Core Components

Adolescent Coping with Depression (CWD-A) is a group based psychoeducational, cognitive-behavioural intervention that targets specific problems typically experienced by depressed adolescents aged 14-18 years, including discomfort and anxiety, irrational or negative thoughts, poor social skills and limited experiences of pleasant activities. CWD-A aims to reduce current depressive symptoms, support remission from current depressive disorders and improve psychosocial functioning. The programme is delivered by trained mental health professionals and comprises 16, two-hour sessions, undertaken twice per week over 8 weeks for mixed gender groups of up to 10 adolescents. The programme is typically delivered as an after-school programme, in outpatient clinics or in community-based services.

The intervention is clearly operationalised with a well-structured detailed Leader's Manual which provides scripted lesson plans for each session and a Student Workbook which is also comprehensive and integrated with the lesson plans in the Leader's Manual. The workbook contains brief readings, structured learning tasks, self-monitoring forms, homework assignments, and short quizzes. Topics covered in the sessions include (1) Mood Monitoring (2) Social Skills (3) Pleasant Activities (4) Relaxation (5) Constructive Thinking (6) Communication (7) Negotiation and Problem Solving and, (8) Life Planning and Maintaining Gains using several different teaching methods such as lectures, discussions, role-playing exercises and homework assignments.

The parents of the adolescents are encouraged to participate in the programme to help foster and maintain positive changes in the adolescents' moods. An adjunct parent programme is available to support this which comprises of nine, 2-hour sessions held weekly on the same night as the adolescent group. Parents are given an overview of the skills and techniques that are taught to their adolescents to promote parental acceptance and reinforcement of their teenagers’ positive changes. Most of the sessions are delivered separately, however, two of the sessions which focus on practising problem solving and negotiations skills are undertaken jointly.

Fidelity

CWD-A follows a structured format and in order to effectively replicate the programme CWD-A requires:
1) Training of group leaders
2) Adoption of a CWD-A therapist manual (Group Leaders) to ensure protocol Adherence
3) Review of sessions adherence and general competence using general competence rating scales
4) Supervisor review of video/audio recordings
5) Implementation of the CWD-A workbook for adolescents or parents available.

Modifiable Components

CWD-A is designed to be delivered to groups of adolescents, other variations are possible depending upon the situation and related goals. With some modification, the course can be used on an individual basis with depressed adolescents and/or in conjunction with other types of treatment (e.g., individual psychotherapy, medications, etc.), with special populations such as adolescents with serious reading problems, or with nondepressed teenagers as a preventive programme.

Adolescent Coping with Depression (CWD-A) was developed by researchers at the Oregon Research Institute and the Kaiser Permanente Center for Health Research in Oregon, USA.

Support for Organisation / Practice

Implementation Support

Support is provided to implementing agencies in the form of a training DVD-rom entitled “Mastering the Coping Course” which can be accessed online.

Licence Requirements

A license is not required to deliver CWD-A.

Start-up Costs

The CWD-A training DVD is available at a cost of $249, the CWD-A Leader manual and Adolescent workbook are available to download online at no cost.

Building Staff Competency

Qualifications Required

Group Leaders are required to have relevant experience and training before offering the course and are typically mental health professionals such as psychologists, psychiatrists, psychiatric social workers and psychiatric nurse practitioners/counsellors with a master’s degree. Individuals who are not adequately trained for independent practice e.g. students and teachers who do not have a mental health background, can only conduct the course under the supervision of a mental health professional.

It is also recommended that group leaders have relevant training and experience in:

• Crisis assessment and intervention especially with suicidal or substance abusive youths;
• Assessment of affective and nonaffective disorders;
• Basic or intermediate training in cognitive-behavioural therapies;
• Experience leading psychotherapeutic groups;
• Familiarity with basic relaxation techniques;
• Experience using behavioural techniques to manage conduct problems in adolescents;
• A developmental perspective regarding the cognitive and emotional changes that take place during adolescence;
• Familiarity with the social learning formulation of depressive disorders.

