the country. These new services have great potential to improve the mental health of rural adolescents. In the context of this new initiative, we have four main objectives with this article. First, we consider the notion of social capital in relation to mental health and reflect on the collective characteristics of rural communities. Second, we review lessons learned from two large community development projects targeting youth mental health. Third, we suggest ways in which the social capital of rural communities might be harnessed for the benefit of youth mental health by using asset-based community development strategies and fourth, we consider the role that rural clinicians might play in this process.

The psychosocial profile of adolescent risk of homelessness.

OBJECTIVE: To contrast the psychosocial profile of adolescents with risk factors for homelessness, identified using Chamberlain and MacKenzie's self-report scale, compared to the profiles of homeless adolescents. METHODS: Multinomial logistic regression analyses were conducted contrasting profiles for (a) 137 homeless adolescents, (b) 766 secondary students reporting risk factors for homelessness, and (c) 4,844 students not reporting risks for homelessness. RESULTS: Fourteen percent of a representative population of at-school adolescents, from Victoria, Australia, showed elevated risk of homelessness. These adolescents showed depressive symptoms at least equivalent to homeless adolescents (RR 6.0, 95% CI: 4.9, 7.3, and RR 3.5, 95% CI: 2.1, 5.8, respectively). In multivariate analyses, homeless and at risk adolescents reported equivalent levels of family conflict, early problem behaviour and low opportunities and rewards for family involvement. Compared to adolescents not at risk, at risk adolescents were more likely to be female and to show poorer social skills/assertiveness and depressive symptoms. Compared to at risk adolescents, homeless adolescents showed additional family, school, peer and individual risks, but lower depressive symptomatology. CONCLUSIONS: The findings highlight the potential we have to quickly and simply detect adolescents showing significant risk of homelessness. This sizable minority of adolescents report risks often equivalent to homeless adolescents. It is hoped that stakeholders working with young people will utilise this screening potential to identify and intervene effectively with this significant subpopulation of youth, and their families, while they are still at home and school.

Does Interpersonal Psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial.

BACKGROUND: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial. METHODS/DESIGN: The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate. Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method. DISCUSSION: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRNO12607000324415.