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Depression Treatment (Child & Adolescent)

Scientific Ratings in this Topic
  • 1 Well-Supported by Research Evidence
  • 2 Supported by Research Evidence
  • 3 Promising Research Evidence
  • 4 Evidence Fails to Demonstrate Effect
  • 5 Concerning Practice
  • NR Not able to be Rated

Topic Areas

Topic Areas

Definition

Depression Treatment (Child & Adolescent) is defined by the CEBC as the treatment of youth with a diagnosis of a depressive disorder, or with elevated symptoms of depression as demonstrated by a standardized screening or assessment tool. Common symptoms may include persistent sad or irritable mood, loss of interest in activities, significant change in appetite or body weight, difficulty sleeping or oversleeping, loss of energy, feelings of worthlessness or inappropriate guilt, and/or difficulty concentrating.

The CEBC has evaluated only replicable programs that do not use medication as an essential component of treatment. The Pharmacological Treatments for Children and Adolescents with Mental Health Disorders page has links to reputable organizations that list information on medications used to help treat children and adolescents with depression and other disorders.

  • Target population: Youth with a diagnosis of a depressive disorder or with elevated symptoms of depression as demonstrated by a standardized screening or assessment tool
  • Services/types that fit: Typically outpatient services - usually either individual or group, but occasionally family therapy or services also
  • Delivered by: Mental health professionals
  • In order to be included: Program must specifically target depression as a goal
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines depression related outcomes, such changes in symptom levels, behaviors, and/or functioning

Downloadable Topic Area Summary

Definition

Depression Treatment (Child & Adolescent) is defined by the CEBC as the treatment of youth with a diagnosis of a depressive disorder, or with elevated symptoms of depression as demonstrated by a standardized screening or assessment tool. Common symptoms may include persistent sad or irritable mood, loss of interest in activities, significant change in appetite or body weight, difficulty sleeping or oversleeping, loss of energy, feelings of worthlessness or inappropriate guilt, and/or difficulty concentrating.

The CEBC has evaluated only replicable programs that do not use medication as an essential component of treatment. The Pharmacological Treatments for Children and Adolescents with Mental Health Disorders page has links to reputable organizations that list information on medications used to help treat children and adolescents with depression and other disorders.

  • Target population: Youth with a diagnosis of a depressive disorder or with elevated symptoms of depression as demonstrated by a standardized screening or assessment tool
  • Services/types that fit: Typically outpatient services - usually either individual or group, but occasionally family therapy or services also
  • Delivered by: Mental health professionals
  • In order to be included: Program must specifically target depression as a goal
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines depression related outcomes, such changes in symptom levels, behaviors, and/or functioning

Downloadable Topic Area Summary

Why was this topic chosen by the Advisory Committee?

The Depression Treatment (Child & Adolescent) topic area is relevant to child welfare because documented research shows that children who enter the child welfare system, particularly those that are removed from their home, experience a significantly higher rate of mental health problems, including depression than children in the general population. This is not surprising, and is likely the result of a number of contributing factors. These factors may include events that precipitated child welfare intervention including abuse, neglect, and abandonment, as well as factors associated with placement, including separation, loss, anger, and fear.

While the child welfare system has historically focused on the physical and safety needs of children, emerging practice within agencies across the country is to now take into account the emotional needs of children as well. Child welfare agencies along with mental health providers have come to recognize the need for timely, appropriate, and effective depression treatment services that support children and families in achieving successful outcomes. In addition, early assessment and timely treatment intervention have been recognized as playing a key role in ensuring successful outcomes for children. As a result, a growing number of new initiatives and programs are being implemented within California counties that support the delivery of an array of mental health services to children and families receiving child welfare services. These services range from mental health screening and assessment to individualized treatment for identified needs.

Additionally, there is heightened awareness among professionals that the delivery of children's mental health services must be carefully coordinated across child serving agencies to thoroughly address their complex needs. Whether children remain living with their parents or are placed outside the home, it is critical that all children in the child welfare system be screened and assessed. Moreover, parents and caregivers must be trained to identify early signs of mental distress enabling them to seek early intervention and appropriate care and treatment.

