Week 7: Assignment/ ABSTRECT

Use PICOT, discussion and assignment over last 6 weeks(plz see attachment) to answer question and to write assignment.

PICOT question: Use of sertraline versus sertraline with CBT (cognitive behavioral therapy) to treat depression in teenagers age 12-18 over a 1-year period of time. – Approved by Dr. S

Assignment Prompt

Points: 100 | Due Date: Week 7, Day 7 | CLO: 1 & 5 | Grade Category: Assignments

Assignment Prompt

Resource: 
Writing Scientific Abstracts (Purdue Owl)

The purpose of this assignment is to write an abstract for your capstone project. The function of an Abstract is to provide a brief, descriptive summary of the essay/report. The function of an Abstract is to inform the reader of the contents of the report /essay so that the reader can see in advance the key areas covered and the main points of the argument. An Abstract clearly states the purpose and direction, the main arguments and the conclusions reached. It is a mini version of the paper. If writing an investigative report which includes research findings, then it is usual to include in the Abstract the aims or objectives, methods, findings or results, conclusions and implications.

Your capstone abstract must be approved by the Capstone Advisor and or Faculty Chair before the final draft.

Keep these guidelines for abstracts in mind:

· Provides a professional, scholarly synopsis of the capstone project

· States the purpose of the capstone clearly and succinctly

· Provides a brief rationale for the capstone project.

· Describes the design and methodology of the main activities of the project

· Describes the expected results or the outcomes of the capstone.

· Provides a summary statement that shows the possible implication of the capstone project to student’s clinical practice setting or profession.

· Utilizes 250-300 words maximum, using 12 point font, either, Arial, Times New Roman, or Courier

Expectations

· Due: Monday, 11:59 pm PT

· Length: Maximum of 250-300 words

· Format: APA 7th ed.

· Research: At least one peer reviewed reference within the last 5 years

Week 7: POSTER FOR CAPSTONE

PICOT question: Use of sertraline versus sertraline with CBT (cognitive behavioral therapy) to treat depression in teenagers age 12-18 over a 1-year period of time. – Approved by Dr. S

Discussion Prompts

Points: 100 | Due Date: Week 7, Day 7 | CLO: 1 & 5 | Grade Category: Assignments

Assignment Prompt

Resource: Poster Template Example

Resource: Scientific Poster Design (Cornell U)

Resource: How to create an effect Poster Presentation (O. Sherman)

The purpose of this assignment is to create a poster that will present the visual and graphic presentation of the capstone project. Poster presentation should clearly articulate what you did, how you did it, why you did it, and what it contributes to your field and the larger field of human knowledge. This assignment is due in week seven and must be presented by the student.

Create your poster per guidance and approval from your capstone course faculty (template provided above). Follow the poster template as outlined and review the recommended resources in creating your poster.

What goals should you keep in mind to construct a poster?

· Clarity of content. Decide on a small number of key points that you want your viewers to take away from your presentation, and articulate those ideas clearly and concisely.

· Visual interest and accessibility. The viewers should notice and take interest in your poster so that they will pause to learn more about your project, and you will need the poster’s design to present your research in a way that is easy for those viewers to make easy sense of it.

From the capstone project, students will create an effective poster with the following information:

Title: Project Title

Authors: Your name, faculty advisor’s name

Background/Significance

Purpose or Aims of the Study

Methods/Design

Expected Results/Outcomes

Anticipated Conclusions

Potential Implications to Practice

Acknowledgements

Contact person: include email address

Expectations

· Due: Monday, 11:59 pm PT

· Length: One page

· Format: Poster Presentation

· Research: At least TWO peer reviewed reference within the last 5 years

EXAMPLE AND FORMATE/RUBRIC

Poster Title – USU Logo

Your name

Significance/Background: Briefly describe the problem you have identified. Include current statistics, relevant to the problem, peer reviewed articles supporting the problem. Explain if this problem has been occurring at your clinical setting

PICO-t: Describe problem, population, intervention, comparison, and expected outcomes and time that you would like to measure the results post intervention. Expand on your answer using support from evidence.

Aims of the Study – What are you planning to achieve with your study, short term and long term goals.

Design/Methods: Your peer reviewed articles support the design and methodology of your project

Proposed Interventions

How would you determine the effectiveness of the proposed interventions/treatments with the identified capstone problem?

Expected Results/Outcomes

Specify the expected outcomes that will result from the interventions that you will implement to solve the problem. The results or outcomes should be supported with the evidence based information from the peer reviewed articles that you have read

Anticipated Conclusions

Include what you have learned in the implementation of this project and will your project benefit your clinical setting/population

Potential Implications to Practice

The effect of your capstone project to the nursing profession and practice and humanities

References and contact information

Acknowledgement(s)

Template below (page 2)

Template for Poster

Create your poster using either PowerPoint or Google Slides. Below is an example of how to format your poster. In week 8, you will be required to add your poster to your final oral presentation. You can create this slide, or use the template below:

To download the template for your own editing use, you can do the following (you must be logged into your USU email account when accessing this document):

Click here to open the Google slide template:
Google Slide Poster Template

– LOOK AT THE SAMPLE ABOVE




Using Google Slides

If you want to use Google Slides to create your poster, open the template above. Click on File on the top menu bar, then click “Make a Copy”. Rename your copy then click Ok. To submit your poster, download your slide as a PowerPoint, then upload to the assignment submission drop box.

