A step too far? Randomized trial of cognitive-behaviour therapy delivered by social workers to depressed adolescents

Objective: To test the hypothesis that depressed adolescents given brief cognitive behaviour therapy by trained social workers will be less depressed after this treatment than depressed adolescents who have routine care from their social workers. Method: Open study, two randomized parallel groups. 86 social workers were randomized to training in brief CBT or delayed training by remote telephone randomization. 25 social workers who attended CBT training recruited 29 depressed adolescents. 22 social workers in the control group recruited 23 depressed adolescents. Results: Social workers' perceptions of their knowledge and skills in dealing with adolescent depression were better after the training than before. However, in intention to treat analyses, adolescents who had therapy from trained social workers had a similar level of depression post treatment (mean depression score 17.5, 95% CI 11.8 to 23.3) to those who did not have such therapy (mean depression score 16.7, 95% CI 11.3 to 22.1). There were no significant differences between the groups on other outcomes or at follow-up. Conclusions: This study failed to recruit enough cases and probably did not therefore have enough statistical power to detect an effect of the intervention. It was also based on a severely impaired sample with many comorbid problems. However, the results suggest that training community-based social workers in cognitive behaviour therapy is neither practical nor effective in improving the outcomes of their clients.