This SBIR application proposes development of an Information Technology Enabled Disease Management System for Treatment of Adolescent Depression (ITEMS-TAD). The need for this system innovation arises from the substantial costs that inadequately treated adolescent Major Depressive Disorder (MDD) has on the course of adolescent development and society as a whole. Although effective treatments involving the combined use of a Selective Serotonin Reuptake Inhibitor (SSRI) and the administration of Cognitive Behavioral Therapy (CBT) have been developed for adolescent MDD, multiple barriers interfere with the implementation and dissemination of this """"""""gold standard"""""""" of care. These barriers include: under recognition of depressive symptoms by parents and pediatricians, inability to assess adolescent depression accurately and reliably in primary care settings, safety concerns related to pharmacologic treatment, monitoring of symptom changes and adverse treatment effects, such as irritability and suicidal behavior, treatment non-compliance, lack of access to an integrated medical and treatment history, and an alarming shortage of properly trained child and adolescent psychiatrists capable of implementing optimal treatment safely, reliably, and effectively. With an emphasis on making tailored forms of CBT broadly and easily accessible to the community, the ITEMS-TAD is intended to address these problems. Development of the system will proceed rapidly by building on an existing prototype created with joint funding from private and federal sources. The technological infrastructure of the proposed approach includes a Computer Assisted Telephone Interview (CATI) platform, a database consisting of patients'real time medical and treatment history, and an underlying set of intelligent algorithms that tailors the intensity of the treatment resources and approaches administered in individual cases. When interacting with patients over the telephone, depression nurses use the CATI to facilitate the reliable assessment of patient status and administer manualized, empirically informed interventions. Phase I will focus on the development and testing of a demo system that embodies critical features of this approach. To this end, the following specific aims will be achieved in Phase I: (1) content for a demo ITEMS-TAD program will be developed;(2) a Rapid Iterative Evaluation &Testing (RITE) study will be undertaken to refine the content of the demo and assess the usability of the technology involved in its delivery;(3) a Pilot Study will be run to evaluate preliminary indicators of feasibility and effectiveness deemed critical for the system's long- term success, such as the therapeutic alliance, treatment fidelity/quality, depression knowledge, and patient self-efficacy that is associated with use of the demo;(4) an Acceptance study will be completed to assess the experience of using the demo from the point of view of patients and providers;(5) full versions of the proposed Phase II ITEMS-TAD modules and related content will be outlined and elaborated, and (6) the research and production design to be implemented in Phase II will be completed.
The lifetime prevalence of Major Depressive Disorder (MDD) among adolescents is extremely high, with substantial costs for individual adolescents, their families, and society. Effective """"""""gold standard"""""""" treatments have been developed for MDD, yet multiple barriers interfere with its availability and delivery on a wide scale basis. This research will develop an innovative treatment administration and management system that will make optimal adolescent depression care significantly more accessible and affordable to larger segments of the population.
