Pilot Project Abstract - Clarke, Greg, PhD

Clarke, Greg, PhD, Senior Investigator, Kaiser Permanente Center for Health Research

“Accelerating the pace of translating evidence-based mental health treatments into practice: a pilot dissemination of brief CBT for youth depression”

Naturalistic outcomes study of youth depression CBT delivered by community therapists, relative to outcomes obtained in more controlled, parallel randomized clinical trial funded by a separate NIMH grant.

Major depression is the 3rd leading cause of premature death and disability out of all health conditions. However, evidence-based treatments (EBTs) for depression, such as cognitive-behavioral therapy (CBT), are incompletely disseminated in community care. Although antidepressants are widely available, their significant side effects (e.g., increased suicidality) and modest benefit reduce their usefulness and reach. CBT is a much more acceptable EBT with no known side effects; its dissemination is a key public health need. Pilot data are needed to understand whether community providers can adopt and adhere to CBT, whether such adherence is related to CBT effects, across the range of community patients We propose to conduct a naturalistic outcomes study of this CBT model delivered by community agency therapists to 25 depressed youth. This naturalistic outcomes study will be conducted in parallel to our ongoing, NIMH-funded randomized trial of this same CBT model, using identical measures of youth outcomes and therapist adherence. We will train community therapists in our CBT approach and record CBT sessions to characterize what is delivered. We will also assess outcomes of depressed youth over 6 months. We will employ benchmarking statistical methods to compare outcomes across the community cases and the RCT cases, adjusted for case differences. These results will help prepare for future dissemination efforts by answering these questions: Does poor therapist CBT adherence lead to inferior patient outcomes relative to results obtained in controlled trials? How should dissemination efforts promote adherence? Do these guidelines vary per the clinical presentation of the patients?