An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial Journal Articles uri icon

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  • Abstract Introduction Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information ‘Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. Methods and analysis We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13–18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale—Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. Ethics and dissemination Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.


  • Courtney, Darren B
  • Barwick, Melanie
  • Amani, Bahar
  • Greenblatt, Andrea T
  • Aitken, Madison
  • Krause, Karolin R
  • Andrade, Brendan F
  • Bennett, Kathryn Jane
  • Cleverley, Kristin
  • Uliaszek, Amanda A
  • de Oliveira, Claire
  • Hawke, Lisa D
  • Henderson, Jo
  • Wang, Wei
  • Watson, Priya
  • Gajaria, Amy
  • Newton, Amanda S
  • Ameis, Stephanie
  • Relihan, Jacqueline
  • Prebeg, Matthew
  • Chen, Sheng
  • Szatmari, Peter

publication date

  • March 8, 2024