Volunteer-Delivery of Behavioral Activation for Senior Center Clients

摘要 1R34MH111849-01 为老年中心客户提供行为激活志愿服务 摘要 摘要针对老年中心大量未经治疗的抑郁症患者和老年精神卫生服务提供者的缺乏，我们与纽约市老年部(DFTA)合作，简化了行为激活，以匹配老年中心可用的年龄匹配的非专业志愿者的技能集(志愿者BA)。志愿人员BA的交付模式：1.利用现有的志愿人员资源；2.有潜力成为可接受和可持续的交付模式；3.预期能吸引BA的目标；但4.其产生可比结果的能力尚未确定。R34建议开展在老年中心提供志愿学士学位的发展工作，以达到以标准化程序进行可持续干预的目的。我们随后进行了一项小型随机对照试验，比较志愿者BA和MSW提供的BA在增加客户活动(目标)和减少抑郁症状(临床结果)方面的比较影响。在这个有效性设计中，我们提出：1.增加活动作为BA干预有效性的“目标”；2.通过手册和研究监督提供干预将导致达到增加活动的目标；3.活动增加将预测改善客户抑郁的结果。具体目标是：1.通过细化和标准化志愿者选择、培训和监督的程序；细化和标准化在BA中吸引客户的程序；以及将程序与高级中心工作人员的偏好相匹配，来评估干预的适合度；2.通过确定干预是否代表足够的“剂量”以产生目标参与来标准化干预；以及3.进行小型随机对照试验，以确定干预的可行性、可接受性、安全性和初步影响。客户参与者将是来自西雅图4个服务于经济和种族不同社区的4个大都会地区老年中心的54名年龄较大(&gt；60岁)的非精神病、非痴呆患者，他们的抑郁症状有所上升。在案例系列中，一个中心的3名志愿者将每周为2名抑郁症患者(总共6名)提供12次治疗。对于RCT，每个中心3名志愿者和1名MSW将分别提供志愿者或标准BA。符合条件的客户将在老年中心内随机分配到志愿者BA(n=36)或MSW提供的BA(n=12)。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心理健康提供者的匮乏，以及发展非传统提供者劳动力的必要性。我们的发现将为最终研究志愿者BA对服务不足和难以参与的人群的有效性奠定基础，并将为老龄服务机构在高级志愿者培训和监督程序上投入精力提供进一步的支持。

Abstract of 1R34MH111849-01 Volunteer-Delivery of Behavioral Activation for Senior Center Clients Abstract ABSTRACT In response to large numbers of senior center clients who suffer untreated depression and the dearth of geriatric mental health providers, we partnered with the NYC Department for the Aging (DFTA) to simplify Behavioral Activation to match the skill set of age-matched lay volunteers available to senior centers (Volunteer BA). The Volunteer BA delivery model: 1. Makes use of existing volunteer resources; 2. has potential for being an acceptable and sustainable delivery model; 3. is expected to engage BA targets; but 4. its capacity to yield comparable outcomes is yet to be determined. This R34 proposes developmental work on delivering Volunteer BA in senior centers, so as to arrive to a sustainable intervention with standardized procedures. We follow with a small RCT testing the comparative impact of Volunteer BA versus MSW-provided BA on increased client activity (the target) and reduced depressive symptoms (clinical outcome). In this effectiveness design, we propose: 1. increased activity as the “target” of the BA intervention's effectiveness; 2. delivery of interventions via manuals and research supervision will result in reaching the target of increased activity; and 3. increased activity will predict improved client depression outcome. The specific aims are to: 1. Assess degree of intervention fit by refining and standardizing procedures for volunteer selection, training, and supervision; refining and standardizing procedures for engaging clients in BA; and matching procedures with senior center staff preferences; 2. Conduct a case series to standardize the intervention by determining whether the intervention represents a sufficient “dose” to produce target engagement; and 3. Conduct a small RCT to establish the feasibility, acceptability, safety and preliminary impact of the intervention. The client participants will be a total of 54 older (>60 years) non-psychotic, non-demented individuals with elevated depressive symptoms from 4 Seattle metropolitan area senior centers serving economically and ethnically diverse communities. For the case series, 3 volunteers at one center will provide 12 weekly sessions to 2 depressed clients each (n=6 total). For the RCT, 3 volunteers and 1 MSW per center will provide either Volunteer or standard BA, respectively. Eligible clients will be randomized within senior centers to either Volunteer BA (n=36) or MSW-delivered BA (n=12). 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. Our findings will set the stage for a definitive study on the effectiveness of Volunteer BA for an underserved and difficult to engage population, and will provide further support for aging service agencies to invest effort in senior volunteer training and supervision procedures.