Exemplars 10

A Novel Approach

School of Social Work

Along with school social workers, teachers, and parents, David Roseborough, professor in the School of Social Work, finds success in the prevention and treatment of depression in youth.

Since completing a Master of Social Work (M.S.W.) at the University of St. Thomas in 1996, I have practiced as a clinical social worker and psychotherapist for the last 13 years at two community mental health centers. While I see primarily adults, I have had the privilege of working among and learning from child and adolescent therapists. I have seen them do excellent work and change lives for the better. I have been struck by how much child and adolescent work is preventive and by how wonderfully open so many of these clients are. Progress with young clients can be fast and dramatic. The human brain is in many ways malleable for all of us, but particularly so for children and adolescents. I often found myself thinking about how positive, early changes could carry forward into and have implications for their adult lives. (This is an idea sometimes referred to as “developmental continuity.”)

As practitioners, though, we would sometimes collectively wonder and remark, “What about the kids who don’t get help or who for any number of reasons don’t make it through the door to our agency?” This general sense was echoed in the findings of a recent national commission (The New Freedom Commission on Mental Health), which pointed out that the majority of children and adolescents referred to formal mental health services do not follow through. This happens for a number of concrete reasons and the document is worth a read for more context. But you can likely imagine: transportation, expense, and stigma all interfere, even with the best of intentions. This presidential commission recommended that mental health services for this age group be, when possible, brought to the schools.

It was in this context that I was approached by Shelley Theisen, a social worker in the Bloomington School District, who works with a committed and thoughtful group of school social workers. Shelley pointed to a treatment manual (you can think of this as a research-based instruction book) designed by people from the University of Michigan’s Schools of Social Work, Medicine, and Nursing. The manual outlined a cognitive behavioral approach (sometimes called “CBT”) to treating and preventing depression using a psychoeducational, group format. This approach was studied with a group of 60 children and adolescents in Michigan with good success. Shelley asked if I would help their team of social workers in this approach. I jumped at the chance.

In that capacity, I trained a skilled and invested social work staff in this cognitive behaviorally based treatment, which focuses on preventing and treating depression among adolescents, in a group format, in a school setting. A number of school social workers, with the help of counselors, teachers and parents, identified a group of students who they saw as at risk of being or becoming depressed. Students could self-refer as well.

We thought it would go well, but even we were surprised by the strength of this intervention. We were able to use the same measures that the University of Michigan study had used, which allowed our study to serve as a sort of replication (repeating a study with a different group helps us to gain greater faith in the initial findings. The social sciences often lack this kind of replication). We found that students, nearly without exception, made significant progress. Using empirical measures (the Beck Depression Inventory-II and others) we found that students made statistically and clinically significant change and found a large statistical treatment effect. Using a nine-month follow-up measure, we found that this change was maintained, even when accounting for seasonal variation. (Most psychotherapy research has historically lacked attention to follow-up or to whether changes are maintained). The students reported new friendships, a desire for the groups to continue, and not surprisingly, were not entirely sold on the value of the homework that was a part of this group.

We have gone on to present findings from this pilot study at the Minnesota Children’s Mental Health Association Conference (MCMHA) in Duluth, Minn. Social workers and school psychologists attended from school districts throughout greater Minnesota. We were able to orient them to this treatment manual and to our experience with it. Several expressed interest in offering a version of it within their own school settings. Social workers at the Bloomington district have gone on to offer the group to a larger number of students. They are also beginning to adapt it for younger (middle school age) students and even to offer a preventive model adapted for elementary or primary school age students. (This has become a fairly widespread phenomenon in both Australia and New Zealand where students are taught cognitive-behavioral principles as important “life skills” in the spirit of good public health as part of public schooling.)

I am very encouraged by what we found and am hopeful for and excited about the next steps this group is taking. Groups like this are important for a number of reasons, not only because–as the New Freedom Commission reminds us–many students are often not accessing services outside of the school but also because of the young age and rapid brain development that characterizes this age group. Addressing, treating, and ideally preventing depression (one of the costliest medical and psychiatric disorders in the world according to the World Health Organization) saves money and saves lives. Emerging research is consistently pointing to the importance of early treatment. Depression is often harder to treat the longer it goes untreated and chronic depression can literally, physically damage the brain. There are a lot of reasons to be optimistic for this young group and for the possibility of offering this nine-week curriculum to a larger group of students. Two graduate MSW students helped to analyze the data and wrote this study up in the form of their capstone research project for our program, a clinical research paper. These papers were presented publically as a form of dissemination. They helped us to get the word out. We are also in the process of writing up the results from this study to publish and to better establish this form of treatment in the academic literature.

David Roseborough
“Addressing, treating, and ideally preventing depression saves money and saves lives.”