This team of adolescent depression specialists is proof that research expertise comes from all career stages

Dr. Darren Courtney and Dr. Bahar Amani

When Gray Liddell first engaged with the CARIBOU care pathway for adolescent depression as a patient, it was hard for them to imagine being a central part of its future development.

Four years later, the 20-year-old is a Youth Engagement Specialist with the Centre for Addiction and Mental Health (CAMH) team driving its proliferation across Ontario and nationwide.

“The transition from patient to employee is a very unique perspective to have, CARIBOU is something that has largely been a part of my life in many different ways,” they said.

“As a youth who has experience with mental health issues and going through that process of reaching out to get help, I’m optimistic about all this great research and adolescent treatment being funded. Even though the numbers may report that rates are increasing, I think we are working towards being able to treat adolescent mental health issues better. We have a more positive approach and understanding of them.”

Building on CARIBOU for the future of young Canadians

Liddell works on a team led by Dr. Darren Courtney, a clinician scientist and psychiatrist in youth addictions and concurrent disorders with CAMH. Much of the team’s current work focuses on two research projects centered around youth depression and the CARIBOU-2 (the latest iteration) pathway. Both projects are supported by the CIHR Institute of Neurosciences, Mental Health and Addiction (CIHR-INMHA) through its Catalyst Grant: Standards for Children and Youth Mental Health Services.

“When I got into independent practice, I realized that there's a lot of gaps in the literature about how to deliver high quality care for adolescents presenting with a variety of mental health concerns,” Dr. Courtney said.

“I think it's important to acknowledge there's a need, but I also want to make sure there's a message of hope.”

One of his current projects, CARIBOU Across Canada: Do mental health organizations have the need, fit and capacity to deliver an Integrate Care Pathway for the treatment of depression in adolescents?, explores the viability of expanding the seven-step CARIBOU-2 pathway to other Canadian jurisdictions.

Dr. Courtney and his team developed the depression care pathway using recommendations from the United Kingdom's National Institute for Health and Care Excellence (NICE) guidelines as reference. After a successful pilot study, the CARIBOU-2 pathway is currently being examined in a  larger controlled trial in four community mental health agencies across Ontario.

"The pathway is intended to facilitate the delivery of evidence-based care," Dr. Courtney explained.

"Now, we're looking at whether there is a match between the CARIBOU-2 pathway and service delivery models in other provinces."

Dr. Bahar Amani, a scientific associate on CARIBOU-2, manages the coordination between co-investigators in British Columbia, Alberta and Quebec who engage with staff and youth partners from various mental health centres in their respective provinces.

"I think what's been really important in our work and with all of Darren's work has really been integrating youth perspectives," she said.

"It's very important for us to listen and learn from youth about the best way of sending research measures out, what kind of language to use, and how we can make things easier for them to match with their lifestyles. It's important to meet youth where they're at."

Liddell agrees.

"They're going through a very critical period of their life," they said.

"Adolescence is hard, man. Reaching out for help in general is hard."

How important is fidelity in CBT?

The team’s other CIHR-INMHA-supported project, Fidelity and Skill Use in Cognitive Behavioural Therapy [CBT] for Adolescents with Depression, explores the relevance of fidelity (adherence to defined standards or processes) in the delivery of CBT, a key component of the CARIBOU-2 pathway.

“A co-investigator on our team has found a lot of variability in terms of what a youth with depression will receive depending on which agency they go to,” Dr. Courtney explained.

“Some people are getting CBT-like or CBT-informed treatment, some people are getting something that's not CBT at all. That variability is a barrier to making sure people have access to evidence-based care.”

“There's a lot of discussion amongst therapists around how rigidly or flexibly CBT should be delivered and whether the principles should be applied in an eclectic fashion, combining concepts from other therapy types . Ultimately, what we're trying to do is see that the youth who are seeking care are getting the best possible care.”

This project will include data collected from a subset of adolescents who participate in a 16-week modular CBT program as part of their treatment in the larger CARIBOU-2 trial.

“I like the focus on developing and testing interventions that are eventually going to be scalable in communities,” Dr. Amani noted.

"There's a lot of focus on great evidence-based treatments delivered within these research-intensive mental health hospitals, but these aren't necessarily accessible to a lot of people since a lot of youth are receiving care in communities. This is what really drew me to work with this team.”

Driving factors for change

The trio all emphasize a positive outlook on the future of adolescent mental health in Ontario. It’s particularly motivating for Dr. Amani and Liddell, who are both early in their careers.

“I want to work with children and adolescents in a refugee context, and this work is helping to create a bridge between research and evidence-based interventions in communities,” Dr. Amani said.

“Getting these interventions into communities would help us ensure that those youth who are newcomers and refugees are able to access evidence-based and effective treatments.”

Liddell is currently in their second year of a social science degree at McMaster University.

“The experience from when I was a teenager and first getting involved with CAMH as a patient, and now being a young adult in university, the stigma even between those four years has changed for the better,” they noted.

“With my generation specifically, we are more open to talk about things and there's more opportunities for us to get involved in these fields.”

“There's so much work that can be done with youth mental health, and there's so many opportunities to go above and beyond in research projects like this. Opportunities like these motivate me every single day.”

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