To convert to PowerPoint for submission: Click on File, then click “Download As”, then click “Microsoft PowerPoint.” This will open the slide in PowerPoint.

EVERYTHING FOR CAPSTONE PROJECT

PICOT question: Use of sertraline versus sertraline with CBT (cognitive behavioral therapy) to treat depression in teenagers age 12-18 over a 1-year period of time. – Approved by Dr. Silverman.

WEEK-2 DISCUSSION

Theoretical Framework or Models to Guide in Implementation of EBP

            Any capstone project should have a theoretical framework or model in place.  The chosen model is the intent-to-treat model, which is a strategy that analyzes the outcomes of a randomized trial in which the participants are enrolled. No consideration is given to whether or not a patient received the treatment they were randomized to receive, and all randomized subjects are included in the statistical analysis. When it comes to this model, noncompliance, deviation from protocol, withdrawal, and other events that occur after randomization are not taken into account; rather, this model evaluates each randomized participant according to their treatment assignment (Peterson et al., 2021). Both the original random treatment allocation and conservative effect are maintained in this new method. Each group’s randomly assigned patients are an essential component.

            Research on the effects of Sertraline on depressed adolescents aged 12 to 18 years and older in critical trials is necessary before drawing any conclusions about the relative merits of Sertraline and Cognitive Behavioral Therapy (CBT) (Peterson et al., 2021). Therefore, the intention-to-treat assessment is a strategy that requires a randomized trial in advance. All participants are evaluated using the original groups to which they were randomly allocated in a randomized study, regardless of the type of treatment offered. Researchers can reach precise conclusions regarding the effectiveness of an intervention using this strategy (Peterson et al., 2021). Since it compares the randomized CBT group to the sertraline group, the model matches the randomized trial.

            According to this approach, there is no doubt that the results are quantitative. Quantitative research are concerned with the development and testing of hypothesis, generating the model and theories that explain the behavior and generalizing  the result  across the many samples (Hoy & Adams, 2015).Sertraline and Cognitive Behavioral Therapy (CBT) are both used to treat depression in the targeted patients, hence the model is quantitative in nature. RCT studies are always quantitative, comparative, and controlled experiments in which the researchers’ study two or more interventions; for example, in this case, is the use of sertraline and CBT in a series of individuals (adolescents aged 12 to 18 years) who receive these treatments in random order.

Week 3 discussion

Discussion Question – Assessing Individual & Community Needs

When treating depression in teens, the effectiveness of antidepressant medicines like sertraline when used in conjunction with psychotherapy like cognitive behavioral therapy (CBT) is debatable, which is why the capstone study was done to see how well the two treatments were used worked together. Anxiety and depressive disorders are quite frequent among children and adolescents. My capstone research topic is based on various individual and/or community needs. Expectations that are too high in terms of school, friends, or family might lead to feelings of rejection and disappointment. Unfortunately, whether anything goes wrong at home or school, teens tend to overreact. Young people generally believe that life is unfair and that things do not always turn out for the best for them. There are angry and perplexed. There are a lot of contradicting signals coming from parents, peers, and society for teenagers. During adolescent years, teens are likely to be subjected to a variety of stressors that might worsen their melancholy. The onset of puberty sees substantial biological growth and development, but the biochemical and psychological changes are more challenging and less visible. These changes can overwhelm and affect an adolescent’s sense of where they fit into the world. Resulting behaviors and unpredictable emotional responses are confusing, but inevitably destabilise the family dynamic, even taking relationships to their breaking point. Teenagers can get involve in substance abuse like alcohol problem and marijuana. They are also For example, on television, in school, in publications, and on the Internet, teenagers are exposed to more of life’s ups and downs than ever before(Morgan, 2019).

Because the goal of CBT is to help people rediscover who they are as individuals, I think my study results will fulfill the stated teenager’s needs in the preceding paragraph. Using CBT, a patient may learn effective coping and self-recovery techniques that will serve them both immediately and in the long run. If you’ve been diagnosed with depression and have anxiety or a history of manic episodes, you may benefit from sertraline; an antidepressant used to treat such symptoms (Liu et al., 2021).

