Advertisement

European Child & Adolescent Psychiatry

, Volume 24, Issue 10, pp 1207–1218 | Cite as

The multidisciplinary depression guideline for children and adolescents: an implementation study

  • Marleen L. M. HermensEmail author
  • Matthijs Oud
  • Henny Sinnema
  • Maaike H. Nauta
  • Yvonne Stikkelbroek
  • Daniëlle van Duin
  • Michel Wensing
Original Contribution

Abstract

It is important that depressed patients receive adequate and safe care as described in clinical guidelines. The aim of this study was to evaluate the implementation of the Dutch depression guideline for children and adolescents, and to identify factors that were associated with the uptake of the guideline recommendations. The study took place in specialised child and adolescent mental healthcare. An implementation project was initiated to enhance the implementation of the guideline. An evaluation study was performed alongside the implementation project, using structured registration forms and interviews with healthcare professionals. Six multidisciplinary teams participated in the implementation study. The records of 655 patients were analysed. After 1 year, 72 % of all eligible patients had been screened for depression and 38 % were diagnosed with the use of a diagnostic instrument. The severity of the depression was assessed in 77 % of the patients during the diagnostic process, and 41 % of the patients received the recommended intervention based on the depression severity. Of the patients that received antidepressants, 25 % received weekly checks for suicidal thoughts in the first 6 weeks. Monitoring of the patients’ response was recorded in 32 % of the patients. A wide range of factors were perceived to influence the uptake of guideline recommendations, e.g. the availability of capable professionals, available time, electronic tools and reminders, and the professionals’ skills and attitudes. With the involvement of the teams, recommendations were provided for nationwide implementation of the guideline. In conclusion, a systematic implementation programme using stepped care principles for the allocation of depression interventions seems successful, but there remains room for further improvement.

