***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Service development innovation in health technology and practice is viewed as a pressing need within the field of mental health yet is relatively poorly understood . Macro-level theories have been criticised for their limited explanatory power and they may not be appropriate for underst and ing local and fine-grained uncertainties of services and barriers to the sustainability of change . This study aim ed to identify context ual influences inhibiting or promoting the acceptance and integration of innovations in mental health services in both National Health Service ( NHS ) and community setting s. Methods A comparative study using qualitative and case study data collection methods , including semi-structured interviews with key stakeholders and follow-up telephone interviews over a one-year period . The analysis was informed by learning organisation theory . Drawn from 11 mental health innovation projects within community , voluntary and NHS setting s , 65 participants were recruited including service users , commissioners , health and non-health professionals , managers , and caregivers . The methods deployed in this evaluation focused on process- outcome links within and between the 11 projects . Results Key barriers to innovation included resistance from corporate departments and middle management , complexity of the innovation , and the availability and access to re sources on a prospect i ve basis within the host organisation . The results informed the construction of a proposed model of innovation implementation within mental health services . The main components of which are context , process , and outcomes . Conclusions The study produced a model of conducive and impeding factors drawn from the composite picture of 11 innovative mental health projects , and this is discussed in light of relevant literature . The model provides a rich agenda to consider for services wanting to innovate or adopt innovations from elsewhere . The evaluation suggested the importance of study ing innovation with a focus on context , process , and outcomes Objective To evaluate whether a new computerised cognitive behavioural therapy intervention ( SPARX , Smart , Positive , Active , Realistic , X-factor thoughts ) could reduce depressive symptoms in help seeking adolescents as much or more than treatment as usual . Design Multicentre r and omised controlled non-inferiority trial . Setting 24 primary healthcare sites in New Zeal and ( youth clinics , general practice s , and school based counselling services ) . Participants 187 adolescents aged 12 - 19 , seeking help for depressive symptoms , with no major risk of self harm and deemed in need of treatment by their primary healthcare clinicians : 94 were allocated to SPARX and 93 to treatment as usual .  Interventions Computerised cognitive behavioural therapy ( SPARX ) comprising seven modules delivered over a period of between four and seven weeks , versus treatment as usual comprising primarily face to face counselling delivered by trained counsellors and clinical psychologists . Outcomes The primary outcome was the change in score on the children ’s depression rating scale-revised . Secondary outcomes included response and remission on the children ’s depression rating scale-revised , change scores on the Reynolds adolescent depression scale-second edition , the mood and feelings question naire , the Kazdin hopelessness scale for children , the Spence children ’s anxiety scale , the paediatric quality of life enjoyment and satisfaction question naire , and overall satisfaction with treatment ratings . Results 94 participants were allocated to SPARX ( mean age 15.6 years , 62.8 % female ) and 93 to treatment as usual ( mean age 15.6 years , 68.8 % female ) . 170 adolescents ( 91 % , SPARX n=85 , treatment as usual n=85 ) were assessed after intervention and 168 ( 90 % , SPARX n=83 , treatment as usual n=85 ) were assessed at the three month follow-up point . Per protocol analyses ( n=143 ) showed that SPARX was not inferior to treatment as usual . Post-intervention , there was a mean reduction of 10.32 in SPARX and 7.59 in treatment as usual in raw scores on the children ’s depression rating scale-revised ( between group difference 2.73 , 95 % confidence interval −0.31 to 5.77 ; P=0.079 ) . Remission rates were significantly higher in the SPARX arm ( n=31 , 43.7 % ) than in the treatment as usual arm ( n=19 , 26.4 % ) ( difference 17.3 % , 95 % confidence interval 1.6 % to 31.8 % ; P=0.030 ) and response rates did not differ significantly between the SPARX arm ( 66.2 % , n=47 ) and treatment as usual arm ( 58.3 % , n=42 ) ( difference 7.9 % , −7.9 % to 24 % ; P=0.332 ) . All secondary measures supported non-inferiority . Intention to treat analyses confirmed these findings . Improvements were maintained at follow-up . The frequency of adverse events classified as “ possibly ” or “ probably ” related to the intervention did not differ between groups ( SPARX n=11 ; treatment as usual n=11 ) . Conclusions SPARX is a potential alternative to usual care for adolescents presenting with depressive symptoms in primary care setting s and could be used to address some of the unmet dem and for treatment . Trial registration Australian New Zeal and Clinical Trials ACTRN12609000249257 Guided by the Behavioral Vaccine Theory of prevention , this study uses a no-control group design to examine intervention variables that predict favorable changes in depressive symptoms at 6- to 8-week follow-up in at-risk adolescents who participated in a primary care , Internet-based prevention program . Participants included 83 adolescents from primary care setting s ages 14 to 21 ( M = 17.5 , SD = 2.04 ) , 56.2 % female , with 41 % non-White . Participants completed self-report measures , met with a physician , and then completed a 14-module Internet intervention targeting the prevention of depression . Linear regression models indicated that several intervention factors ( duration on website in days , the strength of the