None listed
Conditions
Brief summary
The current project aims to: " Use principles of Implementation Science to promote uptake of, and confidence in using the Unified Protocol for Adolescents (UP-A) by CYMHS clinicians with anxious and/or depressed adolescents in the real world setting of a CYMHS community clinic. " Evaluate the UP-A compared to treatment as usual (TAU). It is hypothesised that by the end of the proposed project: " The confidence of CYMHS clinicians in the utility and delivery of the UP-A with anxious and/or depressed adolescents will have increased following a sequence of targeted implementation processes to support uptake of the EBT in community Clinic A; and " The UP-A will produce superior outcomes on measures of adolescent anxiety and depressive symptomatology compared to TAU.
Interventions
The Unified Protocol for the Treatment of Emotional Disorders in Adolescence (UP-A): The UP-A is an emotion-focused, transdiagnostic approach for adolescents (ages 12-18) with a primary emotional disorder. It is a developmental adaptation of the Unified Protocol, a transdiagnostic treatment for adults with emotional disorders. Clinicians present all skills in the context of the emotions most salient to presenting concerns and adolescent/caregiver conceptualizations of treatment needs, thereby personalizing treatment. The UP-A is delivered in a one-on-one face-to-face consultation format. It consists of 8-21 weekly sessions (i.e., if 8 sessions of the intervention are delivered, this would generally occur across an 8-week period; if 14 sessions are delivered, this would generally occur across a 14-week period), with clinician flexibility regarding the sequencing and depth with which various sections are presented to clients and caregivers, as well as the emotions targeted during the course of the intervention. The number of sessions received by adolescents and their parents/guardians is based on the clinician's perception of the young person's treatment needs. Sessions are approximately 60 minutes in duration. Topics covered include: psychoeducation about anxiety, depression and emotions; behavioural and emotional exposure; emotion regulation; and cognitive challenging. A parent or primary guardian is asked to attend all sessions of the UP-A, although the degree of involvement varies based on clinical need. At a maximum, clinicians may elect to use optional parenting materials throughout treatment and for up to three parent-alone sessions. These sessions use the guiding acronym ICE (Independence, Consistency and Empathy) to reinforce youth session materials and problem-solve concerns common in the parenting of youth with emotional disorders (e.g., overprotection, conflict, etc.). The person running the sessions in this trial will be a clinician within one of 4 'active' community clinic treatment sites within Children's Health QLD's (CHQ) Child and Youth Mental Health Service (CYMHS). Supervision will be provided to clinicians implementing the intervention on a weekly basis by Dr. Cobham. Sessions will be audio recorded for treatment adherence. It should be noted that, because this evaluation is occurring in a real world clinical service setting, it is likely that participant adolescents and their families will receive other services over and above the UP-A as individual therapy - for example, medication and/or family therapy.
Sponsors
The University of Queensland
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
12 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Male or female adolescents aged 12-18 years with clinically significant symptoms of anxiety or depression (evidence of clinically significant symptom will be defined as a Clinical Severity Rating - CSR - greater than or equal to 4 on any DSM-5 defined anxiety disorder or depressive disorder). The adolescent lives with a legal guardian and this guardian is willing to attend treatment sessions and participate in study assessments. Adolescents and their parents/guardians are able to complete all study procedures in English.
Exclusion criteria
1. Adolescents who are currently experiencing high levels of suicidal ideation or who have engaged in suicidal behaviors within the past 3 months will be excluded from the trial. 2. Youth with primary conditions not specified for exclusion (e.g., eating disorders, schizophrenia) will be screened. As long as an emotional disorder treatment focus is appropriate, these youth will be included. 3. Adolescents with a reported history of intellectual disability or for whom there is substantial evidence (e.g., multiple learning disorders, extensive school-based accommodations for learning) that the cognitive level of the UP-A would make it inappropriate as an individual therapy modality will be excluded. 4. Given additional complexities obtaining informed consent, adolescents who are currently placed in the foster care system will be excluded.
Outcome results
None listed