DNP 815 Week 2 DPI Project Milestone Paper

Details: The Direct Practice Improvement (DPI) Project incorporates 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. These 10 points are defined and instructions for completion of the DPI Project Milestone: Outline of 10 Strategic Points assignment are provided in “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource. Using the table located within the Ten Strategic Points Instructions and Template document, complete the table.



Grand Canyon University: DNP-815


The 10 Strategic Points Comments or Feedback
Broad Topic Area 1.     Broad Topic Area:

Early recognition and assessment of adolescents with depression.


Literature Review Literature Review:

1. Background of the Problem/Gap:

·       Suicide is ranked second for cause of death in adolescents (age 10-17, all sexes) (Heron, 2017).

·       With the advancement of technology, more and more social pressure and the development of “cyberbullying” attributes to the growth rate of depression in adolescents (Raskauskas, 2010).

·       Depression is a very treatable disorder that can be addressed earlier for those suffering with it (Björkenstam, Pebley, Burström & Kosidou, 2017).

·       The onset of depression usually occurs during the child and adolescent years, but only a small percentage of those who experience depression receive treatment (Björkenstam, Pebley, Burström & Kosidou, 2017).


2. Theoretical Foundations (models and theories to be foundation for study):

·       Beck’s Cognitive Theory states that emotional disturbances come from dysfunctional information processing.  Different stressors cause different cognitive information processing which relate to depression symptoms in children and predictable depression symptoms in adolescents (Weeland, Nijhof, Otten, Vermaes, & Buitelaar, 2017).

·       Self-Efficacy Theory by Bendura relates to a person’s perception they can reach a goal by using experience and mastery.  Cognitive and behavioral psychotherapy for depression are based on theoretical concepts of self-efficacy (Hainagiu, 2012).

3. Review of Literature Topics With Key Organizing Concepts or Topics for Each One

Depression Tools:

·       This study researches the appropriateness and validity of the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-2 (PHQ-2) that is traditionally used to assess depression in adults, to be used to assess adolescents with depression.  The study states that the PHQ-9, which was derived from the Primary Care Evaluation of Mental Disorders interview, is the gold standard for assessing Depressive Disorders in adults.  The results confirmed the appropriateness of the PHQ-9 and PHQ-2 to be used to assess depression in adolescents (Allgaier, Pietsch, Frühe, Sigl-Glöckner, & Schulte-Körne,


·       This study looks at the validity of the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-2 (PHQ-2) to be used in the Primary Care setting.  The intention is to identify depression earlier than seeing a Psychiatrist or Psychologist (Arroll, et al., 2010).

·       This study addresses the reliability of the Kutcher Adolescent Depression Rating Scale (KADS) because adolescent depression detection has been limited within the Caribbean adolescent population.  This study was completed with a sample from elementary schools in Jamaica and Barbados.  Not only was KADS used for the study, but also the Adolescent Depression Rating Scale (ADRS), the Revised Children’s Anxiety and Depression Scale (RCADS), and state and trait anxiety visual analogue scales, as references to compare (Lowe, Lipps, Gibson, Jules, & Kutcher, 2018).

·       This study was conducted to establish a shorter version of The Revised Child Anxiety and Depression Scale (RCADS) for the assessment of depression with reliable outcomes (Sandin, Chorot, Valiente, & Chorpita, 2010).

Cognitive Behavior Therapy:

·       Because adolescent depression increases future depressed episodes, school dropouts, unemployment rates, increased substance abuse, etc., the purpose of the study is to examine the effects of short and long term group CBT for adolescent patients with depression (Keles & Idsoe, 2018).


·       Adolescents seeking care for depression in Primary Care(Allgaier, Pietsch, Frühe, Sigl-Glöckner, & Schulte-Körne, 2012).

·       Primary Care (Arroll, et al., 2010).

·       Elementary schools in Jamaica and Barbados (Lowe, Lipps, Gibson, Jules, & Kutcher, 2018).

·       Psychiatric Care (Sandin, Chorot, Valiente, & Chorpita, 2010).