Marilynne Garrison
Division Chief, Community-Based Support Division
https://dcfs.lacounty.gov/

Why was this topic chosen by the Advisory Committee?

The Depression Treatment (Child & Adolescent) topic area is relevant to child welfare because documented research shows that children who enter the child welfare system, particularly those that are removed from their home, experience a significantly higher rate of mental health problems, including depression than children in the general population. This is not surprising, and is likely the result of a number of contributing factors. These factors may include events that precipitated child welfare intervention including abuse, neglect, and abandonment, as well as factors associated with placement, including separation, loss, anger, and fear.

While the child welfare system has historically focused on the physical and safety needs of children, emerging practice within agencies across the country is to now take into account the emotional needs of children as well. Child welfare agencies along with mental health providers have come to recognize the need for timely, appropriate, and effective depression treatment services that support children and families in achieving successful outcomes. In addition, early assessment and timely treatment intervention have been recognized as playing a key role in ensuring successful outcomes for children. As a result, a growing number of new initiatives and programs are being implemented within California counties that support the delivery of an array of mental health services to children and families receiving child welfare services. These services range from mental health screening and assessment to individualized treatment for identified needs.

Additionally, there is heightened awareness among professionals that the delivery of children's mental health services must be carefully coordinated across child serving agencies to thoroughly address their complex needs. Whether children remain living with their parents or are placed outside the home, it is critical that all children in the child welfare system be screened and assessed. Moreover, parents and caregivers must be trained to identify early signs of mental distress enabling them to seek early intervention and appropriate care and treatment.

Marilynne Garrison
Division Chief, Community-Based Support Division
https://dcfs.lacounty.gov/

Topic Expert

The Depression Treatment (Child & Adolescent) topic area was added in 2010. Amanda Jensen-Doss, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2010 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2010 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Jensen-Doss was not involved in identifying or rating them.

Topic Expert

The Depression Treatment (Child & Adolescent) topic area was added in 2010. Amanda Jensen-Doss, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2010 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2010 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Jensen-Doss was not involved in identifying or rating them.

Programs

Blues Program

The Blues Program is a brief manualized cognitive-behavioral prevention intervention for high school-aged adolescents with elevated depressive symptoms. The program consists of 6 weekly 1-hour group sessions and home practice assignments. Weekly sessions focus on building group rapport and increasing participant involvement in pleasant activities (all sessions), learning and practicing cognitive restructuring techniques (sessions 2-4), and developing response plans to future life stressors (sessions 5-6). In-session exercises help participants learn the program skills. Home practice assignments aim to reinforce the skills taught in the sessions and help participants learn how to apply these skills to their daily life.

Scientific Rating 2

Interpersonal Psychotherapy-Adolescent Skills Training

IPT-AST is a group-indicated prevention program that is based on Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) and its group adaptation. The intervention involves two initial individual sessions and eight weekly 90-minute group sessions. The group focuses on psychoeducation and general skill-building that can be applied to different relationships within the framework of three interpersonal problem areas: interpersonal role disputes, role transitions, and interpersonal deficits. The psychoeducation component includes defining prevention, educating members about depression, and discussing the relationship between feelings and interpersonal interactions. The interpersonal skill-building component consists of two stages. First, communication and interpersonal strategies are taught through didactics, activities, and role-plays. Once group members understand the skills, they are asked to apply them to different people in their lives, practicing first in group and then at home.

Scientific Rating 2

Primary and Secondary Control Enhancement Training

PASCET is a structured individual psychotherapy intervention for depression. Treatment sessions and take-home practice assignments are built on research findings concerning cognitive and behavioral features of depression in children and adolescents, and on the two-process model of perceived control and coping. As suggested by that model, children are trained to gain control of their mood by developing skills that will help them cultivate primary control (i.e., changing objective conditions to make them fit their wishes) and secondary control (i.e., changing themselves [e.g., their expectations, interpretations] so as to adjust to objective conditions and thus control their subjective impact). The sessions include within-session exercises and take-home practice (i.e., homework) assignments, guided by an ACT & THINK Practice Book that each child uses throughout the program, and keeps afterward.

