Improving CLTC System Response to Late Life Depression

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DESCRIPTION (provided by applicant): In response to NIMH PAR-03-078, "From intervention development to services: Exploratory Research Grants" (R34), we seek support to develop a system-level intervention for improving care for depressed older adults who receive publicly funded community long-term care (CLTC) services. Our goal is to develop a system improvement that is acceptable to and can be sustained in public CLTC. We will employ a staged model for intervention development drawing on both published research (global knowledge) and local knowledge of the system of care accrued through our 8 years of clinical epidemiological and service systems research. Specific Aims are to (1) Consolidate global knowledge (from published studies) and local knowledge (gained from prior work in the CLTC system) about (a) depression prevalence, course, and comorbidities; (b) stakeholder preferences for depression treatment, and (c) CLTC resources for responding to depression for purposes of deriving implications for intervention; (2) Engage an expert panel to use this knowledge to specify an intervention, "Assess, Link, and Support," to improve depression care in CLTC; (3) Develop treatment and training manuals; (4) Develop tracking methods for client and system outcomes; and (5) Assess the feasibility, acceptability, and appropriateness of the intervention and collect preliminary data for a subsequent effectiveness study. Quality improvement and organizational complexity theories inform the model of intervention development. Employing behavior aggregation methods, we will convene a multidisciplinary panel of local and national experts to vet a proposed intervention, specific ingredients which are based on theories of competing demands, the gateway filter linkage model, and motivational enhancement-readiness to change. This intervention development effort is responsive to recommendations of the President's New Freedom Commission Report on Mental Health (2003) to institute mental health screening and early intervention programs in public health and human services. Improving depression care through CLTC can extend mental health treatment to socially and economically disadvantaged elders, who historically have underutilized specialty mental health care. We will follow this work by an R01 study to test the intervention's effectiveness rigorously.