The Creating Opportunities for Personal Empowerment (COPE) Program: An Evidence-Based Practice Improvement Project to Improve Adolescent Depression

BACKGROUND: Depression rates in adolescents are rising, while screening and treatment rates remain minimal. Untreated depression leads to poor outcomes related to self-harm and suicide, physical health, education, relationships, and decision making.

LOCAL PROBLEM: A rural Ohio middle school identified increases in mental health issues across its adolescent population. The school did not previously screen all students with a standardized screening tool or teach a mental health program.

METHODS: A Doctor of Nursing Practice (DNP) student developed a project to increase depression screening and improve depression symptoms through implementation of a standardized screening tool and cognitive-behavioral therapy (CBT)-based skill building program. The guiding framework of this project was the evidence-based practice improvement (EBPI) model.

INTERVENTIONS: The Creating Opportunities for Personal Empowerment (COPE) program, a manualized cognitive-behavioral program, was implemented in seven weekly sessions. The Patient Health Questionnaire Modified for Adolescents (PHQ-A) was administered before the first session, immediately after completion of the last session, and two-months post-program completion time periods to monitor depression scores. Students who screen positive for depression in the moderate range or above were referred for further assessment and referral.

RESULTS: Implementation of the PHQ-A increased depression screening and referral rates at the site. Screening scores throughout COPE completion displayed decreases for both the entire sample as well as students who were identified as having depression at baseline. Both groups had clinically significant decreases from the pre-to-post-COPE and post-COPE-to-follow-up scores, as well as clinically and statistically significant decreases from pre-COPE-to-follow-up scores.

CONCLUSIONS: Implementing a manualized cognitive-behavioral therapy-based program and standardized screening tool in the classroom setting can improve depression screening and adolescent coping skills.