Date of Award

12-2012

Degree Type

Dissertation

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

Abstract

Depression among adolescents is underidentified and undertreated due to challenges within mental health systems and primary care settings, resulting in poor outcomes. This project expanded the role of the pediatric nurse practitioner in primary care by redesigning the way depression in adolescents was detected and treated. An evidence-based, 7-session with homework, manualized cognitive behavioral intervention, named “Creating Opportunities for Personal Empowerment” (COPE) curriculum, was implemented in a primary care practice in a Midwestern city. Beck’s Cognitive Model and the Chronic Care Model were used to guide this intervention. A convenience sample of 10 adolescents, 9 female and 1 male, between the ages of 14-18 was used. Attrition and recruitment were difficult as two participants completed the intervention, five attended a portion of the sessions, and three participants did not attend any sessions following the consent process. Outcome measures included improvement in depression related outcomes as measured by the PHQ-9 and the Youth Self Report, adolescent satisfaction with care received as measured by the Youth Client Satisfaction Questionnaire, and a qualitative measure of pediatric primary care provider satisfaction. The participants who either attended a portion of the sessions or did not attend any sessions scored higher on pre-intervention depression measures than those who completed the intervention. Particularly, the participants who attended only a portion of the sessions reported difficulty in the area of sleep. This project confirms difficulties delivering appropriate care to depressed adolescents. Doctor of Nursing Practice roles in the areas of expert clinician, advocate, leadership, scholarship, and education can inform future interventions for this vulnerable population.

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