Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment.

BACKGROUND: Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. OBJECTIVE: The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. METHODS: Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. RESULTS: Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference -6.06) were seen in depression between intake and discharge (t967=-24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). CONCLUSIONS: Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth.

Understanding Treatment Needs of Youth in a Remote Intensive Outpatient Program Through Solicited Journals: Quality Improvement Analysis.

BACKGROUND: Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. OBJECTIVE: The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. METHODS: Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. RESULTS: Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. CONCLUSIONS: These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods.

#freemind: Young Women Using Mindfulness Meditation to Cope with Life in a Juvenile Justice Institution.

The purpose of this study was to introduce mindfulness meditation, a recommended adjunctive treatment for trauma in juvenile justice-involved youth, to incarcerated young women and collect narrative commentary about their experiences to answer the following research questions: What is the experience of incarcerated young women who participate in Internet-based mindfulness meditation classes? How do incarcerated young women apply mindfulness meditation to life in a juvenile justice facility? Participants attended bi-weekly guided meditation sessions and wrote about their experiences after each session in a journal. Three coders used open-coding content analysis to identify topics and themes across 38 journal entries. The primary theme, found in 61% of entries, described the difficulties of living in a juvenile justice facility, providing context for the descriptions found in 58% of entries regarding the usefulness of mindfulness meditation to cope with those difficulties. This study highlights the challenges of living in a correctional institution as a young woman and the barriers such settings pose to the wellbeing and healthy development of their residents. It also points to mindfulness meditation as an operative method of supporting these highly traumatized young women until that time when alternatives to incarceration can be identified.