Grant: Project Grant

Depression is the leading cause of disability in adolescents and a potent risk factor for adolescent suicide. Evidence-based treatments are available; however many clinics do not provide guidelines-based treatments. Integrated Care Pathways (ICPs) are treatment algorithms based on the highest quality practice guidelines intended to facilitate the implementation of evidence-based treatment at the clinic level. Our group has already tested the feasibility of ICP for adolescent depression at an academic setting. Whether or not ICPs actually lead to improved outcomes in adolescent depression is still unknown and testing this approach is a complex undertaking. The aim of this project is to test the feasibility of multi-centre randomized control trial of an ICP for adolescent depression versus treatment-as-usual (TAU) in community settings. We also wish to see if the ICP can be implemented with fidelity in the community. Methods: Participants will consist of adolescents (age 13 to 18) with depressive symptoms presenting to one of 4 community mental health agencies known as "Ontario Youth Wellness Hubs" (Hubs). Two of the Hubs will be randomized to the ICP intervention; two of the Hubs will continue with treatment as usual. Research feasibility outcomes will include: (1) 1-year recruitment rate, and (2) data collection efficiency. Clinical outcomes include: (1) rate of decrease in depressive symptoms and (2) rate of change of functional improvement. Implementation outcomes include: (1) fidelity to the planned implementation process and (2) fidelity to the ICP. Knowledge Translation Strategy: We intend to use the knowledge gained in this trial to later conduct a definitive multicentre randomized control. Should the definitive trial show improved outcomes and "implementability", scaling up the model to other Hubs provincially, nationally and internationally would be indicated.