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

2/3 老年人中心的非专业行为激活 - 行政补充

基本信息

批准号：
10706663
负责人：
JO ANNE SIREY
金额：
$ 21.42万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-12-15 至 2025-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10706663
关键词：
Address Administrative Supplement Adult Age Aging American Area Asian Behavioral Certification Client Clinical Clinical Trials Communities Community Health Aides County Depressed mood Effectiveness Elderly Eligibility Determination English Language Enrollment Face Florida Goals Health Personnel Hispanic Home Household Improve Access Individual Infrastructure Intervention Language Latino Latino Population Limited English Proficiency Mental Depression Mental Health Mental Health Services Methods Modeling National Institute of Mental Health New York City Not Hispanic or Latino Older Population Outcome Parents Participant Persons Population Poverty Provider Public Health Randomized Reporting Resources Rewards Services Severities Site Supervision Testing Training Translating Translations United States Washington Work aged community organizations community setting cultural competence depressive symptoms effective intervention effectiveness testing ethnic minority population experience geriatric mental health improved non-demented parent grant practice setting preference racial minority population randomized effectiveness trial recruit response skills treatment response volunteer

项目摘要

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.

抽象的针对大量患有抑郁症且未得到治疗的老年中心客户以及深度抑郁症的情况，老年心理健康提供者，我们与高级中心利益相关者合作，以简化行为激活（BA）以匹配非专业志愿者的技能（“做得更多，感觉更好”；DMFB）。 1. 利用现有的志愿者资源来解决劳动力不足的问题；以及 2. 有潜力；作为一种可接受且可持续的实施模式，非专业实施的心理健康干预措施可能是可行的。特别适合克服讲西班牙语的老年人面临的语言和文化障碍，基于对改善西班牙心理健康结果的社区卫生工作者的审查然而，该模型参与同一目标（增加活动）和由于专业提供的干预措施尚未完全确定，因此产生可比的临床结果母公司 Collaborative R01 提出了一项全动力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）的影响以及减少抑郁症状。该补充旨在通过以下方式扩大首选语言为西班牙语的客户的现有试验：翻译 DMFB 并通过 96 名西班牙语客户（每个站点 32 名）丰富 DMFB 与 BA 的 RCT。具体目标是： 1. 与 BA 相比，测试 DMFB 对抑郁症的有效性 (PHQ-9>10 Ham-D>14) 老年人 (>60) 整体增加活动水平（目标）并减少抑郁症状；以及 2. 测试活动水平的增加是否预示着抑郁症严重程度的更大程度降低；增加活动对抑郁症的影响是否在不同条件下均不较差。补充将总共 96 名老年（> 60 岁）非精神病、非痴呆个体，其患有高来自 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人中心的抑郁症状符合资格的客户将在高级中心内被随机分配到 DMFB (n=48) 或 BA。（n=48）。每个中心两名非专业志愿者和两名受青睐的志愿者将提供干预。 2012 年国际移民组织 (IOM) 报告强调了老年人心理健康服务提供者的缺乏以及需要培养非传统服务提供者的劳动力队伍 DMFB 是一种具有巨大潜力的简化 BA 干预措施。通过利用高级志愿者资源和监督基础设施来实现可持续性我们的研究结果将为服务不足且难以参与的人群确定有效的干预措施，我们的老龄化服务合作伙伴很乐意实施 BA 的任一交付格式来激活此外，我们的合作伙伴还鼓励这项西班牙语倡议，该倡议已有潜力接触到大量且不断增长的讲西班牙语的美国老年人，其中许多人经历抑郁症并在获得心理健康服务方面遇到障碍。