Week 4 discussion

Discussion Question – Implementing Evidence in Clinical Practice

The effectiveness of the proposed evidence-based intervention is achieved through the implementation process. Various activities are undertaken to ensure a successful implementation process. One of the activities will be to inform the stakeholders, such as nurses and other team members, about the need for change and how the proposed intervention will help in improving the overall health outcomes of the patients and how it can affect their practices. This is important in reducing the level of resistance encountered during the implementation. The data on the incidences of depression amongst the selected participants before the implementation will be collected to help in evaluating the effectiveness of the intervention (Liu et al., 2021). The next step is to gather the required resources and the team responsible for the implementation. The team include nurses, caregivers, family members, therapists, and the patients.

            The team is informed about the treatment approaches undertaken using both pharmacological approaches (sertraline) combined with the non-pharmacological approach (cognitive behavioral therapy). The teenagers of 12 to 18 years will be placed on medication, and nurses, caregivers, and family members will be informed about their roles in the implementation process. These stakeholders will help ensure that therapists are assisted in achieving the desired goal throughout the one year of implementation (Liu et al., 2021). They will collaborate to ensure that necessary changes or adjustments are made to achieve the desired goal. Once the targeted period elapses, the overall outcomes will be compared to the baseline data before the implementation process to determine whether there was a drop in the incidences of depression amongst teenagers of 12 to 18 years.

The Anticipated Challenges

            The anticipated challenges during the implementation can include the language barrier and challenges brought by the cultural differences since patients come from different ethnic and cultural backgrounds. The other challenge is the possibility of failure in the communication amongst the key stakeholders (Castaldelli-Maia et al., 2019). The other challenge that might be encountered is the resistance from some caregivers, such as nurses.

How to overcome the challenges

            The resistance from the nurses and other team members will be overcome by informing them earlier about the proposed intervention. They will be informed about the importance of the proposed intervention in addressing the issue of depression amongst the targeted population and how it will improve their work and satisfaction during service delivery (Castaldelli-Maia et al., 2019). A translator will be hired to help overcome the challenge associated with cultural barriers. Senior providers will be consulted throughout to help in understanding some of the cultural differences.

 

Week 5 discussion

Discussion Question – Evaluation and Linking Evidence-Based Practice to Clinical Outcomes

Mental health diseases are among the health issues that affect the well-being and health of the population. Various treatment approaches are adopted to help improve the symptoms caused by mental diseases such as depression. The treatment approaches to mental disease involve pharmacological and non-pharmacological interventions. According to David et al. (2018), combined therapy involving medicine and cognitive behavioral therapy (CBT) promotes the successful management of mental disease and the development of coping skills. According to Carpenter et al. (2018), the CBT approach helps manage mental disorders such as anxiety. It also helps address mental health issues such as panic disorders and post-traumatic disorder. It reduces the depressive symptoms as an independent strategy or when combined with other medications like antidepressants. Among many anti-depression medication project will concentrate on use of sertraline among teenager with depression and use of CBT in combination with sertraline.   

            Therefore, based on the above pieces of evidence, the implementation of the sertraline medication in combination with the cognitive behavioral therapy is expected to result in a reduction in the rates of the mental diseases like depression, improvement and full recovery of the patients, reduction in the negative thoughts such as suicidal ideation that are replaced by the positive behaviors, improvement in the thought patterns, improvement in the behaviors, and improvement in the ability to develop the coping strategies with the symptoms. 

            The success of the implementation is assessed to ensure that the intervention helps achieve the program’s objectives. The assessment also helps make the necessary adjustments to the activities or changes that ensure that the objectives are achieved. Therefore, the baseline data will be collected before the implementation. This data will be compared to the data generated after implementing sertraline and cognitive behavioral therapy (Lange, 2021). Therefore, the success of the program is assessed based on whether there is a reduction in the rates and severity of diseases reported, improvement in the behavior, thoughts, and an increase in the ability to cope with the symptoms of the mental illness such as depression.

     In order to evaluate the capstone project, author plan to check the patient’s outcome in specific timeline where author will be checking the symptoms relief or complete remission of the disease, how effective was the medication and or the medication plus the CBT. Author  also planning to check the accuracy off the research articles and to see if they were supported by evidence. Provided information on the treatment plan are aligns with the newer guideline for depression management as that can affect the outcome of the project. Author also planning to see the relevance of the articles to see if it’s not too advanced or elementary 

 

WEEK-6 discussion

Role of Outcomes in Evaluating Practice Change Through Research

The benefits linked to the process of evaluating the role of the outcomes within a practice change via research.

Various benefits are associated with evaluating the functions of the outcomes in the practice change through the research process. The evaluation leads to the enhancement of the chances that the objectives and goals of such initiatives are likely to be achieved. The evaluation process of the role of the outcomes in practice makes it possible to determine the value of the practice change in terms of money. For example, it is expected that the allocated resources will yield the greatest benefits for the customers and the stakeholders. Such evaluation procedures help identify the components of an initiative that do not work and the possible causes (Staley & Barron, 2019). In this case, it allows making an adjustment or improvement to ensure that the proposed practice change leads towards attaining the objective or goals it was intended for.