Keywords

Qualitative research Depression Implementation Guidelines Children Adolescents 

Notes

Acknowledgments

The study was funded by the Netherlands Organisation for Health Research and Development (ZonMW), Grant Number 80-92440-98-012. Anna Muntingh (AM) was one of the researchers who conducted the data collection and analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Costello EJ, Erkanli A, Angold A (2006) Is there an epidemic of child or adolescent depression? JCPP 47:1263–1271Google Scholar
  2. 2.
    Angold A, Costello EJ (2001) Epidemiology of depression in children and adolescents. In: Goodyer I (ed) The depressed child and adolescent, 2nd edn. Cambridge University Press, Cambridge, pp 143–178CrossRefGoogle Scholar
  3. 3.
    Dierker LC, Albano AM, Clarke GN et al (2001) Screening for anxiety and depression in early adolescence. JAACAP 40:929–936Google Scholar
  4. 4.
    Pavuluri M, Birmaher B (2004) A practical guide to using ratings of depression and anxiety in child psychiatric practice. Curr Psychiatry Rep 6:108–116CrossRefPubMedGoogle Scholar
  5. 5.
    Thapar A, Collishaw S, Pine DS, Thapar AK (2012) Depression in adolescents. Lancet 379:1056–1067PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Smit E, Bohlmeijer E, Cuijpers P (2003) Wetenschappelijke onderbouwing depressiepreventie. Epidemiologie, aangrijpingspunten, huidige praktijk, nieuwe richtingen. Trimbos-instituut, UtrechtGoogle Scholar
  7. 7.
    Chassin L, Ritter J (2001) Vulnerability to substance use disorders in childhood and adolescence. In: Ingram RE, Price JM (eds) Vulnerability to psychopathology: risk across the lifespan. Guilford Press, NY, pp 107–134Google Scholar
  8. 8.
    Keenan-Miller D, Hammen CL, Brennan PA (2007) Health outcomes related to early adolescent depression. J Adolesc Health 41:256–262CrossRefPubMedGoogle Scholar
  9. 9.
    Hasler G, Pine DS, Kleinbaum DG et al (2005) Depressive symptoms during childhood and adult obesity: the Zurich cohort study. Mol Psychiatry 10:842–850CrossRefPubMedGoogle Scholar
  10. 10.
    US Burden of disease collaborators (2013) The state of US health, 1990–2010. Burden of diseases, injuries and risk factors. JAMA 310:591–608CrossRefGoogle Scholar
  11. 11.
    Harrington R (2001) Depression, suicide and deliberate self-harm in adolescence. Br Med Bull 57:47–60CrossRefPubMedGoogle Scholar
  12. 12.
    National Collaborating Centre for Mental Health (2005) Depression in children and young people: identification and management in primary, community and secondary care. The British Psychological Society and the Royal College of Psychiatrists, LeicesterGoogle Scholar
  13. 13.
    Beyondblue (2010) Clinical practice guidelines: depression in adolescents and young adults. Beyondblue, the national depression initiative, MelbourneGoogle Scholar
  14. 14.
    Birmaher B, Brent D, AACAP Work Group on Quality Issues (2007) Practice parameter for the assessment and treatment of children and adolescents with depressive disorder. J Am Acad Child Adolesc Psychiatry Pediatrics 46:1503–1526CrossRefGoogle Scholar
  15. 15.
    Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ (2009) Richtlijn voor depressie bij jeugd, addendum. Trimbos-instituut, UtrechtGoogle Scholar
  16. 16.
    Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients care. Lancet 362:1225–1230CrossRefPubMedGoogle Scholar
  17. 17.
    Perera A, Gupta P, Samuel R, Berg B (2007) A survey of anti-depressant prescribing practice and the provision of psychological therapies in a South London CAMHS from 2003 to 2006. Child Adolesc Ment Health 12:70–72CrossRefGoogle Scholar
  18. 18.
    Hetrick SE, Thompson A, Yuen K, Finch S, Parker AG (2012) Is there a gap between recommended and “real world” practice in the management of depression in young people? A medical file audit of practice. BMC Health Serv Res 12:178PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Morrato EH, Libby AM, Orton HD, Degruy FV, Brent DA, Allen R (2008) Frequency of provider contact after FDA advisory on risk of pediatric suicidality with SSRIs. Am J Psychiatry 165:42–50CrossRefPubMedGoogle Scholar
  20. 20.
    Grol R, Wensing M (2004) What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust 180(Suppl 6):S57–S60PubMedGoogle Scholar
  21. 21.
    Murray J, Cartwright-Hatton S (2006) NICE guidelines on treatment of depression in childhood and adolescence: implications from a CBT perspective. Behav Cognitive Psychother 34:129–137CrossRefGoogle Scholar
  22. 22.
    Van der Linden D, De Graaf I (2010) State of the art. Bekendheid met en gebruik van evidence based interventies in de jeugd-ggz. Trimbos-instituut, UtrechtGoogle Scholar
  23. 23.
    Grol R, Wensing M (2006) Implementatie. Effectieve verbetering van de patiëntenzorg. Elsevier Gezondheidszorg, MaarssenGoogle Scholar
  24. 24.
    Strengthening the reporting of observational studies in epidemiology (STROBE) statement (2013) STROBE initiative. www.strobe-statement.org. Accessed 23 Oct 2013
  25. 25.
    RATS (2013) Biomed central. http://www.biomedcentral.com/authors/rats. Accessed 23 Oct 2013
  26. 26.
    Wilson T, Berwick DM, Cleary PD (2003) What do collaborative improvement projects do? Experience from seven countries. Jt Comm J Qual Saf 29:85–93PubMedGoogle Scholar
  27. 27.
    Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP (2008) Evidence for the impact of quality improvement collaboratives: systematic review. BMJ 336:1491–1494PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM (2013) Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q 2:354–394CrossRefGoogle Scholar
  29. 29.
    Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM (2014) A literature review of learning collaboratives in mental health care: used but untested. Psychiatr Serv 9:1088–1099CrossRefGoogle Scholar
  30. 30.
    Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N (2010) Tailored interventions to overcome identified barriers to change: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD005470 PubMedCentralGoogle Scholar
  31. 31.
    Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 4:50PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    VERBI GmbH (2007) MAXQDA. The art of data analysis. http://bit.ly/1aQrdcX. Accessed May 2012
  33. 33.
    Kramer TL, Miller TL, Phillips SD, Robbins JM (2008) Quality of mental healthcare for depressed adolescents. Am J Med Qual 23:96–104CrossRefPubMedGoogle Scholar
  34. 34.
    Hermens MLM, van Splunteren PT, van den Bosch A, Verheul R (2011) Barriers to implementing the clinical guideline on borderline personality disorder in the Netherlands. Psychiatric Serv 62:1381–1383CrossRefGoogle Scholar
  35. 35.
    Van Splunteren P, Hermens M (2011) From knowledge to action. Application of guidelines in mental healthcare [in Dutch: Van kennis naar actie. Toepassing van richtlijnen in de ggz]. Tijdschr Voor Gedragstherapie 44:285–297Google Scholar
  36. 36.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, text revision. APA, Washington, DCGoogle Scholar
  37. 37.
    Deming WE (1986) Out of the crisis: quality, productivity and competitive position. Cambridge University Press, CambridgeGoogle Scholar
  38. 38.
    Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP (1996) The improvement guide. A practical approach to enhancing organizational performance. Jossey-Bass Publishers, San FranciscoGoogle Scholar
  39. 39.
    Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for children for DSM-IV: children and parent version. Psychological Corporation/Graywind Publications Incorporated, San AntonioGoogle Scholar
  40. 40.
    Achenbach TM (1991) Manual for the child behaviour checklist/4–18, YSR and TRF profiles. University of Vermont (Department of Psychiatry), BurlingtonGoogle Scholar
  41. 41.
    Kovacs M (1992) Children’s depression inventory manual. Multi-Health systems, North TonawandaGoogle Scholar
  42. 42.
    Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988CrossRefPubMedGoogle Scholar
  43. 43.
    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345CrossRefPubMedGoogle Scholar
  44. 44.
    Van Oort M, van’t Land H, de Ruiter C (2005) Screeningsinstrument psychische stoornissen voor Bureau Jeugdzorg: Schriftelijk of mondeling?. Trimbos-instituut, UtrechtGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Marleen L. M. Hermens
    • 1
    Email author
  • Matthijs Oud
    • 1
  • Henny Sinnema
    • 1
  • Maaike H. Nauta
    • 2
  • Yvonne Stikkelbroek
    • 3
  • Daniëlle van Duin
    • 1
    • 4
  • Michel Wensing
    • 5
  1. 1.Netherlands Institute for Mental Health and Addiction (Trimbos Institute)UtrechtThe Netherlands
  2. 2.Department of Clinical Psychology, Faculty of Behavioural and Social SciencesUniversity of GroningenGroningenThe Netherlands
  3. 3.Child and Adolescent StudiesUniversity UtrechtUtrechtThe Netherlands
  4. 4.Center of Expertise, Treatment, Rehabilitation and Recovery of People with Severe Mental IllnessPhrenosUtrechtThe Netherlands
  5. 5.Scientific Institute for Quality in HealthcareRadboud University Medical CentreNijmegenThe Netherlands

Personalised recommendations