Helps Teen

Helps Teen

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Posted on September 9th, 2014 by Dr. Francis Collins

As many as one in five U.S. teenagers experience an episode of major depression by the time they turn 18. Sadly, depression among teens often goes unrecognized, increasing the risk of suicide, substance abuse, and many other problems. Even among those who are diagnosed, few receive proper treatment. But now there’s a ray of hope from a new NIH-funded study that’s found success using a team approach that pairs depressed teens and their parents with a counselor [1].
Faced with a shortage of psychiatrists who specialize in child mental health, a multidisciplinary team from the Seattle Children’s Research Institute, University of Washington School of Medicine, and Group Health in Seattle decided to use a strategy called “collaborative care” to treat depressed teenagers. There are more than 70 clinical trials showing that team-based care approaches work well for adults with depression, but there were only two such previous studies in teens—and results were mixed.
To carry out their study, pediatrician Laura Richardson and her colleagues identified 101 teens who screened positive for major depression at nine primary care clinics in the Group Health system in Washington state. (Depressed teens who also had substance abuse problems or who had attempted or planned suicide were not included in this study group). The teens were then randomly assigned to either usual care or collaborative care.
In the usual approach, Group Health sent a letter to the depressed teen and his or her parents that described the teen’s condition and encouraged the teen to use the Group Health system to get help in the form of psychotherapy or anti-depressant medication. The letter listed phone numbers that could be used to schedule either a psychotherapy session with a child mental health specialist or a visit to a doctor who could prescribe antidepressants.
In the collaborative approach, contact was initiated by depression care managers with master’s degrees in social work, psychology, or family therapy, plus experience in working with teens. A depression care manager set up a face-to-face meeting with each teen and his or her parents to discuss the teen’s symptoms, the impact on the family, and possible treatments. At their initial meeting, this “team” jointly weighed the pros and cons of psychotherapy versus anti-depressants and together decided what treatment or combination of treatments to try. The depression care manager then facilitated the choice by scheduling psychotherapy sessions with the teen and/or by coordinating with a physician to write a prescription for anti-depressant medication. The care manager also followed up, by phone or in person, with the teenager every week or two to monitor the impact of the intervention.
As part of the collaborative care strategy, depression care managers tracked the teens’ symptoms using a short, standardized screening questionnaire. The results of the questionnaire were analyzed and discussed in weekly meetings between the care manager and a supervisory team that consisted of a psychiatrist, psychologist, and a pediatrician. If a teen’s depressive symptoms weren’t improving or were growing worse after four to six weeks, the care manager would reach out to the teen, figure out why, and, in consultation with the supervisory team, recommend a change in treatment. At the end of the 12-month study, the care manager, teen, and parents met again to devise a relapse prevention plan and to discuss steps to take if the depression recurred.
Researchers found that this team-based approach to treating depression among adolescents appears to pay off. Far more teens responded to collaborative care (67%) than usual care (39%), with half of the collaborative care group experiencing complete remission of their depressive symptoms compared to just one-fifth of the usual care group.
The key to collaborative care’s impressive success seems to lie in its initial face-to-face meeting, and continued visits and calls. If faced with side effects from medications or difficulties in scheduling therapy, many depressed teens are likely to stop treatment rather than call a medical professional for help. However, through a proactive, team-based approach, depression care managers were able to establish rapport with the teens and their parents, helping them to troubleshoot, address, and sometimes even avoid issues with medications or psychotherapy.
The interpersonal connections forged among the team members at the first meeting and strengthened by regular follow-up really seem to have made the difference. The next challenge is to implement this team-based strategy more broadly, perhaps incorporating the role of a depression care manager into more health care settings across the nation with the aim of improving outcomes for depressed teens and their families.
[1] Collaborative care for adolescents with depression in primary care: a randomized clinical trial. Richardson LP, Ludman E, McCauley E, Lindenbaum J, Larison C, Zhou C, Clarke G, Brent D, Katon W. JAMA . 2014 Aug 27;312(8):809-16.
Laura P. Richardson , Center for Child Health, Behavior and Development, Seattle Children’s Research Institute
Depression in Children and Adolescents (National Institute of Mental Health/NIH)
Recognizing teen depression (National Library of Medicine/NIH)
NIH support: National Institute of Mental Health
When i was a teenager myself and believe I may have depression yet I’m not sure what to do about it. I feel happy and then I will have a sudden fall. I have also found myself sleeping throughout the day and isolating from my family I am really not sure on what to do. very informative thank you for sharing this with us.
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Healthy Children > Ages & Stages > Teen > Dating & Sex > Helping Teen Parents and Their Children Build Healthy Futures

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Teen parents have plenty of obstacles to navigate. Their kids will likely face some too.

The good news is that as a grandparent, there's a lot you can do to help.
It helps to be aware of the possible challenges your teenager may face as a parent. That way, you can help your child meet them head-on.

Transitioning to parenthood. Becoming a parent isn't easy even when you're an adult with some experience behind you. For teens, it's even more difficult since they're not finished developing themselves. Your teen may feel isolated from and jealous of their friends. They could feel unprepared for parenthood. They might be anxious about their future.

Finishing school. Teen moms aren't as likely to graduate from high school or to go to college. This can have a negative impact on their—and their children's—future.