Scientific Rating 2

ACTION

ACTION is a developmentally sensitive group treatment program for depressed youth that follows a structured therapist's manual and workbook. Each of the 20 group and 2 individual meetings lasts approximately 60 minutes. The child treatment is designed to be fun and engaging while teaching the youngsters a variety of skills and therapeutic concepts that are applied to their depressive symptoms, interpersonal difficulties, and other stressors. Skills are taught to the children through didactic presentations and experiential activities. The skills are rehearsed during in-session activities and are applied through therapeutic homework. Skills application is monitored and recorded through completion of workbook activities, and completion of the therapeutic homework is encouraged through an in-session reward system. In general, the first nine sessions focus primarily on affective education and teaching coping and problem-solving skills. Sessions 10–19 focus primarily on learning and applying cognitive restructuring as well as continued use of previously learned strategies. Beginning with the 11th meeting and continuing through the 20th meeting, children work to improve their sense of self.

Scientific Rating 3

AFFIRM Youth

AFFIRM Youth is an eight-session, manualized affirmative cognitive-behavioral group intervention. It is designed to reduce depression and improve coping skills and self-efficacy for LGBTQ+ youth. Using a trauma-informed approach, AFFIRM Youth is tailored to the experiences of LGBTQ+ youth and provides them opportunities to develop identity cognition (e.g., self-awareness, identifying risk), mood (e.g., recognizing the link between thoughts and feelings), and behavior (e.g., identifying strengths and ways of coping), as well as equipping them with the tools to self-manage their mental health.

Scientific Rating 3

Adolescent Coping With Depression Course

The Adolescent Coping With Depression Course (CWD-A) is a cognitive-behavioral group intervention that targets specific problems typically experienced by depressed adolescents. These problems include discomfort and anxiety, irrational/negative thoughts, poor social skills, and limited experiences of pleasant activities. The CWD-A consists of 16 two-hour sessions that are conducted over an 8-week period for mixed-gender groups of up to 10 adolescents.

Core components of the program include:

  • Cognitive-Behavioral Therapy (CBT) model of change
  • Mood monitoring
  • Increasing pleasant activities (behavioral activation)
  • Social skills training
  • Relaxation training
  • Identification of negative thoughts and cognitive restructuring
  • Communication and problem-solving training
  • Relapse prevention

Each participant receives a workbook that provides structured learning tasks, short quizzes, and homework forms. To encourage generalization of skills to everyday situations, adolescents are given homework assignments that are reviewed at the beginning of the subsequent session.

Scientific Rating 3

Attachment-Based Family Therapy

ABFT is an attachment-based, trauma-informed, emotion-focused intervention for youth with suicide, depression anxiety, and/or trauma. Treatment strengthens secure parent-child relationships which can reduce family conflict and buffer against stress. The model is structured yet flexible, requiring therapists to be focused as well as emotionally attuned. Treatment is constructed around five tasks:

  • The Relational Reframe task helps families focus on relationship repair as the initial goal of therapy.
  • The Adolescent Alliance task helps link current distress to attachment ruptures and prepares the adolescent to talk about this with caregivers.
  • The Parent Alliance task focuses on reducing caregiver distress, increasing empathy, and improving parenting skills.
  • The Attachment Task brings the family members back together to discuss these attachment ruptures. This helps families resolve problems and practice new interpersonal and affect regulation skills.
  • As trust reemerges, therapy focuses on Promoting Autonomy task, wherein caregivers help promote adolescent autonomy and competency outside the home.

ABFT is generally delivered in weekly sessions for 12-16 weeks.

