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BACKGROUND: Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. AIMS: To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. METHOD: Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. RESULTS: Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. CONCLUSIONS: C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents.

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INTRODUCTION: The 1 year prevalence of depression in adolescents is about 2%. Treatment with antidepressant medication is not recommended for initial treatment in young people due to concerns over high side effects, poor efficacy and addictive potential. Evidence suggests that cognitive behaviour therapy (CBT) is an effective treatment for depression and is currently one of the main treatment options recommended in adolescents. Given the affinity young people have with information technology they may be treated effectively, more widely and earlier in their illness evolution using computer-administered CBT (CCBT). Currently little is known about the clinical and resource implications of implementing CCBT within the National Health Service for adolescents with low mood/depression. We aim to establish the feasibility of running a fully powered randomised controlled trial (RCT). METHODS AND ANALYSIS: Adolescents aged 12-18 with low mood/depression, (scoring ≥20 on the Mood and Feelings Questionnaire (MFQ)), will be approached to participate. Consenting participants will be randomised to either a CCBT programme (Stressbusters) or accessing selected websites providing information about low mood/depression. The primary outcome measure will be the Beck Depression Inventory (BDI). Participants will also complete generic health measures (EQ5D-Y, HUI2) and resource use questionnaires to examine the feasibility of cost-effectiveness analysis. Questionnaires will be completed at baseline, 4 and 12-month follow-ups. Progress and risk will be monitored via the MFQ administered at each treatment session. The acceptability of a CCBT programme to adolescents; and the willingness of clinicians to recruit participants and of participants to be randomised, recruitment rates, attrition rates and questionnaire completion rates will be collected for feasibility analysis. We will estimate 'numbers needed' to plan a fully powered RCT of clinical and cost-effectiveness. ETHICS AND DISSEMINATION: The current trial protocol received a favourable ethical opinion from Leeds (West) Research and Ethics Committee. (Reference: 10/H1307/137). TRIAL REGISTRATION NUMBER: ISRCTN31219579.

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BACKGROUND: "Stressbusters" is an interactive computer software programme based on a clinically effective face-to-face CBT protocol for young people with depression. It was designed for teenagers with mild to moderate depression, and comprises eight 45-minute sessions. METHOD: Twenty-three young people (aged 12-16; mean age 14.87 years) with symptoms of depression were recruited from CAMHS teams in Manchester and London, and received the Stressbusters treatment (range 1 - 8 sessions, mode 8 sessions). RESULTS: On the K-SADS at initial assessment, 95% met diagnostic criteria for a depressive disorder, with a high group mean score of 35.48 (SD 9.84) on the MFQ. Post-treatment, 22% of young people met criteria for a depressive disorder, with the group mean score on the MFQ falling significantly below clinical cut-off to 20.32 (SD 11.75). These gains were maintained at 3-month follow-up. Significant improvements were also found in the adolescents' global functioning (CGAS), self-reported anxiety (RCMAS), depressive cognitions and attributions (ATQ and CTI-C), and in adolescent- and parent-reported emotional and behavioural difficulties (SDQ). CONCLUSIONS: Taken together, these results provide promising preliminary data for the clinical efficacy of Stressbusters as a valid form of CCBT for adolescents with depression.

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Behaviour problems make up approximately 30-50% of all referrals to child and adolescent mental health services. Behavioural parent training is one of the most effective interventions for young children. However, those families most at risk of difficulties fail to access services. This paper outlines the Children And Parents Service (CAPS), a citywide multi-agency, early intervention service to young children and their families. The intervention includes parent training groups, multi-agency training and liaison in community settings. The model of service delivery is outlined and the obstacles to service implementation and the strategies used to overcome them are discussed. The service has adopted a well validated evidence-based model of parent training, monitoring of outcomes and user involvement, and is delivered in the wider context of multi-agency systems. A thorough evaluation of service delivery models, including CAPS, would be beneficial. Whilst research trials examine the efficacy of treatments, the effective delivery of treatments within clinical services requires clarity about the place of the intervention within wider systems. The CAPS model proposes a framework for delivering interventions within these systems.

