Grant: Catalyst Grant: Standards for Children and Youth Mental Health Services

Background: Depressive disorders in adolescents (DD-A) are prevalent and debilitating. Relevant NICE guidelines recommend Cognitive Behavioural Therapy (CBT) as a first-line treatment for DD-A. The proposed study leverages an ongoing large-scale randomized controlled trial (RCT) to answer the following research questions: (1) How variable is clinician delivery of CBT after standardized training? (2) Does higher clinician fidelity to CBT predict decreases in depressive symptoms at baseline, 4 weeks, 12 weeks and 24 weeks? (3) What are barriers and facilitators to clinician fidelity in the delivery of CBT. Method: The primary study is an ongoing stepped wedge cluster RCT examining effectiveness and implementation of a care pathway for DD-A based on NICE guideline recommendations compared to treatment as usual (TAU). The study is coordinated at the Centre for Addiction and Mental Health, Toronto, Canada. We are enrolling 650 adolescents (325 per arm) with DD-A from 6 community mental health agencies across Ontario, Canada. A key component of the pathway is a 16-week modular CBT program- delivered in group and/or individually, virtually and/or in person. For the current proposal, quality measurement of clinician fidelity to CBT will be collected. This requires specialized resources. This funding would allow us to introduce this additional line of inquiry, not currently budgeted for in the trial. Impact: If greater fidelity is found to be related to greater improvement in depressive symptoms for adolescents receiving CBT, this would inform standards on how CBT is delivered. This could improve the lives of many young people with DD-A. Qualitative methods will be used to explore barriers and facilitators to optimizing treatment fidelity. Research Team: Our research team includes individuals from multiple disciplines including psychology, implementation science, social work, biostatistics, youth engagement, and psychiatry.