title: Does Interpersonal Psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial.
abstract: BACKGROUND
  Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial.
  
  
  METHODS
  The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate. Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method.
  
  
  CONCLUSIONS
  This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services.
  
  
  BACKGROUND
  Australian Clinical Trials Registry ACTRNO12607000324415.
authors.affiliation: School of Psychology, Psychiatry and Psychological Medicine, Monash University, Traralgon, Victoria, Australia. Cate.Bearsley-Smith@med.monash.edu.au
authors.forename: Cate
authors.initials: C
authors.lastname: Bearsley-Smith
authors.forename: Mark Oakley
authors.initials: MO
authors.lastname: Browne
authors.forename: Ken
authors.initials: K
authors.lastname: Sellick
authors.forename: Elmer V
authors.initials: EV
authors.lastname: Villanueva
authors.forename: Janice
authors.initials: J
authors.lastname: Chesters
authors.forename: Karen
authors.initials: K
authors.lastname: Francis
authors.forename: Prasuna
authors.initials: P
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D006284:Health Plan Implementation; D006801:Humans; D015337:Multicenter Studies as Topic; D017064:Process Assessment, Health Care; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design; D019035:Rural Health Services; D014739:Victoria