This application requests five years of funding through a Mentored Patient-Oriented Research Career Development Award for the candidate to develop into an independent mental health services researcher who will contribute on a national level to improving the care of depressed adolescents. The primary goal is to acquire the scientific expertise to develop and evaluate effective quality improvement interventions, in collaboration with clinical settings, that will move evidence- and consensus-based treatments into the real world. The educational plan details how the candidate will develop knowledge in content areas pertinent to adolescent depression, clinical epidemiology, advanced statistical methods, and research design as well as quality improvement theory and application. Three studies will complement the proposed educational activities. The studies are sequentially organized to support the development, evaluation, and refinement of a quality improvement intervention for adolescent depression treatment. The intervention will address identified gaps in the quality of care and provider and consumer barriers to evidence- or consensus-based treatment. In order to develop the quality improvement intervention, Study 1 will identify problematic areas in the assessment, acute, and continuation phases of treatment for 50 depressed adolescents in inpatient and outpatient mental health specialty care settings. In Study 2, the feasibility, acceptability, and effectiveness of the intervention will be evaluated by comparing the quality of care and outcomes for depressed adolescents (n=60) in a test and comparison site. Study 2 will also assess barriers and facilitators to high quality care through qualitative follow-up interviews with providers and consumers. Study 3 will re-evaluate the intervention after it is refined - based on findings from Study 2 - and expanded to include the continuation phase of treatment.
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