|Title:||School Adolescent Mood Project: Efficacy of Counselor-Implemented IPT-AST|
|Principal Investigator:||Young, Jami||Awardee:||Children's Hospital of Philadelphia|
|Program:||Social and Behavioral Context for Academic Learning [Program Details]|
|Award Period:||5 years (07/01/2019 - 06/30/2024)||Award Amount:||$3,599,539|
Purpose: The purpose of this study is to test whether the Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) Tier 2 depression prevention program is effective when implemented by school counselors. When delivered by research personnel in schools, IPT-AST improves depression and anxiety symptoms, rates of depression diagnoses, overall functioning, and school-related outcomes for adolescents with depressive symptoms.
Project Activities: The research team will randomly assign high school counselors to deliver IPT-AST or services-as-usual (SAU) and provide training and ongoing consultation to the IPT-AST counselors to support intervention fidelity. The team will then randomly assign adolescents with elevated depressive symptoms to IPT-AST or SAU. The research team will collect data from adolescents, parents, teachers, and school records to evaluate between-group differences on emotional and school outcomes and to examine moderators and mediators of intervention effects. The research team will also conduct an implementation study to determine acceptability, feasibility, fidelity, and sustainability of school counselor delivered IPT-AST, and they will calculate the cost and cost-effectiveness of the intervention.
Products: Products include information about the efficacy of IPT-AST delivered by school counselors compared to services as usual for 9th and 10th grade students with symptoms of depression. Other products include information about costs and cost-effectiveness of school counselor delivered IPT-AST. The research team will also produce peer-reviewed publications and a final dataset.
Setting: This study will take place in 12 urban high schools in Pennsylvania.
Sample: Participants include about 240 racially and ethnically diverse 9th and 10th grade students with elevated symptoms of depression. Parents, teachers, counselors, and administrators will also participate in various aspects of the research.
Intervention: Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is an evidence-based indicated depression prevention program that teaches communication and interpersonal problem-solving strategies to decrease conflict, increase support, and improve social functioning. The intervention consists of eight group sessions, two individual pre-group sessions, one mid-group session that counselors invite parents to attend, and up to six individual booster sessions.
Research Design and Methods: The research team will register this study on ClinicalTrials.gov. Researchers will randomly assign counselors within each school to deliver IPT-AST or services-as-usual (SAU) and provide training and ongoing consultation to IPT-AST counselors. They will then randomly assign adolescents with elevated depressive symptoms to IPT-AST or SAU. The research team will collect data from adolescents, parents, teachers, and school records to evaluate between-group differences on emotional and school outcomes and to examine moderators and mediators of intervention effects. They will also conduct an implementation study to determine acceptability, feasibility, fidelity, and sustainability of school counselor delivered IPT-AST.
Control Condition: School counselors and students randomly assigned to the control condition will participate in SAU, which may include brief supportive counseling and/or referral for services.
Key Measures: The research team will assess social processes (interpersonal conflict, social functioning), emotional outcomes (depression and anxiety symptoms, depression diagnoses), and school outcomes (school engagement, grades) using standardized measures for adolescents, parents, and teachers and school records. Researchers will collect data on services received in IPT-AST and SAU, techniques utilized in both conditions, and feasibility, acceptability, fidelity, sustainability, and costs of IPT-AST using session logs, time diaries, standardized measures, counselor- and consultant-rated fidelity checklists, and qualitative interviews.
Data Analytic Strategy: The research team will analyze this data using hierarchical linear models (HLM) and hierarchical generalized linear models (HGLM) to assess the effects of IPT-AST relative to SAU on proximal and distal outcomes and to explore hypothesized moderators. They will test mediation using causal mediation approaches. They will assess the acceptability, feasibility, fidelity, and sustainability of IPT-AST using mixed methods.
Cost Analysis: The research team will assess overall costs and cost-effectiveness of the two study conditions from the perspective of the payer (education and health care sectors) using the resource costing method. Using the estimated mean cost and mean effect per adolescent by intervention group, they will construct an incremental cost-effectiveness ratio (ICER) for each significant outcome. They will generate a joint distribution of incremental mean costs and effects for the two intervention arms using non-parametric bootstrapping procedures. They will generate cost-effectiveness acceptability curves by plotting these probabilities for a range of ceiling ratios. Finally, they will explore cost-offset associated with IPT-AST with the aim of exploring financial benefits that might accrue through potential reductions in healthcare service use resulting from improved outcomes.