The procedure of evaluating the roles of the outcome via change practice from the research outcomes

         The effectiveness of the outcomes from the change practice is evaluated to determine whether they meet the objective or the goals of the intervention. One of the strategies used to evaluate the roles of the outcomes is asking the clinical questions. The development of the clinical questions helps find out whether the proposed intervention for the practice change helps in attaining the objectives from the clinical questions. Other strategies adopted to help evaluate the roles of the outcomes involve the collection of the best research literature to find the information about some of the effectiveness of the proposed intervention for the practice change (American Association of Nurse Anesthesiology, 2022). It is also important to use the critical appraisal approach of the evidence and effectively integrate the evidence using the critical expertise and the patient preferences.   

 

WEEK-1 ASSIGNMENT

Theory Logic Model for Depression Treatment Using Sertraline and Cognitive Behavioral Therapying in Teenager

Need or Problem to be Addressed using the program

The treatment of depression among teenagers between age 13-19 using Sertraline and sertraline with CBT.

The teenagers’ signs and symptoms of depression. These symptoms tend to be considered the normal part of the growth (Loades et al., 2021).

How to get better outcome weather to use only sertraline or sertraline with CBT.

Strategies proposed to address the need

Targets the early screening using different tools for teenagers’ depression as recommended by USPSTF for kids between 12-18(Mufson et al., 2022).

Choosing treatment using sertraline or CBT.

Using combination therapy with CBT and sertraline.

It helps meet the goals set by the United States Preventive Services Task Force (USPSTF), which proposes for early screening procedure (Mufson et al., 2022).

Context for the project/program

Depression is a major health concern for teenagers.

The United States Preventive Services Task Force (USPSTF) has recommended the ongoing screening procedure for depression in 12 to 18 years old within the primary care settings (Patra & Kumar, 2022).

First line therapy and only approved antidepressant is Sertraline (SSRI)(Moreland & Bonin, 2021). 

Effectiveness of treatment with only sertraline and conjunction with CBT.

The Expected Outcomes

The expected outcome is an increase in the number of patients visiting the facility for early screening for depression. And receiving relief from depression using sertraline or sertraline with CBT.

The other expected outcome is a reduction in the rates of teenagers’ depression or symptoms.

Theoretical foundation for depression treatment using sertraline and CBT in teen age 12-18

Factors that will influence the use of strategy

The implementation of the treatment tool for depression to help in the early screening and symptom management process is influenced by several factors:

Such as the level of willingness and cooperation amongst healthcare providers, patients and parents.

Availability of mental health support for in and outpatient mental health need. (Mufson et al., 2022).

The partnership between the primary care practice and the mental health practitioners is also important in more in-depth CBT and treatment hence improving the clinical utility of this recourses.

Evidence-based for the proposed strategies

According to Moreland & Bonin, (2021) Roughly 40 percent of children and adolescents with depressive disorders are not treated in USA

 Psychotherapy alone is used most often

Second choice is monotherapy

List use treatment is psychotherapy plus an antidepressant.

The resulting impact of the project if the outcomes are achieved

The program’s effect is the institution of the universal program for depression in teenagers of ages 12to 18 years.

The program will ensure effective implementation and use of the available treatment tools, thus lowering the symptoms and progression of depression.

WEEK-2 ASSIGNMENT

Theoretical Framework or Models for Evidence Based Capstone Project

The Key Features of The Selected Framework or Model and Its Major Components

The selected model is the intent-to-treat model, which is a method that involves the analysis of the outcomes in a prospective randomized study. There is inclusion of all the randomized study subjects into the statistical analysis and assessed according to the group they were originally assigned, without considerations of the treatments provided. The key feature of this model is that it considers every randomized participants according to the treatment assignment; it does not consider noncompliance, deviations in the protocol, withdrawal, and anything happening after randomization (Peterson et al., 2021). It also maintains the prognostic balance produced from the original random treatment allocation and estimates the conservative impact. The key component is the randomized patients in the groups randomly assigned.

The specific research strategy suitable for the use of the theoretical model and how it fits the intended project

The clinicians, institutions, and policymakers utilize the results from the randomized controlled trials to decide on therapeutic interventions for the population and patients. Comparing the Sertraline vs. Cognitive Behavioral Therapy (CBT) for the treatment of depression amongst teenagers 12-18 years and above requires knowing the effects of the intervention on these patients within critical trials (Peterson et al., 2021). Therefore, the intention-to-treat evaluation is a method that involves a prospective randomized study.

In the randomized study, the randomized participants become part of the statistical evaluation process and assessed based on the original groups that the participants were assigned, regardless of the type of treatment provided. This method is important as it enables a researcher to draw accurate conclusions about the effectiveness of the intervention (Peterson et al., 2021). The model, therefore, fits the randomized study since it compares the population randomized to sertraline vs. the randomized CBT.

