Treating adolescent depression in multi-professional school health and welfare services with IPC-A: Implementation results from a national pilot trial

Background: Implementation of research-based interventions for adolescent depression to primary level services is important, given the need for treatment among depressive youth. Knowledge of factors facilitating or hindering implementation in multiprofessional school health and welfare services (SHWS) is needed.
Method: A national pilot project implemented IPC-A to SHWS in upper secondary schools of Espoo in 2016-2017. Fifty-five professionals (psychologists, social workers, nurses), 28 delivering IPC-A and 27 comparison intervention, were trained in the first year. Process and individual level implementation variables, and trainees’ clinical IPC-A skills were examined with basic statistical methods and qualitative analyses.
Results: Over half of adolescents were identified by nurse referral, 24% self-referred and 22% had been advised to seek support by teacher/friend. No additional cross-profession referrals were observed. Adolescents reported equal rates of interpersonal/family-related (49%) and emotional (51%) problems when specifying the reason for needing help. SHWS professionals reported multiple roadblocks in introducing the new intervention to the school context, including identifying adolescents with severity of symptoms targeted by the intervention, assessing depression and time constrains. Those providing comparison intervention without a specified model, supervision or support perceived it as difficult. As implementation facilitators, SHWS professionals relied on health checks, screenings and informing teachers and other professionals. Professionals trained in IPC-A delivered on average one IPC-A intervention per year, those delivering comparison interventions even less. IPC-A counsellors self-reported mastery of most IPC-A delivery skills in their first interventions. They experienced IPC-A as widely beneficial for adolescents and themselves as professionals. Supervisors’ assessments of counsellors’ competence indicated that delivery skills related to basic principles of IPC-A were relatively well mastered, but skills related to specific IPC-A techniques were inconsistent and poorly mastered.
Conclusion: Implementation efforts should take into account issues related to identification and assessment of mental health disorders. Inconsistent mastery of IPC-A intervention skills by trainee counsellors suggests that a systematic approach to clinical training and supervision, and protected time for professionals to learn skills are of key importance.