Childcare. Finding safe, high-quality childcare may not be affordable.

Inexperience. Children have the greatest physical, emotional, and cognitive development during their first three years of life. This means the interactions they have with their parents and caregivers are crucial during this period. But because teen parents are young and inexperienced, they may not realize how much influence—good or bad—they have on their children's development.

Finding a job. It may be harder to keep or find a job that fits around school and parental responsibilities.

Earning enough money. Research shows that teen mothers tend to earn less than women who have children later in life. They're also more likely to experience poverty.

Negative perceptions. There are still negative stereotypes surrounding teen parents. People tend to see adolescent moms as sexually irresponsible and adolescent dads as uninvolved or absent.

Depression. Studies indicate that being a teen mother may increase the likelihood of mood disorders like depression . Young fathers are at a higher risk of becoming depressed too. This is probably partly due to factors like learning to become a parent, juggling responsibilities, and stress in relationships with family members, romantic partners, and/or friends. Stress and depression can also put adolescent parents at risk for
substance use .

Repeat births. Around 17% of babies born to adolescents are repeat births. Having more than one child as a teenager can intensify the challenges of finishing school, earning enough money, and finding quality childcare. Repeat pregnancies are also associated with a higher risk of low birth weight and infant death.
Adolescent moms and their children have some unique health risks too. This is why it's so important for them both to be under the care of a pediatrician.
Research shows that pregnant teen moms are more at risk of having these complications:
Premature birth, low birth weight, and infant death
The risks are higher for mothers under the age of 17 years. These complications also seem to be more common in teens that don't have proper prenatal care.
Children of teen parents have some higher risks too, including:
Yes, there are many challenges and risks involved with being a teenage parent. But as a grandparent, your love and support can make all the difference. Here are some ways to help your child so they can find a healthy, positive life path.
Seeing an obstetrician regularly helps both mother and baby stay healthy. It also lessens the risk for labor and delivery complications.
Watch out for signs of tobacco use, drinking , or taking drugs. Using any of these can harm the baby. Let your child's obstetrician know if you think these might be a problem.
It's a good idea to start classes during pregnancy so your child can learn how to take care of a baby before it arrives. Getting educated will also help your child manage the transition to parenthood more smoothly. And because parent-child interactions are so important, especially during the first three years, keeping up these classes benefits everyone.
Encourage your child to get a high school diploma and then a trade school or college degree. This will give your child confidence and help them support their child.
Because teen moms are at a high risk of getting pregnant again, it's important that they know about their
contraceptive options. For instance, they can have an intrauterine device (IUD) or implant placed right after birth. This helps reduce the likelihood of a repeat pregnancy during adolescence. Both the IUD and the implant last for years (depending on the type) and are completely reversible.
Breast milk is the best nutrition for babies. In fact, the American Academy of Pediatrics and Centers for Disease Control and Prevention recommend that moms of any age exclusively breastfeed for the first six months. After that, it's best to keep
breastfeeding along with introducing other foods until the baby is at least one year old. Not only does breastfeeding help mothers bond with their babies, but it also promotes cognitive development.
Breastfeeding classes and support help adolescent mothers breastfeed longer. Check with your child's pediatrician or obstetrician about breastfeeding resources like a lactation consultant.
You and your child (and possibly the other parent and grandparents) will need to sort through how much of a role you will play in caring for your grandchild. You may need to get a social worker or counselor to help with this.
Don't be afraid to step in and help parent your grandchild if that works for your family. Studies show that coparenting, which usually involves maternal grandmothers, can have positive effects on both children and grandchildren. This is especially true if you and your child have minimal conflict. The less conflict there is, the more positive the coparenting experience is for everyone.
No matter how you feel about your grandchild's other parent, remember that positive parent-child relationships are critical for healthy child development. For your grandchild's sake, try to encourage and support the other parent's role.
Research shows that when fathers engage with their children, they positively influence their kids' behavior, intellect, and mental well-being. Kids of teen moms who stay close with their biological father do better in school and at work. They're also less depressed, and their risk of becoming teen parents themselves is lower.
Even when fathers can't help support the baby financially, they can support them emotionally and physically. And the sooner they gets actively involved with their child, the more likely it is that they'll stay involved.
One of the best things young parents can do with their children is to play with them and read to them. Both of these activities promote bonding and boost young kids' social and cognitive development.
Visit your local library and check out Dolly Parton's
Imagination Library , which mails a free book every month to children from birth to age five, regardless of income.

There are many government and community programs and resources out there designed to help parents and young children, such as:
Tuition and childcare assistance programs
Parenting and child development classes
What's available depends on where you live. Check with your city, county, or state department of social services to start with. Your child's school may be another potential resource. It's possible you'll need to find services from a variety of
government and private resources, such as:

Temporary Assistance for Needy Families — Helps families with financial assistance and support services.

Child Welfare Information Gateway — Resources for parents and grandparents.

Early Head Start — Programs for kids under age 3 and pregnant women.

Nurse-Family Partnership — Connects first-time, low-income moms with a personal nurse.

Parents As Teachers — This home visiting program is for all families with young children.
Helping your child access these services can ease many of their burdens and paves the road to their success as a parent.

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