Scientific Rating 3

Interpersonal Psychotherapy for Depressed Adolescents

Interpersonal Psychotherapy (IPT) is a time-limited, manualized psychosocial treatment for depression in adolescents and adults. IPT for adults has been rated by the CEBC in the area of Depression Treatment (Adult). IPT identifies how interpersonal issues are related to the onset or maintenance of depressive symptoms while recognizing the contributions of genetic, biological, and personality factors to vulnerability for depression. Patients work to understand the effects of interpersonal events on their mood and to improve their communication and problem-solving skills in order to increase their effectiveness and satisfaction in current relationships.

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is defined in a treatment manual that was adapted to address the developmental needs of adolescents and their families. IPT-A is an outpatient treatment designed for adolescents with mild to moderate depression severity. It is not indicated for adolescents who are acutely suicidal or homicidal, psychotic, bipolar, or mentally retarded, or for adolescents who are actively abusing substances.

Scientific Rating 3

Stressbusters

Stressbusters is a 10-session intervention designed to reduce depressive symptoms and improve coping and functioning in children. The intervention combines group cognitive-behavioral therapy with family education.

Scientific Rating 3

Programs

Blues Program

The Blues Program is a brief manualized cognitive-behavioral prevention intervention for high school-aged adolescents with elevated depressive symptoms. The program consists of 6 weekly 1-hour group sessions and home practice assignments. Weekly sessions focus on building group rapport and increasing participant involvement in pleasant activities (all sessions), learning and practicing cognitive restructuring techniques (sessions 2-4), and developing response plans to future life stressors (sessions 5-6). In-session exercises help participants learn the program skills. Home practice assignments aim to reinforce the skills taught in the sessions and help participants learn how to apply these skills to their daily life.

Scientific Rating 2

Interpersonal Psychotherapy-Adolescent Skills Training

IPT-AST is a group-indicated prevention program that is based on Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) and its group adaptation. The intervention involves two initial individual sessions and eight weekly 90-minute group sessions. The group focuses on psychoeducation and general skill-building that can be applied to different relationships within the framework of three interpersonal problem areas: interpersonal role disputes, role transitions, and interpersonal deficits. The psychoeducation component includes defining prevention, educating members about depression, and discussing the relationship between feelings and interpersonal interactions. The interpersonal skill-building component consists of two stages. First, communication and interpersonal strategies are taught through didactics, activities, and role-plays. Once group members understand the skills, they are asked to apply them to different people in their lives, practicing first in group and then at home.

Scientific Rating 2

Primary and Secondary Control Enhancement Training

PASCET is a structured individual psychotherapy intervention for depression. Treatment sessions and take-home practice assignments are built on research findings concerning cognitive and behavioral features of depression in children and adolescents, and on the two-process model of perceived control and coping. As suggested by that model, children are trained to gain control of their mood by developing skills that will help them cultivate primary control (i.e., changing objective conditions to make them fit their wishes) and secondary control (i.e., changing themselves [e.g., their expectations, interpretations] so as to adjust to objective conditions and thus control their subjective impact). The sessions include within-session exercises and take-home practice (i.e., homework) assignments, guided by an ACT & THINK Practice Book that each child uses throughout the program, and keeps afterward.

Scientific Rating 2

ACTION

ACTION is a developmentally sensitive group treatment program for depressed youth that follows a structured therapist's manual and workbook. Each of the 20 group and 2 individual meetings lasts approximately 60 minutes. The child treatment is designed to be fun and engaging while teaching the youngsters a variety of skills and therapeutic concepts that are applied to their depressive symptoms, interpersonal difficulties, and other stressors. Skills are taught to the children through didactic presentations and experiential activities. The skills are rehearsed during in-session activities and are applied through therapeutic homework. Skills application is monitored and recorded through completion of workbook activities, and completion of the therapeutic homework is encouraged through an in-session reward system. In general, the first nine sessions focus primarily on affective education and teaching coping and problem-solving skills. Sessions 10–19 focus primarily on learning and applying cognitive restructuring as well as continued use of previously learned strategies. Beginning with the 11th meeting and continuing through the 20th meeting, children work to improve their sense of self.

