Uncovering Modifiable Contributors to Depressive Symptoms During Antidepressant Prescription Renewal: A Primary Care Case Report.

The incidence and prevalence of youth psychiatric disorders in the U.S. is a significant public health problem: psychiatric disorders onset before age 14 for 50% of the population, and before age 24 for 75% of the population (James et al., ). Moreover, suicide is the second leading cause of death for youth ages 10–24, with suicide deaths in this group increasing by 54% over the past two decades (CDC, ). Recently, the American Academy of Pediatrics (AAP), Child and Adolescent Psychiatry (AACAP), and Children's Hospital Association (CHA) declared a National State of Emergency in Children's Mental Health (, ) Late‐childhood through adolescence is a crucial period of social‐emotional development marked by substantial maturation of key brain systems involved in emotion regulation and social processing, facilitating significant shifts in interpersonal functioning (e.g., increased autonomy, greater peer influence, emergence of cliques and romantic relationships; Baker et al., ; Spear, ). This developmental period also coincides with the typical onset window for many mood and anxiety disorders, as symptoms frequently emerge during adolescence alongside major biological and hormonal changes (Black & Rofey, ; H. C. Meyer & Lee, ). Interventions that improve social‐emotional functioning during this developmental period have potential to significantly reshape trajectories of mental health as youth transition to adulthood (Dahl et al., ). In response to calls by AAP, AACAP, and CHA, we examined the relationship between psychopathology and social‐emotional skills in a large ( = 926) sample of adolescents. As described in Kaplan et al. (), the Division of Child and Adolescent Psychiatry at McLean Hospital has implemented a division‐wide, measurement‐based care initiative (the “Child and Adolescent Routine Evaluation [CARE] Initiative”), in which every patient in every program has the opportunity to complete a standard battery of measures as part of routine clinical care. The current study is a collaborative effort between members of the Child and Adolescent Division, as well as support from hospital leadership (D.E.S, A.B.) and technical support (A.K.). The long‐term goal of this project is to provide an empirical basis for integrative approaches that target specific symptoms while leveraging a youth's unique social‐emotional strengths throughout treatment. seeks to combine the art of clinical medical expertise with the science of standardized assessment, for more comprehensive diagnostic evaluations. By reducing the variability inherent in most of clinical medicine, which only relies on the clinical art of medicine (i.e., well‐trained empathic healthcare professionals), measurement‐based care seeks to improve outcomes, including recidivism, lack of remissions, and suicide. Current standard of care rarely uses standard assessments in any branch of healthcare. For example, studies show fewer than 17.9% of psychiatrists and 11.1% of psychologists routinely use any standardized assessments, such as symptom or functional impairment scales (Fortney et al., ). In contrast, the CARE Initiative uses standardized assessments collected from all youth patients receiving care across the division's 13 clinical programs. Although housed within a single division, the CARE Initiative is consistent with a multi‐site study, as our programs are located in 4 locations, spread over a 60‐mile radius, include highly specialized and more generalized programs, and provide care across the range of intensity from acute inpatient to residential, partial hospital, and outpatient.