Whether the model is quantitative or qualitative methods or both

This model involves a randomized control study; therefore, it is most certainly quantitative. The outcomes in comparing the use of sertraline vs. CBT for the treatment of depression in the targeted individuals are measured, thus making the model based on the quantitative method. The randomized control trial studies always tend to be quantitative, comparative, and controlled experiments whereby the investigators study two or more interventions; for example, in this case, is the use of sertraline and CBT in a series of individuals (teenagers of 12-18 years) who are receiving these treatments in the random order.

The quantitative methods that are most appropriate

The quantitative method for this method involves the experimental method that uses the sequential multiple assignment randomized trial (SMART). This method helps in successfully assessing whether the start of the CBT or sertraline medication appears to be more effective for improving the teenagers’ rated anxiety symptoms (main effect 1). Suppose the initial intervention does not cause a clinical remission within the specific period of one year. In that case, there will be an opportunity to evaluate whether maximum use of the initial treatment method alone or the addition of other methods while making maximum use of the first leads to the improvement of the symptoms within one year (main effect 2). The method also gives the chance to assess the stability of the treatment for more than one year after the completion of the one-year trial.

How the theoretical model might be used to assess the program or project and critique how well it fits the program

Appropriateness of Model for Program or Project

The intent-to-treat model helps in the assessment of the program. It helps compare the teenagers randomized to the sertraline vs. teenagers randomized to the CBT first. It allows assessing the treatment sequence that can be adapted to help treat the patient’s conditions, for example, whether the CBT-CBT-CBT-MED or the MED-MED-MED-CBT in non-remitters (Peterson et al., 2021). This helps predict whether there are significantly better or worse outcomes using the four treatment sequences compared to main effects alone, i.e., CBT or sertraline alone.

The method fits the program since it allows for analyzing the participants based on the randomized interventions that are consistent with the standard practice in clinical trials. It enables the research to provide the distribution of the outcomes using the graphically examined variable. The model is effective since it allows assessing the moderating impacts of the patients’ features on main effects 1 and 2 and on their interaction to help in the identification of the tailoring variables that can support the personalized interventions for the selection of the initial and subsequent sequencing of the treatment modalities for the teenager’s depression (McCoy, 2017). It is possible to find out the differential impacts of the proposed intervention, i.e., use of sertraline vs. CBT, on other patient-centered outcomes such as their well0being, the abilities in the school activities, the ability to cope with change, the adverse effects of the treatments, the comorbid psychiatric symptoms, the self-efficacy, satisfaction in life, well-being, family, social function, and the ability to regulate emotions.

WEEK-3 ASSIGNMENT

SCOT ANALYSIS

Strengths

· Adolescents may benefit from psychotherapy and pharmacotherapy since therapy provides them with life skills that will aid them in the future when they become adults (Stikkelbroek et al., 2020).

Using combined therapy , individuals may better understand and control their emotions and ideas by exploring their thoughts, beliefs, and behaviors

Weaknesses

· As a result, treatment effectiveness decreases and patients develop drug resistance more quickly when they are treated with psychotherapy and medication.

· Geographical limitations, therapist shortages, costs, the need for continued treatment, and therapy time consumption are all drawbacks (Liu et al., 2021).

Opportunities

· Although this sertraline is useful in treating teenage depressive symptoms, it is more effective when paired with CBT.

· Future treatment recommendations may be substantially altered if CBT is shown to have a more therapeutic impact through providing behavioral adjustments, rather than a short-term benefit of medication (Liu et al., 2021).

Threats

· Behavior and emotional problems have a high occurrence rate.

· As a result, some opponents say that CBT may not adequately address the probable underlying causes of mental health concerns, such as an unhappy upbringing (Stikkelbroek et al., 2020).

WEEK-4 ASSIGNMENT

Role and Engagement of Stakeholders Summary

The successful management of the mental health disorder requires effective treatment approaches. Various treatment approaches are used, including the pharmacological approach alone, the non-pharmacological or the psychotherapeutic and the combination of the two approaches (pharmacological and the non-pharmacological) (Liu et al., 2021). This paper offers a discussion on the role and the engagement of the stakeholders concerning the picot question focused on the use of the sertraline vs the sertraline with Cognitive behavioral therapy (CBT).

The roles of the stakeholders

The successful implementation of the proposed evidence-based practice or intervention requires the involvement of the key stakeholders. One of the key stakeholders who is directly affected is the patients. Patients as the stakeholders play an important role in the implementation since they are used as the participants in determining the effectiveness of a combined therapy that involves CBT and sertraline for the treatment of mental health conditions such as depression. In this case, the patients can have an opportunity to act as their therapists and develop the skills that enable them to experience a change in thoughts, emotional issues, and behaviors. The other stakeholder is the therapists who help in prescribing the medication and guiding the CBT process. Nurses and caregivers act as mediators between the therapists and the patients or the family members. They help dispense the medications recommended by the therapists and guide the CBT process in the absence of the therapists. The family members also form an important role in ensuring that the patient adheres to medications and effectively participates in the proposed CBT treatment process (Eisman et al., 2021). The other stakeholder is the mental health institute or department that deals with mental conditions. Their role, in this case, is to help in the collection of the data after implementation so that they can form a basic guideline for the treatment of mental illnesses.