Training Requirements

Training on the CWD-A programme is suggested but not required and is available by the DVD-rom. The DVD-rom provides a step-by-step unique, personalised training experience for educators and mental health professionals who want to improve their skills in helping depressed adolescents.

Supervision Requirements

It is recommended that new leaders receive regular weekly or bi-weekly local clinical supervision to discuss the therapeutic issues that are not explicitly addressed in the Leader’s Manual.

Theory of Change

Adolescent Coping with Depression (CWD-A) is based upon Bandura’s social learning theory analysis of depression with the second theoretical foundation specifically addressing actions, feelings and thoughts that have been shown to be functionally related to depression. The programme aims to teach depressed patients to modify their social behaviour to significantly improve their depressed mood.

Values

Adolescent Coping with Depression (CWD-A) uses psychoeducational and cognitive behavioural therapy (CBT) approaches to support adolescents to reduce their symptoms of depression.

• Does supporting adolescents to reduce their symptoms of depression using a CBT approache fit with the key values of your organisation?

Priorities

Adolescent Coping with Depression (CWD-A) is a group intervention for young people aged 14 – 18 years old. It aims to reduce current depressive symptoms, support remission from current depressive disorders and improve psychosocial functioning in adolescents.

• Is a group intervention for adolescents aimed at improving their depressed mood and improving their social functioning a priority for your organisation?

Existing Initiatives

• Does your service already provide CBT treatment programmes that aim to reduce symptoms of depression in adolescents?
• Does your area have practitioners trained in delivering the CWD-A programme?
• Do you have links with CAMHS, Adult Mental Health Services and Child Protection Services to refer onto if required?

Workforce

To deliver Adolescent Coping with Depression (CWD-A) requires a trained group leader who is a mental health professional. Group leaders should have relevant experience and training and are typically mental health professionals such as psychologists, psychiatrists, psychiatric social workers and psychiatric nurse practitioners/counsellors with a master’s degree. Teachers who do not have a mental health background, can only deliver CWD-A under the supervision of a mental health professional.

• Do you have enough qualified mental health professions available to commit to undertake training to become a Group Leader?

Delivery of CWD-A is to groups of up to 10 adolescents over 16, two-hour sessions. Sessions take place twice per week over 8 weeks.

• Do you have enough qualified mental health professionals available to commit to delivering the full extent of this programme?

Technology Support

Minimal technology support is required to deliver CWD-A. The online manual and workbook require downloading and printing via web access on a computer and printing and photocopying facilities.

• Do you have access to adequate technology to support group leaders to effectively deliver the technological components of the programme?

Administrative Support

Administrative support is required to market the programme and recruit participants.

• Do you have enough administrative capacity these administrative needs?

Financial Support

To deliver CWD-A, purchase and review of the DVD-rom is suggested at a cost of US$249.

• Do you have the finances to purchase the training DVD-rom?

Comparable Population

Adolescent Coping with Depression (CWD-A) is designed for all adolescents aged 14-18 years across the full range of socio-economic levels suffering with clinically significant symptoms of depression or diagnoses of major depression. Evidence of its effectiveness included children aged 13 to 18 years in Oregon.

• Is this comparable to the population you serve?
• Does your organisation have existing contacts with this population?
• Are you likely to receive enough referrals/demand for eligible adolescents to populate a recurring programme of CWD-A?

Desired Outcome

CWD-A aims to reduce current depressive symptoms, support remission from current depressive disorders and improve psychosocial functioning in adolescents. Research has identified that CWD-A is effective in reducing depression scores, improving targeted behaviours and social functioning, and reducing parent-adolescent conflict.

• Is reducing symptoms of depression in adolescent’s desirable outcome for your service?
• Does your organisation have other initiatives in place the effectively and efficiently address the above outcomes?