Active Monitoring emphasizes all of the important things that can occur BEFORE initiating a formal psychotherapeutic or pharmacological treatment to address a patient’s suicide risk.

The following list contains some of the elements of active monitoring:

Pediatricians may utilize active monitoring at every visit, including AFTER treatment has started. During active monitoring, pediatricians track progress of psychotherapy, medication use, health choices, social life, activities, assess behavior change, self-care, sleep hygiene, family dynamic, and school progress.

Refer to the Glad PC Tool Box   for more guidance on active monitoring.

A skills based psychotherapy treatment that conceptualizes the onset and maintenance of clinical depression within the context of cognitive vulnerabilities and negative psychosocial events. It focuses on identifying cognitive distortions that may lead to depressed mood, encourages activities that promote positive mood, and teaches problem solving skills to promote better coping with negative life events. CBT is indicated for children and adolescents ages 6 and above.

Referring depressed youth for treatment and making sure they receive proper follow-up care is a crucial step for primary care providers. Making sure youth don’t fall through the cracks always requires careful planning and clear communication between primary care and mental health providers. Once either a consultative relationship has been established or a referral has been made, primary care physicians and mental health practitioners should carefully define and discuss follow-up roles and continue to coordinate patient care until presenting problems are resolved.

Pediatricians treating Pennsylvania families with Medical Assistance, can use the Pennsylvania Telephonic Psychiatric Consultation Service Program (TiPS) program.

Used when a youth has achieved complete remission of depressive symptoms to consolidate the treatment response and avoid relapse. Should occur every 2-4 weeks for a duration of 6-12 months. Frequency can be determined by multiple factors including clinical status, functioning, existing support systems, environmental stressors, motivation, and co-morbidity.

A psychotherapy intervention that recognizes the relationship between family interaction and the onset and course of pediatric depression. This type of approach specifically targets family processes and stresses, and often emphasizes fostering positive and supportive parent-child interactions and enhancing family and child coping and problem solving.

An outpatient mental health therapeutic intervention more structured and intensive than traditional outpatient therapy. IOP’s usually meet 2-3 times per week and often involve individual, family, and group therapy.

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A skills based psychotherapy treatment that conceptualizes clinical depression as having developed in a social and interpersonal context and that believes that the onset, response to treatment, and outcomes are influenced by the interpersonal relations between the depressed patient and significant others. It includes strategies and techniques, such as education, facilitation of social competence, communication analysis, and problem solving, all designed to help the patient master the interpersonal context of the depression. IPT-A is indicated for adolescents ages 12-18.

Obtaining services in the community for patients may or may not be difficult. During discussions about counseling, Pediatrician may assess whether therapy has started, if the therapeutic relationship is an appropriate match for patient, if frequency is appropriate, and if therapy type is a good fit for symptoms.

Used when a youth has reached recovery. Indicated when a youth has a history of chronic or severe depression, or at least two prior episodes of depression. Occurs every 1-3 months for a duration of one year or longer, based on clinical judgement. Goal is to foster healthy growth and development and to provide enough practice of strategy use to decrease the rate of recurrence.

Outpatient mental health programs that patients attend for six or more hours a day, every day or most days of the week. These programs, which are more intensive that IOP but less intensive than inpatient hospitalization, will commonly offer group therapy, educational sessions and individual counseling. A PHP may be part of a hospital's services or a freestanding facility.

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A period of 2 – 8 weeks with no or few symptoms of depression. Alternatively, remission can be defined based on the following:

• A reduction of 50% or greater from total symptom severity as assessed on pre-treatment or baseline rating scales.
• CGAS improvement in functioning for two weeks or longer
• BDI < 9
• PHQ-9 or PHQ-A < 5
• CDRS-R total score < 28

When the child or adolescent was in remission and symptoms reemerge. A relapse is considered a continuation of the index episode, not a new episode.

Being in remission for a significant period (longer than 2 months).

When the youth has been in recovery but then experiences a new episode of depression

Talk therapy involving active listening and reflection as well as education, support, and case management regarding family and school stressors. Supportive psychotherapy also often includes the teaching of specific skills such as problem-solving, coping, and sleep hygiene.

Navigating mental health services can be confusing and frustrating. Patients who are depressed may experience personal barriers to scheduling and attending in-person visits, and may have difficulties articulating questions and concerns. Pediatrician offices, as medical homes for patient care, can increase availability for directing patients to the right resources and referrals by utilizing telephone support from a Social Worker or Nurse advocate. Telemedicine visits are available to providers and offer a convenient way to review therapy, response to medication and overall functioning. Office visits offer a better evaluation which includes in office self-report screens.