Identification of the stakeholders

The key stakeholders for the proposed project are the patient, nurses, family members, caregivers at home, therapists, and the institutional staff working in the mental health department. These stakeholders are supportive since they are both focused on the patients’ overall well-being and on arriving at an effective solution for addressing the issue of mental health disorders. Nurses, therapists, and the institutional mental staff focus on arriving at effective evidence-based practice intervention (Eisman et al., 2021). The nurse, caregiver, patients, and family members focus on the overall well-being and reduction in the symptoms of the mental health disease.

The list of the stakeholders who will be interested in the outcomes of the project

The project’s focus is to arrive at the best intervention to address the issue of depression, especially for teenagers aged 12 to 18 years. The common practice involves using sertraline alone, while others use sertraline combined with CBT. Therefore, arriving at an effective intervention will give the interested stakeholders, such as nurses, therapists, and the medical staff at the mental health department to develop a guideline for the treatment of depression. These stakeholders will be focused on comparing the baseline data on the incidence of depression when using sertraline alone and then comparing it with the outcomes from the proposed evidence-based project of CBT (Johnson et al., 2019). The positive outcome, i.e. reduction in the depression incidences amongst teenagers of 12 to 18 years, will conclude that the combined treatment approach of sertraline with CBT is effective in treating depression in these individuals.

Promotion of the stakeholder participation

It is important to ensure that every stakeholder is involved in implementing the project. In this case, the family members, patients, nurses, caregivers, therapists, and the staff members from the department of mental health must engage in a collaborative approach to ensure that implementation goes successfully. The participation process must have clear guidelines for both parties to be aware of the necessary steps or procedures (Nabors, 2020). Nurses/caregivers must work hand in hand with family members to ensure that patients adhere to the medications and attend the psychotherapy program recommended by the therapists.

Possible concerns or barriers

The successful implementation process of the proposed intervention can be affected by various barriers. One of the barriers is the language barrier that can be brought by the misunderstanding of the language used by the providers. The other challenge is the cultural differences; for example, the patient might believe in the traditional practices and reject the proposed intervention or fail to adhere to the treatment guidelines. The cultural barrier can also be brought by the refusal to be treated by the opposite gender. The other barrier is poor communication between the stakeholders; for example, the nurse or caregiver might fail to update the therapists about the progress of the patient or the need for changes (Castaldelli-Maia et al., 2019). The nurses might also fail to communicate or give feedback to the family members on some of the changes made in the treatment process. The other challenge is the resistance from the nurses and the caregivers to the changes in the practices whereby the new treatment and new intervention are introduced.

The strategies to gain support and assistance from the stakeholders

It is important to ensure that the above barriers are addressed and reduced. One of the approaches that can be adopted is to inform the providers, such as nurses, about the proposed changes and how it is likely to affect their practice and improve the overall outcomes of the patients. This approach is important in reducing the resistance level of the affected providers. The other intervention is to be culturally competent. The approach is important since it allows learning about the patients’ culture and appreciating them. The other approach is to ensure the inclusion of the senior provider who has worked in this field for a long and understands the challenges associated with cultural differences (Castaldelli-Maia et al., 2019). It is also important to include the translator to help overcome the language barrier issues. Effective communication amongst the stakeholders is also important in ensuring that the proposed changes are made.

WEEK-5 ASSIGNMENT

Design and Statistical Analysis

Evaluative Criteria in Responding to The Evaluation Question

The program’s focus is to determine the effectiveness of using the sertraline alone versus using the sertraline with cognitive-behavioral therapy (CBT) in treating depression amongst teenagers of ages 12 to 18 years. The first variable, in this case, is the independent variable related to therapy. The independent variable includes the use of sertraline with the CBT. The other variable considered the dependent variable is the successful treatment of depression (David et al., 2018). Therefore, the success of the independent variable implementation leads to positive outcomes for the dependent variable.

The evaluation criteria for these variables involve the assessment of the marked improvement in the outcomes in terms of the depression cases and symptom exposure to CBT approaches such as the exposure, the behavioral activation, reduction of the safety, and the avoidance behavior resulting in long-term success in the management of depression. The evaluation criteria also focus on developing the coping ability of the patients in dealing with the symptoms (von Brachel et al.,2019). In this case, patients must be able to use their coping strategies and direct instructions to enable them to apply their approaches after the termination of the treatment process.

Research Approaches to Be Adopted to Respond to The Questions

The research approach adopted involved using the stratified sampling method to select the targeted population from the targeted setting of Shanty Healing Center. This procedure is important since it aids the division of the population into small groups known as strata. This method considers the shared features of the population (von Brachel et al.,2019). The research will also involve purposive sampling, especially for the therapists from the targeted setting. The method helps ensure that therapists are provided with equal opportunity of being selected to attain the study’s objectives.

