1. Treating Depression From an Integrated Approach
A Collaborative Approach to Care
May 4, 2019 * Tex-CHIP Training Series

2. Psychological Assessment of Depression (and contributing factors)
Thomas Graf, PhD

3. Understanding Provider Roles in Treating Depression (when to consult or refer)
Does patient need inpatient treatment or can he be seen as outpatient?
Do you have the training, current emotional resources and current availability to see this patient with his or her level of problems? Are you going practice within your scope of training and knowledge? Do you need consultation with this one? or to refer all together?
PCP: rule out medical problem, like endocrine (hypothyroidism), neurological(tumor), systemic illness (cancer)
Psychologists: If persisting learning problems are a factor, psychologist can evaluate for cognitive factors: Borderline and Mild Intellectual Disability, or for specific learning disabilities versus ADHD -these factors often go undetected.

4. When to Consult (continued)
Personality disorders specialists: if PD suspected, who in community works with personality disorder/traits (and depression), for ex DBT
Addiction specialist in case of alcohol, drug problems
Family treatment: in case of severe mental illness, violence, poverty, recent suicides,lack of control by or participation of family
Psychiatry: medication treatment of depression and for treatment of bipolar and schizoaffective or other severe mental illness
Cultural acceptance: are you considered an acceptable healer for this person from her or his culture? Can they educate you on this or are the barriers to high?

5. Considerations when Interacting with Clients
look for an emotional connection through demonstrating empathy with their despair and feelings
obtain informed consent about limitations of confidentiality
establish therapeutic alliance by eliciting and defining what patient would see as improvement and treatment goal that you can help with
evaluate level of depression, and factors that make life easier and harder for the person, and being able to stay at home with support or go to more secure place
presence of family conflict and support and acceptance
have knowledge and follow an assessment/intervention plan that works with depressed/suicidal patient like CAMS (Collaborative Assessment and Management of Suicidality) or similar proven approaches.
Determine need for consultation and referral

6. Our Treatment Plan Healthcare Domain: Psychological Assessment
Provider: Psychologist
Objective:
Decrease in symptoms as indicated by client report of:
(a) sleeps through the night 5/7 nights
(b) able to concentrate in school 6/7 classes
(c) feels enough energetic 5/7 days
(d) socializes with family and friends daily
Goals:
a)  determine level of depression and needed level of treatment and referrals
b) engage in activities that are worthwhile and generate accomplishments and improved mood
c)  Mourn and accept losses
Interventions:
a)  Refer and consult as indicated
b)  help rekindle interests, identify strengths the patient can build on, engage in physical activity, a natural antidepressant
 c)Help identify, tolerate and accept negative emotional experiences

7. Measuring Outcomes/Success
pre and post:
Beck Depression Inventory 2nd Edition
Children’s Depression Scale 2nd Edition
Columbia Suicide Severity Rating Scale
or number of depression symptoms reported

8. Communication Needed from Counselors
find out who sees what kinds of problems in the community for you to refer to.
Call individual psychologist if you are not sure if they will see this kind of person and within what time frame