2/3 Lay-delivered Behavioral Activation in Senior Centers

摘要 针对大量患有未经治疗的抑郁症和缺乏治疗的老年中心客户， 老年心理健康提供者，我们与高级中心利益相关者合作， 激活（BA）以匹配非专业志愿者的技能集（“做得更多，感觉更好”; DMFB）。 奠定交付模式：1.利用现有的志愿者资源， 劳动力; 2。有可能成为可接受和可持续的交付模式。然而，能力 该模型的目标相同（活性增加），并产生与 专业提供的干预措施尚待在充分有力的试验中确定。 本协作R 01提出了充分把握度的随机有效性试验，以测试DMFB在 与专业提供的BA（MSW BA）相比，活动水平（目标）增加， 抑郁症状 具体目标是：1.测试DMFB的有效性，与MSW BA相比，对于抑郁症（PHQ- 9>10和Ham-D>14）老年人（>60）增加整体活动水平（目标）和减少抑郁症 症状; 2。测试活动水平的增加是否预示着抑郁症严重程度的降低， 增加活动对抑郁症的影响是否在各种条件下都是非劣效的。 客户参与者将是总共288名老年（>60岁）非精神病、非痴呆的个体， 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， 和种族多样的社区。符合条件的客户将在老年中心内随机分配至DMFB （n=144）或MSW BA（n=144）。每个中心将有2名非专业志愿者和2名医务工作者提供干预。 我们的建议是对2012年国际移民组织报告的回应，该报告强调了老年人缺乏心理健康服务提供者的问题。 成年人和需要发展非传统供应商的劳动力。DMFB是一种简化的BA干预措施 通过利用未开发的志愿者资源和监督， 老年中心内的基础设施。我们的研究结果将确定有效的干预措施， 很难吸引人口，我们的老龄服务合作伙伴将很乐意实施任何一种交付方式 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.