·       Adolescents in psychiatric therapy (Keles & Idsoe, 2018).DNP 815 Week 2 DPI Project Milestone Paper


·       American Board of Psychiatry and Neurology (n.d.). Retrived from

·       American Board of Professional Psychology (n.d.). Retrieved from

·       Council of Social Work Education (n.d.). Retrieved from

Network Systems:

·       Association for Psychological Science: Network Analysis. Retrieved from

·       Professional Networking in Social Work. Retrieved from

4. Summary

·       Gap/Problem: There is a need to assess adolescents for depression within the school systems prior to seeking professional help

·       Prior studies: Prior studies show that identifying depression early on will assist in adolescents receiving the proper intervention early.

·       Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with the adolescent and provider.

·       Significance: Improving rate of follow-up with primary care provider and the student will improve health outcomes of adolescents while still in high school.

Problem Statement While the literature indicates that suicide is the second leading cause of death in adolescents, it is not known if having early detection and therapy will decrease this statistic.  Having school nurses trained in assessing depression and having the skills to provide therapy may combat this issue.
PICOT Questions
In school nurses (P), will education on utilizing an adolescent depression toolkit (I) that includes depression assessment and treatment options, make untrained school nurses (C) more comfortable (O) in detecting at-risk students after training and 2 month application in practice (T)?
Sample Location: California

Population: Suburban city covering a unified school district for student grades K – 12.

Sample: 15 Credentialed School Nurses

Define Variables Independent Variable: Adolescent Depression Toolkit

Dependent Variable: Follow-up with untrained school nurse

Methodology  and Design While using a quantitative and qualitative methodology with  quasi-experimental correlation design, the comfort level and ease of use of the tool kit will be assessed before and after training.
Purpose Statement The purpose of this quasi-experimental correlational project is to compare the depression and suicide untrained school nurse to the trained school nurse for nurses at the school district.  The untrained school nurse will be measured by a pre-knowledge questionnaire, then after training, will be given a post-knowledge questionnaire.  


Data Collection Approach Depression Tool Kit with before and after training survey questionnaires.
Data Analysis Approach Descriptive statistics will describe the sample characteristics and variable results. Of the school nurses, statistics such as age, gender, race, education background, and years of experience will be calculated.  Qualitative data will be discussed from the school nurses before and after training.  Then quantitative data will be calculated on comfort level and ease of use of the depression tool kit.



Allgaier, A., Pietsch, K., Frühe, B., Sigl-Glöckner, J., & Schulte-Körne, G. (2012).  Screening for the depression in adolescents: Validity of the patient health questionnaire in pediatric care.  Depression & Anxiety (1091-4269), 29(10), 906. doi:10.1002/da.21971

Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., & … Hatcher, S. (2010). Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population. Annals of Family Medicine, (4). 348.

Björkenstam, E., Pebley, A. R., Burström, B., & Kosidou, K. (2017). Childhood social adversity and risk of depressive symptoms in adolescence in a US national sample. Journal Of Affective Disorders, 21256-63. doi:10.1016/j.jad.2017.01.035

Heron, M., Ph. D. (2017, May 03). National Vital Statistics Report. Retrieved August 18, 2018, from

Hainagiu, S. M. (2012). The Influence of Self Efficacy in Managing Depression in Hemodialytic Patients a Proposition of an Alternative Intervention Model. Proceedings of the Scientific Conference AFASES, 355–358. Retrieved from

Keles, S., & Idsoe, T. (2018). A meta-analysis of group Cognitive Behavioral Therapy (CBT) interventions for adolescents with depression. Journal Of Adolescence, doi:10.1016/j.adolescence.2018.05.011

Lowe, G. A., Lipps, G. E., Gibson, R. C., Jules, M. A., & Kutcher, S. (2018). Validation of the Kutcher Adolescent Depression Scale in a Caribbean student sample. CMAJ Open, 6(3), E248-E253.

Raskauskas, J. (2010). Text-Bullying: Associations With Traditional Bullying and Depression Among New Zealand Adolescents. Journal of School Violence, (1). 74.

Sandin, B., Chorot, P., Valiente, R. M., & Chorpita, B. F. (2010). Development of a 30-Item version of the revised child anxiety and depression scale.  Revista De Psicopatologia Y Psicologia Clinica, 15(3), 165-178.

Weeland, M. M., Nijhof, K. S., Otten, R., Vermaes, I. P. R., & Buitelaar, J. K. (2017). Beck’s cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability. Research in Developmental Disabilities, 39. DNP 815 Week 2 DPI Project Milestone Paper


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