relationship with the physician , perceptions of ease of use , and the perceived relevance of the material presented ) were significantly associated with greater reductions in depressive symptoms from baseline to follow-up . Automatic negative thoughts significantly mediated the relation between change in depressive symptoms scores and both duration of use and physician relationship . Several intervention variables predicted favorable changes in depressive symptom scores among adolescents who participated in an Internet-based prevention program , and the strength of two of these variables was mediated by automatic negative thoughts . These findings support the importance of cognitive factors in preventing adolescent depression and suggest that modifiable aspects of technology-based intervention experience and relationships should be considered in optimizing intervention design This study assessed the usability and desired enhancements for the MacArthur Foundation ’s Depression and Primary Care ( MDPC ) Web site to determine if re sources for integrated depression care that are disseminated through the Web site are incorporated into routine clinical care . Since its launch in 2003 , more than 20,000 users registered as members of the MDPC website to read and download depression care re sources . Subjects were r and omly selected from MDPC Web site users who had previously downloaded the depression toolkit .  Web-based survey , which was administered anonymously , included the following domains : ( 1 ) socio-demographic data , ( 2 ) confidence in managing depression ( 3 ) Web site content and design features , ( 4 ) desired enhancements to Web site and content , ( 5 ) use of re sources downloaded from the Web site , and ( 6 ) importance of depression care re sources . Of the 3,478 r and omly selected participants , 666 ( 19.1 % ) responded .  Web site content was rated “ good ” or “ excellent ” for screening and diagnosis ( 84.3 % ) , treatment ( 69.8 % ) , patient education ( 66.2 % ) , and care management ( 66.9 % ) . The Patient Health Question naire-9 ( PHQ-9 ) was rated “ very useful ” by 68.3 % ; 47.1 % reported using it in at least 25 % of encounters with patients who are depressed . PHQ-9 use was significantly associated with higher self-confidence in managing depression ( P = 0.05 ) . Evidence -based re sources for depression care can be disseminated effectively through a dedicated Web site and may help clinicians incorporate effective care models into routine practice Social anxiety is the most prevalent anxiety disorder of late adolescence , yet current treatments reach only a minority of youth with the disorder . Effective and easy-to-disseminate treatments are needed . This study pilot tested the efficacy of a novel , online cognitive bias modification for interpretation ( CBM-I ) intervention for socially anxious youth and their parents . The CBM-I intervention targeted cognitive biases associated with early adolescents ' maladaptive beliefs regarding social situations , and with parents ' intrusive behavior , both of which have been theoretically linked with the maintenance of social anxiety in youth . To investigate the efficacy of intervening with parents and /or children , clinical ly diagnosed early adolescents ( ages 10 - 15 ; N=18 ) and their mothers were r and omly assigned to one of three conditions : the first targeted early adolescents ' cognitive biases related to social anxiety ( Child-only condition ) ; the second targeted  parents ' biases associated with intrusive behavior ( Parent-only condition ) ; and the third targeted  both youth and parents ' biases in t and em ( Combo condition ) . The use of a multiple baseline design allowed for the efficient assessment of causal links between the intervention and reduction in social anxiety symptoms in youth . Results provided converging evidence indicating modest support for the efficacy of CBM-I , with no reliable differences across conditions . Taken together , results suggest that online CBM-I with anxious youth and /or their parents holds promise as an effective and easily administered component of treatment for child social anxiety that deserves further evaluation in a larger trial OBJECTIVE To explore the implementation of CATCH-IT ( Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training ) , an  Internet-based depression intervention program in 12 primary care sites , occurring as part of a r and omized clinical trial comparing 2 versions of the intervention ( motivational interview + Internet program versus brief advice + Internet program ) in 83 adolescents aged 14 to 21 years recruited from February 1 , 2007 , to November 31 , 2007 . METHOD The CATCH-IT intervention model consists of primary care screening to assess risk , a primary care physician interview to encourage participation , and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders . Specifically , we evaluated this program from both a management/organizational behavioral perspective ( provider attitudes and demonstrated competence ) and a clinical outcomes perspective ( depressed mood scores ) using the RE- AIM model ( Reach , Efficacy , Adoption , Implementation , and Maintenance of the intervention ) . RESULTS While results varied by clinic , overall , clinics demonstrated satisfactory reach , efficacy , adoption , implementation , and maintenance of the CATCH-IT depression prevention program . Measures of program implementation and management predicted clinical outcomes at practice s in exploratory analyses . CONCLUSION Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community setting s. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care setting s. TRIAL REGISTRATION Clinical Trials.gov identifiers : NCT00152529 and NCT00145912 
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Conclusion To date , research studies have largely focused on acceptability and appropriateness , while government/organizational documents state goals and recommendations regarding costs , feasibility , and sustainability of eMental healthcare technologies .