The study will be conducted quantitatively to enable stronger statistical inferences for the whole group. The quantitative study method helps give the figures and the percentages in terms of the effectiveness of the sertraline with CBT in the management of depression amongst teenagers of 12 to 18 within one year (von Brachel et al.,2019). The diagnostic interview, the brief-symptom inventory (BSI), and the Beck Depression Inventory (BDI) will aid the performance of the interview for the collection of the relevant data.

Collecting Concerning Evaluative Criteria or Indicators, Validity and Reliability of The Tools, The Data Collection Tools, And Data Collection Methods

The collection of the data will be made successful through the interview process. In this case, the semi-structured interview (MINI-DIPs) will be utilized to assess the present and all-life time diagnosis of the disease either via phone or face-to-face. The interview will target the graduate learners in clinical psychology who had undertaken 30 hours of training during the interview. The other method adopted for collecting data is the questionnaire, and this involved the use of the Brief Symptom and the Beck Depression Inventory (BDI). The Brief Symptom Inventory (BSI) is a 53-item scale capturing symptom severity of obsession-compulsion, interpersonal sensitivity, depression, anxiety, somatization, phobic anxiety, and psychoticism (Lange, 2021). The BDI is an important tool effective in the assessment of depression. It has 21-items that have a forced-choice scale of 0 to 3 and has four different statements on none to severely depressed mood. This tool will be used to collect data on the feeling of the patients during the implementation process. The convergent validity of the BDI with other self-reported measures for mental illness such as depression and the observer ratings tend to be high.

The Analysis of The Data with Specific Statistical Tests to Be Utilized

The data were analyzed using five steps. The first one will involve describing the status of the study subjects at the follow-up process through descriptive statistics such as mode and standard deviations. The t-test will test the existing variations in the participants who agreed to participate and those who did not agree. The second step will involve tabulating the patients’ ratings concerning their previous therapy, the recurrence of the issues, and the post-therapy enhancement. The third step will involve testing the effectiveness of the proposed intervention in the post-treatment and the follow-up program. This will be achieved by using the Cohens’ D test to help quantify the magnitude of the changes in the pre and post to follow-up process (von Brachel et al.,2019). There will be scrutinization of the clinical impacts of the proposed changes at the individual level. The reliable change index will be calculated to help find out the patients showing the changes that will be larger than the changes in the changes in the change.

WEEK-6 ASSIGNMENT

Proposed Project Interventions

The Extent of The Evidence-Based the Proposed Interventions

The use of the sertraline with cognitive-behavioral therapy (CBT) has been studied to compare its effectiveness in reducing mental health symptoms compared to the use of sertraline alone. A study by David et al. (2018) shows that the use of the combined therapy involving the use of medicine and the CBT helps promote successful management of mental disease and improve the coping ability of the patients.

CBT effectively manages anxiety and other mental health issues like panic disorders and post-traumatic disorders. It assists in reducing depression when used as a single therapeutic approach or in combination with other medications such as antidepressants. Based on this evidence from the research works (Carpenter et al., 2018). It is clear that CBT, together with the medications such as sertraline, helps reduce the symptoms and successful treatments of mental health conditions.

Factors That Can Impact the Use of The Proposed Interventions

The use of the proposed interventions can be impacted by factors that might affect the attainment of its objectives. One of the factors is the poor understanding of the procedures involved in the activities during the implementation process. It is important to ensure that both the affected persons and the implementers understand the use of the interventions. The failure of the patient to adhere to the medication procedure can affect the outcome of the implementation process, thus making it hard to determine whether the intervention was effective. The providers need to inform the patients on whom the medications and the CBT are used to remain compliant throughout the process (Carrier et al., 2022). The miscommunication between the providers and the patients is another factor that must be looked into. The patients must be informed whether there is an improvement in the symptoms to make adjustments.

Identification of The Barriers Related to The Proposed Interventions

The barriers to the proposed interventions can be linked to the poor implementation of this procedure. The failure to follow the required implementation procedures implies that the expected outcomes are unlikely to be achieved. The other barrier is the poor communication process between the team of the providers and the family members. The effectiveness of this intervention requires updating on the progress of the patients and informing one another about the adjustments made. The lack of a clear channel of communication and feedback reduces the chances of adjustment that needs to be made. The other barrier can be linked to resistance from the healthcare providers. Usually, the implementation of the CBT requires spending time with the patient and learning about the strength, weaknesses, and coping strategies. The patients are also put under stimuli to observe their behaviors (Liu et al., 2021). On the other hand, medication use requires a prescription and then discharging the patient. Combining the two treatment approaches might be a hard task that requires commitment, and some providers might not be willing to endure the process, leading to resistance.

