Treating Depression From an Integrated Approach

1. Treating Depression From an Integrated Approach A Collaborative Approach to Care May 4, 2019 * Tex-CHIP Training Series

2. Treating Depression Through Counseling

3. Understanding Provider Role in Treating Depression Counselor works to establish a strong therapeutic alliance. The counselor emphasizes collaboration and active participation with client and family. The counselor is goal oriented and problem focused. The counselor is educative, aims to teach the client to be their own therapist, and emphasizes relapse prevention. Counselor aims to structure sessions. Cognitive behavior therapy teaches clients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs. Cognitive behavior therapy uses a variety of techniques to change thinking, mood, and behavior.

4. Understanding Provider Role in Treating Depression Counselor is understanding of developmental and age-related differences in the presentation of depression. The counselor is skillful at eliciting and responding to verbal and non-verbal feedback throughout the session. The counselor understands the client’s “internal reality” and is skillful at communicating this understanding. Able to maintain confidentiality while also drawing the line at recognizing threats to safety, and signs of suicidality and risky behavior. Counselor displays warmth, concern, confidence, genuineness, and professionalism.

5. Considerations when Interacting with Clients • Encourage participation and keeps clients actively involved. • Build a collaborative relationship. • Previous history of treatment and stages of change. • Emphasize links between feelings, actions, and thoughts when approaching clients using cognitive behavioral therapy. • Normalize client experiences. • Review client’s treatment goals regularly. • Review the role and function of client’s medications. • Consider the role of family members and arrange family sessions.

6. Considerations when Interacting with Clients FRAMES Components: Feedback- Provide youth with personal feedback regarding their individual status and where they stand in relationship to norms and standards. Responsibility- Emphasize the youth’s freedom of choice and personal responsibility for their choices. Advice/Education- Provide clear recommendations or advice in a supportive, nonthreatening manner. Menu- Provide options for youth to chose from. Empathy- Express empathy; accurate reflective listening, warm and genuine manner, non-judgmental approach. Self-Efficacy- Reinforce the youth’s sense of self-efficacy regarding their ability to make or maintain behavioral or lifestyle changes.

7. Our Treatment Plan

8. Measuring Outcomes/Success Goal:Andrew wants to feel better about himself and regain an interest in life. Objective #1: Within the next 90 days, Andrew will know he is working towards feeling better about himself when he learns and can demonstrate at least three strategies to overcome unhelpful thoughts evidenced by personal and family report. Objective #2: Within the next 90 days, Andrew will know he is working towards regaining an interest in life when he learns and can demonstrate at least three strategies to engage in fun social activities and success activities that will help him feel happier and promote social interest and school achievement evidenced by personal and family report. Intervention #1:Andrew will meet with counselor for session at home, office, and/or at school for one hour per week to participate in Cognitive Behavioral Therapy and will learn cognitive strategies such as the ABC model, 3C’s, personality triangle, and behavioral strategies through role-playing, thought tracking, journaling, and homework. Intervention #2:Andrew will meet with counselor for session at home, office, or at school once a week to learn about positive social and positive success activities through behavioral therapy using lessons from the STEADY teen workbook (activity contracts, making a plan worksheets).

9. Measuring Outcomes/Success Personal interviews from client and family. Tracking mood and activity level using mood and activity diary. Weekly review of mood questionnaire and fun social and success activity contracts. Weekly review of thought tracking, and homework. Child and Adolescent Needs and Strengths Assessment (CANS) quarterly reviews. Quarterly review of goals on recovery/treatment plans.

10. Communication Needed From Other Providers Consistent updates from case managers on client and family information (updated contact information, family relations, home environment, family history). Client’s engagement during skills training and medication education with case manager. Family partner’s perception of parent’s needs and strengths. Staffing with school counselors on client’s attendance, school behavior, and participation. Steps to make environment safe at school. Recommendations by psychologist from psychological evaluations. Recommendations from psychiatrist.

11. References Clarke, G., DeBar, L., Ludman, E., Asarnow, J., & Jaycox, L. (2002). Steady Project Intervention Manual: Collaborative Care, Cognitive-Behavioral Program for Depressed Youth In a Primary Care Setting. Retrieved on May 1, 2019 from http://www.kpchr.org/research/public/common/getdoc public.aspx?docid=366e2233-793a-4caa-86e8- 732cbe32eba6