Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Karen Burritt PhD, RN

Second Advisor

Patricia Thomas, PhD

Third Advisor

Carrie Mull, DNP


Introduction: Depression and anxiety are chronic recurring medical conditions that impact all aspects of health. When depression and anxiety are present with other comorbid diseases, mortality and health care costs are higher. Children and young adults are particularly vulnerable to mental health issues. Suicide is the 2nd leading cause of death for this demographic. Depression is common in adolescents with an incidence of 8 to 20 percent. Primary care provides 70 percent of mental health care in the United States, and the primary intervention offered is pharmacological. Evidence suggests that a combination of medication and psychotherapy provide superior relief of depression and anxiety compared to either therapy alone. Additionally, integrating standardized behavioral health into primary care has been shown to be superior to usual care.

Objectives: The purpose of this proposal is to evaluate a short-term cognitive behavioral therapy (CBT) intervention to improve mental health outcomes in the primary care setting

Methods: The framework for this intervention was the Chronic Care Model. Six providers in a primary care clinic will be trained on a CBT intervention called Creating Opportunities for Positive Empowerment (COPE). The COPE intervention will be evaluated using patients’ pre and post scores on psychometric tests, patient satisfaction, provider satisfaction, and COPE visit reimbursement.

Results: Depression and Anxiety scores will improve compared to baseline. COPE implementation will be satisfactory to providers and patients, and the organization will successfully receive reimbursement for COPE visits.

Conclusions: Short term CBT methods like COPE are feasible for providers to implement in a primary care setting. COPE will be viewed as a valuable tool for providers to use to impact patient anxiety and depression. COPE can be successfully integrated into primary care in a financially sustainable manner.

Implications: Integrated mental health care into the primary care setting results in superior care to usual care.