2/3 Lay-delivered Behavioral Activation in Senior Centers

摘要 为了应对大量患有未经治疗的抑郁症的高级中心客户和缺乏 老年心理健康提供者，我们已经与高级中心利益相关者合作，简化行为 激活(BA)以匹配业馀志愿者的技能集(“做得更多，感觉更好”；DMFB)。 外行提供模式：1.利用现有的志愿者资源，解决不足的问题 2.具有成为可接受和可持续的交付模式的潜力。然而，运力 该模型的目标相同(活动增加)，并产生与 专业提供的干预措施尚未在完全有效的试验中确定。 Collaborative R01建议进行全功率随机有效性试验，以测试DMFB在 与专业提供的BA(MSW BA)相比，活动水平(目标)增加和减少 抑郁症状。 其具体目的是：1.测试DMFB与MSW BA相比，对抑郁症(PHQ- 9&>10和Ham-D&>14)老年人(&>60)提高整体活动水平(目标)和减少抑郁 症状；以及2.测试活动水平增加是否预示着抑郁严重程度的更大程度的降低 运动增加对抑郁的影响是否在不同条件下都不逊色。 客户参与者将是总共288名年龄较大(&>60岁)的非精神病、非痴呆症患者。 来自6个西雅图、6个纽约市和6个坦帕地区老年中心的抑郁症状为经济服务 和种族多元化的社区。符合条件的客户将在高级中心内随机分配到DMFB (n=144)或城市生活垃圾管理局(n=144)。每个中心将有两名非专业志愿者和两名医务工作者提供干预。 我们的建议回应了国际移民组织2012年的报告，该报告强调了老年人心理健康提供者的匮乏 以及培养一支非传统提供者队伍的必要性。DMFB是简化的BA干预 通过利用未开发的志愿者资源和监督，这具有很高的可持续性潜力 老年中心内的基础设施。我们的发现将确定对服务不足和 很难吸引人口，我们的老龄服务合作伙伴将很高兴实施这两种服务中的一种 BA的形式，以激活抑郁的老年人。

ABSTRACT In response to large numbers of senior center clients who suffer untreated depression and the dearth of geriatric mental health providers, we have partnered with senior center stakeholders to simplify Behavioral Activation (BA) to match the skill set of lay volunteers (“Do More, Feel Better”; DMFB). The lay delivery model: 1. makes use of existing volunteer resources that can address the insufficient workforce; and 2. has potential for being an acceptable and sustainable delivery model. However, the capacity of this model to engage the same target (increased activity) and to yield comparable clinical outcomes as professionally-delivered interventions is yet to be determined in a fully-powered trial. This Collaborative R01 proposes fully powered randomized effectiveness trial testing the effect of DMFB in comparison to professionally-delivered BA (MSW BA) on increased activity level (target) and decreased depressive symptoms. The specific aims are to: 1. Test the effectiveness of DMFB, in comparison to MSW BA, for depressed (PHQ- 9>10 and Ham-D>14) older adults (>60) on increasing overall activity level (target) and reducing depression symptoms; and 2. test whether increased activity level predicts greater reduction in depression severity and whether increased activity's impact on depression is non-inferior across conditions. Client participants will be a total of 288 older (>60 years) non-psychotic, non-demented individuals with elevated depressive symptoms from 6 Seattle, 6 New York City, and 6 Tampa area senior centers serving economically and ethnically diverse communities. Eligible clients will be randomized within senior center to either DMFB (n=144) or MSW BA (n=144). Two lay volunteers and 2 MSWs per center will provide the intervention. Our proposal responds to the 2012 IOM report which highlighted the dearth of mental health providers for older adults and the need to develop a workforce of nontraditional providers. DMFB is a streamlined BA intervention that has high potential for sustainability by making use of an untapped volunteer resource and supervision infrastructure within senior centers. Our findings will identify effective interventions for an underserved and difficult to engage population, our partners in aging services would be pleased to implement either delivery format of BA to activate depressed older adults.