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

摘要 为了应对大量患有未经治疗的抑郁症的高级中心客户和缺乏 老年心理健康提供者，我们已经与高级中心利益相关者合作，简化行为 激活(BA)以匹配业馀志愿者的技能集(“做得更多，感觉更好”；DMFB)。层级交付模式： 1.利用现有的志愿者资源，以解决劳动力不足的问题；及2.具有潜力 作为一种可接受和可持续的交付模式。业馀人员提供的心理健康干预措施可能是 特别适合克服说西班牙语的老年人面临的语言和文化障碍， 根据对改善西班牙精神健康状况的社区卫生工作者的审查- 说成年人的话。然而，这一模式参与相同目标(增加活动)和 与专业提供的干预措施相比，产生类似的临床结果尚未完全确定- 有动力的试验。Parent Collaborative R01提出了一种全功率随机有效性试验测试 DMFB与专业提供的BA(BA)在增加活动水平(目标)和 减少抑郁症状。 本附录旨在通过以下方式扩大针对首选语言为西班牙语的客户的现有试用范围 翻译DMFB并丰富DMFB与BA的RCT，拥有96个讲西班牙语的客户(每个站点32个)。 具体目的是：1.与BA相比，测试DMFB对抑郁症的有效性(PHQ-9和GT；10 和Ham-D&gt；14)老年人(&gt；60)提高整体活动水平(目标)和减少抑郁 症状；以及2.测试活动水平增加是否预示着抑郁严重程度的更大程度的降低 运动增加对抑郁的影响是否在不同条件下都不逊色。此活动的客户参与者 补充对象为96名年龄较大(&>60岁)的非精神病、非精神错乱患者。 2个西雅图、2个纽约市和2个坦帕地区提供西班牙语服务的老年中心的抑郁症状- 会说话的社区。符合条件的客户将在高级中心内随机分配到DMFB(n=48)或BA 48例。每个中心将有两名非专业志愿者和两名临床医生提供干预。我们的建议回应了 国际移民组织2012年的报告强调了老年人精神健康提供者的匮乏，以及有必要 培养一支非传统的供应商队伍。DMFB是一种简化的BA干预，具有很高的潜力 通过利用未开发的志愿者资源和老年人内部的监督基础设施来实现可持续性 中锋。我们的发现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乐于实施BA的任一交付格式以激活 抑郁的老年人。此外，我们的合作伙伴鼓励这项西班牙语倡议，该倡议已 接触到数量庞大且不断增长的讲西班牙语的老年美国人的潜力，其中许多人 体验抑郁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.