2/3 Lay-delivered Behavioral Activation in Senior Centers - Administrative Supplement

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）。铺设交付模式： 1.利用现有的志愿者资源，解决劳动力不足的问题; 2.具有潜在 成为一个可接受的和可持续的交付模式。非专业人员提供的心理健康干预可能是 特别适合克服讲西班牙语的老年人所面临的语言和文化障碍， 根据对社区卫生工作者的审查，他们改善了西班牙人的心理健康结果， 成年人说话。然而，这种模式的能力，从事同一目标（增加活动）， 产生可比的临床结果，因为专业提供的干预措施尚未在一个全面的 动力试验母公司协作R 01提出了一项完全有效的随机有效性试验测试 与专业提供的BA（BA）相比，DMFB对增加活动水平（目标）的影响， 减少抑郁症状。 该补充文件旨在扩大现有的审判，为客户的首选语言是西班牙语，通过 DMFB的翻译，并通过96名讲西班牙语的客户（每个研究中心32名）丰富DMFB与BA的RCT。 具体目标是：1.测试DMFB与BA相比对抑郁症（PHQ-9>10）的有效性 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。客户参与者在此 补充剂将是总共96名老年（>60岁）非精神病、非痴呆个体， 来自2个西雅图、2个纽约市和2个坦帕地区老年中心的抑郁症状， 说话的社区。合格的客户将在老年中心内随机分配至DMFB（n=48）或BA （n=48）。每个中心将有2名非专业志愿者和2名临床医生提供干预。我们的建议回应了 国际移民组织2012年的报告强调，老年人缺乏心理健康服务提供者，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，具有很高的潜力 通过利用未开发的志愿者资源和监督基础设施， 中心.我们的研究结果将为服务不足和难以参与的人群确定有效的干预措施， 我们的老龄服务合作伙伴将很乐意实施BA的任何一种交付形式， 抑郁的老年人此外，我们的合作伙伴鼓励这一西班牙语倡议， 有可能接触到越来越多的讲西班牙语的美国老年人，其中许多人 经历抑郁症和获得心理健康服务的障碍。

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. Lay-delivered mental health interventions may be particularly well suited to overcome the language and cultural barriers faced by Spanish-speaking older adults, based on reviews of community health workers who have improved mental health outcomes for Spanish- speaking adults. 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. The parent Collaborative R01 proposes a fully powered randomized effectiveness trial testing the effect of DMFB in comparison to professionally-delivered BA (BA) on increased activity level (target) and decreased depressive symptoms. This supplement seeks to expand the existing trial for clients whose preferred language is Spanish, through translation of DMFB and enriching the RCT of DMFB vs. BA with 96 Spanish-speaking clients (32 per site). The specific aims are to: 1. Test the effectiveness of DMFB, in comparison to 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 in this supplement will be a total of 96 older (>60 years) non-psychotic, non-demented individuals with elevated depressive symptoms from 2 Seattle, 2 New York City, and 2 Tampa area senior centers serving Spanish- speaking communities. Eligible clients will be randomized within senior center to either DMFB (n=48) or BA (n=48). Two lay volunteers and 2 clinicians 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. Moreover, our partners have encouraged this Spanish language initiative, which has the potential to reach the large and growing numbers of Spanish-speaking older Americans, many of whom experience depression and barriers to accessing mental health services.