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PROBLEM: A number of interventions are effective in treating older children with internalizing symptoms. However, little is known about the efficacy of psychological interventions in treating younger children. This study examined the impact on internalizing symptoms of a parenting skills training program. METHODS: Forty-three parents took part in a parenting skills training program. Externalizing and internalizing behaviors were measured before and after treatment and after a 6-month period. FINDINGS: Externalizing symptoms fell after treatment. Interestingly, internalizing scores fell to an approximately equivalent degree. CONCLUSIONS: An intervention targeted towards parenting may be efficacious in the treatment of children's internalizing symptoms.

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OBJECTIVE: To test the hypothesis that depressed adolescents given brief cognitive behaviour therapy by trained social workers will be less depressed after this treatment than depressed adolescents who have routine care from their social workers. METHOD: Open study, two randomized parallel groups. 86 social workers were randomized to training in brief CBT or delayed training by remote telephone randomization. 25 social workers who attended CBT training recruited 29 depressed adolescents. 22 social workers in the control group recruited 23 depressed adolescents. RESULTS: Social workers' perceptions of their knowledge and skills in dealing with adolescent depression were better after the training than before. However, in intention to treat analyses, adolescents who had therapy from trained social workers had a similar level of depression post treatment (mean depression score 17.5, 95% CI 11.8 to 23.3) to those who did not have such therapy (mean depression score 16.7, 95 % CI 11.3 to 22.1). There were no significant differences between the groups on other outcomes or at follow-up. CONCLUSIONS: This study failed to recruit enough cases and probably did not therefore have enough statistical power to detect an effect of the intervention. It was also based on a severely impaired sample with many comorbid problems. However, the results suggest that training community-based social workers in cognitive behaviour therapy is neither practical nor effective in improving the outcomes of their clients.

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BACKGROUND: Asthma continues to be a common childhood chronic illness managed principally in primary care. Self-management requires co-ordinated efforts of young people, carers and health professionals. Non-compliance occurs even when parents are supervising care, suggesting that decisions are made on the basis of beliefs that contrast with professional advice. Health professionals therefore need to understand the views of parents (or other carers) and patients to promote good self-management. Little attention has been given to carers' and young people's perspectives on asthma. AIM: To gain insights into the beliefs of a group of 25 young people aged nine to 16 years old and their carers about asthma and its management. DESIGN OF STUDY: Qualitative study using conversational-style interviews. SETTING: Generally deprived urban areas of Greater Manchester. METHOD: Interviews were conducted with 25 young people with asthma and separately with their carers. The interviews were analysed using the principles and procedures of grounded theory. RESULTS: Carers reported assessing asthma symptoms through observed effects on the child and other family members, including emotions and behaviours that disrupted family life. Young people emphasised the effect of asthma on their everyday lives and in particular the extent to which they appeared different to their peers. Some young people reported continuing symptoms and restrictions of activity that differed widely from the reports of their carers. CONCLUSION: Differences between young people's and carers' criteria for assessment suggest explanations for some 'non-compliant' behaviour. Carers' assessment of asthma severity through the absence of acute attacks is consistent with managing asthma as intermittent acute episodes. Professionals should take account of differences between young people's, carers' and professionals' perceptions of asthma.

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BACKGROUND: Despite the frequently reported association between maternal depression and childhood psychopathological disorder, few studies have attempted to intervene with both conditions. AIMS: To evaluate the effect of group cognitive-behavioural therapy (CBT) on child behaviour problems and maternal depression in a group of women with young children. METHOD: An assessor-masked, randomised placebo-controlled trial compared three treatments: CBT for depression and parenting skills enhancement; a mothers' support group; and no intervention. An epidemiological (general population) sample was recruited. RESULTS: Analysis showed no significant difference between the groups. Within-group comparison suggested that at the end of treatment and at 6-month and 12-month follow-up, child problems and maternal depression had improved significantly in the CBT group. CONCLUSIONS: There was no statistically significant difference between groups. Both contact interventions seemed to provide some benefits to mothers with depression, with a possibly improved outcome resulting from CBT for children with behavioural problems. The results must be treated with caution.

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