The List of Resources Required

Amongst the key resources required is medication such as sertraline. The other resource includes the facility or a room that can be used for the performance of the CBT program. The online tools and the learning communities are required to support the training of the providers to ensure that they acquire the skills and knowledge for the provision of evidence-based CBT. Support system actors must offer the clinicians resources such as the treatment manuals or the technological infrastructure (Carrier et al., 2022). It is also possible to use videoconferencing or telephone to deliver the remote CBT in real-time when there are barriers such as logistics.

Steps or The Sequence of Events or Specific Implementation Activities

The first step in the implementation process is to inform the key stakeholders involved in the implementation process, for example, the nurses and clinicians. They are informed about the need for the change, the effectiveness of the proposed intervention, how it will affect their operations, the expected overall outcomes, and the impacts on the quality of services to the patients and the satisfaction levels of the providers. The other step is to ensure the availability of the required resources and the implementation team. The data on the number of the targeted population with depression are collected to help in the implementation process and compare the outcomes. The team is briefed on the procedures of the implementation process, i.e., the CBT and sertraline treatment process. The targeted population of teenagers ages 12 to 18 are placed on the two treatment procedures. Each stakeholder is informed about their roles. The implementation takes place for one year, and during this time, the adjustment will be made to ensure that the objectives are attained. The final results will be collected and compared with the baseline data to determine whether there is success in the program.

Monitoring, Tracking, And the Ongoing Review

The patients are monitored during the implementation process to ensure that they adhere to the medications and follow or attend the CBT program. The providers are also expected to ensure that they adhere to the implementation of all the procedures during the treatment of patients using the sertraline and CBT therapy. The tracking process involves the process where the providers communicate with the fellow providers and the family members or patients to consult and inquire about the progress of the patients. The necessary adjustments are made when the patient fails to stick to the recommended treatment guidelines (Liu et al., 2021). The ongoing review process is done to determine the changes in the patients’ symptoms during the implementation process.

Performance of Tasks Needed for The Implementation, Staff Responsible for The Implementation Process, and Their Qualifications

The tasks will involve the training of the providers who will be expected to help in the implementation of the proposed intervention. The clinical psychologists and other therapists or providers will be trained adequately on CBT (Carrier et al., 2022). The online training programs will also be adopted to ensure that the CBT components are delivered to help compensate for the lack of specialized human resources.

The healthcare providers such as nurses, therapists, or clinicians will assist in delivering healthcare services to the targeted population group. They will assist in delivering the sertraline, and CBT combined therapy, whose effectiveness is later compared to the previous medication that involved the use of sertraline alone. The CBT providers can use the remote CBT delivery to circumvent the common personal barriers, such as logistics (Liu et al., 2021). The providers will also offer self-guided treatment augmented with the asynchronous interactions with the therapists or coach. This approach will give a chance to cover many patients without increasing the number of therapists.

The clinicians or nurses will provide the patients with the book or manuals. On some occasions, group therapy will be initiated to help in the reduction of the therapist’s time per patient. The transdiagnostic CBT procedures will target the common signs and the processes across anxiety disorders (Carrier et al., 2022). The procedure will enable the therapists to offer a higher percentage of patients with similar training.

Strategies That Promote the Implementation of The Proposed Intervention

One of the strategies is to ensure that the required resources are provided to help implement each step of the program. The other strategy is to ensure full support from the management. The management must offer every resource required by the team. The providers must also be involved in every decision made by the management of their leaders. This will help in reducing the level of resistance hence successful implementation. The other strategy is the ongoing communication process (Carrier et al., 2022). There must be a clear channel of communication between the team to prevent any errors. The ongoing review of the procedures utilized in the implementation must be done to ensure that the required adjustments are made.

Timeline

To ensure that the success of the combined therapy of CBT and sertraline compared to sertraline alone is achieved in reducing or treating depression amongst 12 to 18 teenagers, the implementation is planned to take place for one year. This period is enough to conclude the effectiveness of the proposed intervention.

The Expected Outcomes to Be Achieved

The successful implementation of the combined therapy of CBT with sertraline medication for depression is expected to help in the successful treatment of depression in teenagers of age 12 to 18 years. It is expected that there will be an improvement in the symptoms as the teenagers will demonstrate improved behaviors. There will be an improvement in the coping skills. It is expected that there will be a full recovery process, reduction in the negative thoughts like the suicidal ideation, and replacement of the negative thoughts with positive thoughts.

References

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Carrier, J-D., Gallagher, F., Vanasse, A., & Roberge, P. (2022) Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review. PLoS ONE 17(3): e0264368. https://doi.org/10.1371/journal.pone.0264368

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David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry9, 4.  Doi: 
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Lange, K. W. (2021). Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. Global Health Journal5(3), 120-127. 
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Liu, W., Li, G., Wang, C., Wang, X., & Yang, L. (2021). Efficacy of Sertraline Combined with Cognitive Behavioral Therapy for Adolescent Depression: A Systematic Review and Meta-Analysis. Computational and Mathematical Methods in Medicine2021. Doi: 10.1155/2021/5309588

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