Abstract
BackgroundDepression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes. To meet the demand for treatment for adolescent depression, there is a need for evidence-based interventions suitable for delivery outside of specialist Child and Adolescent Mental Health Services (CAMHS). Interpersonal Counselling for Adolescents (IPC-A) is a brief manualised intervention for adolescent depression suitable for delivery by staff who are not qualified health professionals following participation in a brief training course. While initial piloting within Local Authority services has generated promising results, the effectiveness and cost-effectiveness of IPC-A has yet to be established. This study aims to assess the feasibility of a randomised controlled trial (RCT), evaluating the effectiveness and cost-effectiveness of IPC-A delivered by staff without core professional training in comparison to current provision.MethodFeasibility RCT with process evaluation using ethnographic methodology. Eligible young people (n = 60) will be randomised in a 1:1 ratio to receive either IPC-A or treatment as usual (TAU). Participants will be assessed pre-randomisation (baseline) and followed up at 5, 10 and 23 weeks post-randomisation. A parallel process evaluation will generate understanding of intervention implementation across services and explore the acceptability of the intervention from the perspective of young people and other key stakeholders.ParticipantsYoung people aged 12–18 years presenting to non-specialist services with symptoms of depression. Youth workers, young people and stakeholders will participate in the process evaluation.DiscussionThe need for effective and accessible interventions for young people with mild/sub-threshold depression who, in most cases, do not meet the threshold for mainstream mental health services is long overdue. The primary output of this feasibility trial will be the design of the subsequent full-scale trial. If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority RCT of the effectiveness and cost-effectiveness of IPC-A in comparison to TAU for adolescents presenting to non-specialist services with depressive symptoms. If satisfactory solutions to any problems encountered cannot be identified, alternative research designs will be considered. If proven effective, an IPC-A training programme could be implemented.Trial registryISRCTN registry, ISRCTN82180413, Registered 31 December 2019.
Highlights
Depression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes
If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of Interpersonal Counselling for Adolescents (IPC-A) in comparison to treatment as usual (TAU) for adolescents presenting to non-specialist services with depressive symptoms
Interpersonal counselling (IPC) is an adaptation of Interpersonal psychotherapy (IPT) with three main differences: the treatment duration is shorter (3–6 sessions), it is designed for clients with mild depression, and it can be delivered by non-mental health professionals after participation in a brief (2-day) training course
Summary
A strong commitment to improve mental health services for children and young people was set out in 2015’s Future in Mind [39] and 2016’s Five Year Forward View for Mental Health [40], and reaffirmed in the recent Green Paper, Transforming children and young people’s mental health provision [41]. The NHS Long Term Plan [42] further continues to invest in the improvement and development of CYP MH services. Achieving this goal of improved access to treatment will require a joint-agency approach and a greater focus on providing evidencebased interventions outside of specialist CAMHS. We propose that IPC-A could be an effective treatment for young people with depression, which could be delivered by such non-specialist services. In order to contribute to the evidence-base for interventions for adolescent depression that can be delivered outside of specialist CAMHS, an evaluation of the effectiveness and cost-effectiveness of IPC-A is needed. The process of recruiting, randomising and conducting research assessments is not part of normal practice in non-specialist services, and it is important to demonstrate that this is feasible
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