Quality statement 5: Monitoring progress

Quality statement

Children and young people receiving treatment for depression have their health outcomes recorded at the beginning and end of each step in treatment.

Rationale

It is important to monitor the mood and feelings of children and young people who are receiving treatment for depression so that the effectiveness of treatment can be assessed and adjustments made to ensure maximum benefit.

Quality measures

Structure

Evidence of local arrangements to ensure that the health outcomes of children and young people receiving treatment for depression are recorded at the beginning and end of each step in treatment.

Data source: Local data collection.

Process

Proportion of children and young people receiving treatment for depression who have their health outcomes recorded at the beginning and end of each step in treatment.

Numerator – the number of people in the denominator who have their health outcomes recorded at the beginning and end of each step in treatment.

Denominator – the number of children and young people receiving treatment for depression.

Data source: Local data collection. For CAMHS (Child and Adolescent Mental Health Services), data on outcomes are collected in the Child and Adolescent Mental Health Services secondary uses data set. Routine outcome monitoring is part of The Children and Young People's IAPT project.

What the quality statement means for service providers, healthcare professionals, social care practitioners and commissioners

Service providers ensure that systems are in place for the health outcomes of children and young people receiving treatment for depression to be recorded at the beginning and end of each step in treatment.

Healthcare and CAMHS professionals record the health outcomes of children and young people receiving treatment for depression at the beginning and end of each step in treatment.

Commissioners ensure that they commission services that record the health outcomes of children and young people receiving treatment for depression at the beginning and end of each step in treatment.

What the quality statement means for patients, service users and carers

Children and young people being treated for depression are asked a set of standard questions every time their treatment changes to check whether the treatment is working.

Source guidance

Depression in children and young people (2005) NICE guideline CG28, recommendations 1.1.3.8 and 1.1.4.5.

Definitions of terms used in this quality statement

Methods to monitor health outcomes

NICE guideline CG28 indicates that healthcare and CAMHS professionals can use self‑report measures, as used in screening for depression (for example, the Mood and Feelings Questionnaire), or generic outcome measures (for example, Health of the Nation Outcome Scale for Children and Adolescents or the Strengths and Difficulties Questionnaire) to record health outcomes.

A step in treatment

This is the movement between steps of the stepped‑care model as described in NICE guideline CG28:

Focus

Action

Responsibility

Detection

Risk profiling

Tier 1

Recognition

Identification in presenting children or young people

Tiers 2−4

Mild depression (included dysthymia)

Watchful waiting

Tier 1

Non‑directive supportive therapy/group cognitive behavioural therapy/guided self‑help

Tier 1 or 2

Moderate to severe depression

Brief psychological therapy

+/− Fluoxetine

Tier 2 or 3

Depression unresponsive to treatment/recurrent depression/psychotic depression

Intensive psychological therapy

+/− Fluoxetine, sertraline, citalopram, augmented with an antipsychotic

Tier 3 or 4