title: A manual-based intervention to address clinical crises and retain patients in the Treatment of Adolescents With Depression Study (TADS).
abstract: OBJECTIVE
  To describe a manual-based intervention to address clinical crises and retain participants in the Treatment for Adolescents With Depression Study (TADS).
  
  
  METHODS
  The use of adjunct services for attrition prevention (ASAP) is described for adolescents (ages 12-17 years) during the 12-week acute treatment in TADS, from 2000 to 2003. Logistic regression, controlling for site, was used to predict use.
  
  
  RESULTS
  Of 439 enrolled participants, 17.8% (n = 78) used ASAP primarily for suicidality or worsening of depression. Of these, 46.2% continued in their assigned treatment through week 12, 47.4% received out-of-protocol treatment but continued participating in assessments, and 10.3% withdrew consent, including 3 who terminated treatment and withdrew consent on the same date. ASAP use did not differ between treatments (p =.97) and typically occurred early in treatment. At the end of the 12 weeks, 37.2% of participants using ASAP remained in their assigned treatment, although 80.8% continued participating in assessments. ASAP was associated with, at baseline, a higher severity of depression (p <.01), substance use (p <.01), and precontemplation level of change (p <.02).
  
  
  CONCLUSIONS
  ASAP may be useful to retain adolescent participants and as a safety intervention in placebo-controlled trials. In clinical practice ASAP-like procedures may be useful to encourage adherence in patients engaging in long-term treatment. Clinical trial registration information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006286.
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha. Electronic address: dmay@unmc.edu.
authors: Diane E
authors: DE
authors: May
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Christopher J
authors: CJ
authors: Kratochvil
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Susan E
authors: SE
authors: Puumala
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Susan G
authors: SG
authors: Silva
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Amy J
authors: AJ
authors: Rezac
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Mary J
authors: MJ
authors: Hallin
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Mark A
authors: MA
authors: Reinecke
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Benedetto
authors: B
authors: Vitiello
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Elizabeth B
authors: EB
authors: Weller
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Sanjeev
authors: S
authors: Pathak
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: Anne D
authors: AD
authors: Simons
authors: Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
authors: John S
authors: JS
authors: March
mesh_terms: D000293:Adolescent; D002648:Child; D003419:Crisis Intervention / Q000379:methods*; D003617:Dangerous Behavior; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D004637:Emergency Services, Psychiatric; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008370:Manuals as Topic; D010349:Patient Compliance; D011795:Surveys and Questionnaires