Scientific Rating 3

AFFIRM Youth

AFFIRM Youth is an eight-session, manualized affirmative cognitive-behavioral group intervention. It is designed to reduce depression and improve coping skills and self-efficacy for LGBTQ+ youth. Using a trauma-informed approach, AFFIRM Youth is tailored to the experiences of LGBTQ+ youth and provides them opportunities to develop identity cognition (e.g., self-awareness, identifying risk), mood (e.g., recognizing the link between thoughts and feelings), and behavior (e.g., identifying strengths and ways of coping), as well as equipping them with the tools to self-manage their mental health.

Scientific Rating 3

Adolescent Coping With Depression Course

The Adolescent Coping With Depression Course (CWD-A) is a cognitive-behavioral group intervention that targets specific problems typically experienced by depressed adolescents. These problems include discomfort and anxiety, irrational/negative thoughts, poor social skills, and limited experiences of pleasant activities. The CWD-A consists of 16 two-hour sessions that are conducted over an 8-week period for mixed-gender groups of up to 10 adolescents.

Core components of the program include:

  • Cognitive-Behavioral Therapy (CBT) model of change
  • Mood monitoring
  • Increasing pleasant activities (behavioral activation)
  • Social skills training
  • Relaxation training
  • Identification of negative thoughts and cognitive restructuring
  • Communication and problem-solving training
  • Relapse prevention

Each participant receives a workbook that provides structured learning tasks, short quizzes, and homework forms. To encourage generalization of skills to everyday situations, adolescents are given homework assignments that are reviewed at the beginning of the subsequent session.

Scientific Rating 3

Attachment-Based Family Therapy

ABFT is an attachment-based, trauma-informed, emotion-focused intervention for youth with suicide, depression anxiety, and/or trauma. Treatment strengthens secure parent-child relationships which can reduce family conflict and buffer against stress. The model is structured yet flexible, requiring therapists to be focused as well as emotionally attuned. Treatment is constructed around five tasks:

  • The Relational Reframe task helps families focus on relationship repair as the initial goal of therapy.
  • The Adolescent Alliance task helps link current distress to attachment ruptures and prepares the adolescent to talk about this with caregivers.
  • The Parent Alliance task focuses on reducing caregiver distress, increasing empathy, and improving parenting skills.
  • The Attachment Task brings the family members back together to discuss these attachment ruptures. This helps families resolve problems and practice new interpersonal and affect regulation skills.
  • As trust reemerges, therapy focuses on Promoting Autonomy task, wherein caregivers help promote adolescent autonomy and competency outside the home.

ABFT is generally delivered in weekly sessions for 12-16 weeks.

Scientific Rating 3

Interpersonal Psychotherapy for Depressed Adolescents

Interpersonal Psychotherapy (IPT) is a time-limited, manualized psychosocial treatment for depression in adolescents and adults. IPT for adults has been rated by the CEBC in the area of Depression Treatment (Adult). IPT identifies how interpersonal issues are related to the onset or maintenance of depressive symptoms while recognizing the contributions of genetic, biological, and personality factors to vulnerability for depression. Patients work to understand the effects of interpersonal events on their mood and to improve their communication and problem-solving skills in order to increase their effectiveness and satisfaction in current relationships.

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is defined in a treatment manual that was adapted to address the developmental needs of adolescents and their families. IPT-A is an outpatient treatment designed for adolescents with mild to moderate depression severity. It is not indicated for adolescents who are acutely suicidal or homicidal, psychotic, bipolar, or mentally retarded, or for adolescents who are actively abusing substances.

Scientific Rating 3

Stressbusters

Stressbusters is a 10-session intervention designed to reduce depressive symptoms and improve coping and functioning in children. The intervention combines group cognitive-behavioral therapy with family education.

Scientific Rating 3