In this presentation, we describe the design and methods of a primary-care and community-based CBT prevention program (P2P) for at-risk adolescents. The P2P study is a two-arm, longitudinal trial examining the relative short- and long-term effectiveness of Teens Achieving Mastery over Stress (TEAMS; online, group CBT) and Competent Adult Transition with Cognitive-behavioral, Humanistic, and Interpersonal Training (CATCH-IT; online modular CBT) at 32 rural and urban sites across five health care systems. TEAMS CBT was delivered in face-to-face groups of 4-8 youth and were led by a licensed clinician. Eight weeks of 90-minute “acute” treatment were followed by 6 monthly group “continuation” sessions. The CATCH-IT online prevention course included modules addressing Behavior Activation, CBT, Interpersonal Psychotherapy, and Motivational Interviewing. The program includes 14 interactive teen modules and 5 parent-family modules. CATCH-IT works across device types (i.e., Smartphone, computer, laptop) and includes three, 15-minute MI phone calls to improve engagement. Engagement with community stakeholders was accomplished through regular Teen and Community Advisory meetings at each site. These were used to provide feedback on program design, discuss progress, enhance participation, and improve engagement. Participants included 536 13-17 year-old youth recruited through primary care settings. Participants were at-risk for experiencing a Major Depressive episode, as evidenced by elevated depressive symptom levels on the PHQ-9. They were excluded if they had a current diagnosis of Major Depression, Bipolar Disorder, Schizophrenia, severe alcohol or substance abuse, if they were currently receiving CBT, had a history of significant self-harm, or were experiencing current suicidal ideations. Stratified cluster randomization was completed at the clinic-level, with controls for SES, race-ethnicity, rural-urban, and level of community distress. Outcome variables included the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid) and the Depression Rating Scale (DRS) to determine depression severity and time-to-event, and the Global Assessment Scale (GAS) to assess functioning. Assessments were completed at baseline, 2, 6, 12, and 18 months. Primary analyses followed an intent-to-treat (ITT) design.
