Improving CLTC System Response to Late Life Depression

描述（由申请人提供）：根据NIMH PAR-03-078，“从干预发展到服务：探索性研究资助”（R34），我们寻求支持，开发一种系统级干预，以改善接受公共资助的社区长期护理（CLTC）服务的抑郁老年人的护理。我们的目标是开发一个系统的改进，是可接受的，并可以在公共CLTC持续。我们将采用一种分阶段的干预发展模式，利用已发表的研究（全球知识）和通过我们8年临床流行病学和服务系统研究积累的当地护理系统知识。具体目标是：(1)巩固全球知识（来自已发表的研究）和当地知识（来自CLTC系统先前的工作）关于(a)抑郁症的患病率、病程和合并症；(b)利益相关者对抑郁症治疗的偏好，以及(c) CLTC应对抑郁症的资源，以得出干预的含义；(2)聘请专家小组利用这些知识来指定干预措施，“评估，联系和支持”，以改善CLTC的抑郁症护理；(3)制订治疗和培训手册；(4)制定客户和系统结果的跟踪方法；(5)评估干预措施的可行性、可接受性和适当性，并为后续的有效性研究收集初步数据。质量改进和组织复杂性理论为干预发展模型提供了理论依据。采用行为聚合方法，我们将召集一个由地方和国家专家组成的多学科小组来审查拟议的干预措施，基于竞争需求理论的具体成分，网关过滤器链接模型，以及动机增强-改变的准备。这项发展干预措施的努力响应了总统新自由委员会关于精神健康的报告（2003年）的建议，即在公共卫生和人类服务中建立精神健康筛查和早期干预方案。通过CLTC改善抑郁症护理可以将心理健康治疗扩展到社会和经济上处于不利地位的老年人，这些老年人历来没有充分利用专业精神卫生保健。我们将通过R01研究来严格测试干预的有效性。

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.