Intensive group therapy program improves pediatric mood disorders

Outpatient interventions for children and adolescents with mood disorders are more effective when caregivers are involved, yet families are often excluded from treatment. The Child and Adolescent Integrated Mood Program (CAIMP) at Mayo Clinic's campus in Rochester, Minnesota, exists to serve these patients and their families, with a focus on evidence-based care.

"We fill a gap in service," says program founder and director Jarrod M. Leffler, Ph.D., L.P., a child and adolescent psychologist at Mayo's Minnesota campus. "The program is intensive, so if a family hasn't tried outpatient treatment before, that might be the best place to start. But if a child isn't benefiting from good outpatient management and perhaps has had a psychiatric hospitalization, then CAIMP is a likely next step."

A hospital-based, outpatient, group psychotherapy program, CAIMP is offered in two formats, one for children under 14 years of age and one for those 14 and older. In both, families and patients — individually and together — participate in education and therapy groups for 10 consecutive weekdays from 8:00 a.m. to 4:00 p.m. A variety of evidence-based interventions for pediatric mood disorders are used, including cognitive behavioral therapy, mindfulness and interpersonal techniques. Other interventions focus on psychoeducation, wellness and behavioral activation.

"Our groups are led by highly experienced providers — psychologists, licensed clinical social workers, nurses, dietitians, and occupational and recreational therapists. In two weeks, families receive more hours of treatment than they would in a year of weekly outpatient therapy, but from a variety of providers," Dr. Leffler says.

Integrated medication management is a crucial part of the program; providers see patients every day and can modify medications in real time. A family-based treatment model also is central to CAIMP.

"Often, a parent may not only be struggling to help a child but may experience a mood disorder as well, so our interventions focus on how parents can help both their child and themselves," Dr. Leffler says. "If you change one element in a family system, the rest of the system has to change; when a child in an outpatient setting is working toward change but the family system is stuck, then the change can't happen in a healthy way. We help enhance the system so that family members are working in concert instead of against each other."

Families also learn to be better consumers of mental health services — to take advantage of standard outpatient care rather than relying on the emergency department in times of crisis. That message is folded into the follow-up care plan, which identifies interventions that support each patient's needs and goals.

"We have a plan for outpatient therapy, medication management, and returning to or re-engaging in school in a productive and healthy way," Dr. Leffler explains. "Many young patients are notably behind academically, so that is a focus of follow-up care. If they need a case manager through the county, we assist the family in connecting with those services."

Outcomes

Since CAIMP's inception in 2012, 295 patients have been referred to the program and 209 have attended — a 71 percent referral-to-attendance rate, with an overall completion rate of 91 percent. Sixty-two percent of patients had multiple caregivers attend with them.

"For the 12 months following CAIMP completion, there is an 80 percent reduction in inpatient hospital re-admissions," Dr. Leffler says. "Mood symptoms also show improvement or stability, and parents report they strongly agree that their children benefit from attending CAIMP; children agree that parents also benefit. Most think the program has improved the parent-child relationship. Ordinarily, when a child is in crisis, families are not actively involved in treatment. Our approach enhances the parent-child interaction in therapy."

Booster sessions also are offered — what Dr. Leffler calls the dental model of care, where routine checkups help prevent the need for larger and more expensive interventions.

"Mood disorders are episodic, and sometimes previously learned skills have changed or families need a refresher on how to help their child," he says. "But overall, we believe our graduates and their families are better health care consumers and are psychologically healthier."