This is a resubmission of an R34 exploratory/developmental grant application. The proposed pilot study is designed to evaluate the feasibility and preliminary efficacy of telehealth problem-solving therapy (tele-PST) for homebound older adults suffering from clinically significant moderate-to-severe depressive symptoms. Equipment includes a broadband cable or DSL modem and a wireless videoconferencing device that is securely connected to an older adult's home television set and to the therapist's workstation, with the conferencing beginning when the therapist calls the older-adult client. The real-time, interactive videoconferencing is likely to allow the therapist and the client most of the benefits of in-person sessions. In order to pursue the study aims, we have chosen a two-phase research design. In Phase I, we will implement an uncontrolled feasibility study of six weekly sessions of tele-PST with 10 subjects recruited from a Meals on Wheels program and an in-home support services program in central Texas and evaluate the subjects'acceptance of the intervention and procedural and logistical issues that may arise during its implementation. At a 2-week, one-time follow-up, the subjects'depression, disability, and resourcefulness will also be assessed. In Phase II, we will implement a small-scale, three-group RCT with 30 subjects in each group. The first group will receive up to six weekly tele-PST sessions. The second group will receive up to six weekly in- person PST sessions. Both groups will also receive six monthly maintenance calls from their therapists following the PST sessions. The Phase I findings will guide any modifications and adaptations in tele-PST and in-person PST procedures to be used in Phase II. In-person PST serves as the benchmark or gold standard of comparison for detecting signals that are suggestive of efficaciousness of tele-PST. The third group, an attention control group, will receive six weekly telephone calls and six monthly calls. All three groups will continue to receive their usual services of home-delivered meals or in-home support services and case management from their agency case managers. Two MSW-level therapists will be used, each of whom will conduct both tele-PST and in-person PST sessions.
Specific aims i n this phase are to (1) assess adequacy of recruitment, enrollment, and retention strategies with special attention to racial/ethnic minorities, and of research instruments;(2) compare compliance rates and service delivery cost between tele-PST and in- person PST;and (3) estimate preliminary effect size and detect clinically significant signals with regard to depression, disability, other health status, and resourcefulness outcomes of tele-PST compared to those of in- person PST and attention control condition at 2 weeks, 12 weeks, and 24 weeks following the conclusion of the 6 weekly PST sessions. The findings are expected to provide data necessary for designing a future RCT to test the replicability, therapeutic efficacy, and cost effectiveness of tele-PST with a larger sample of disabled homebound persons. The public health significance of this study lies in the fact that telehealth PST (tele-PST) may have potential to significantly reduce access barriers not only among homebound older adults but among other disabled persons. Given the current and projected shortage in the mental health workforce, tele-PST holds promise as the most practical and accessible depression treatment for homebound older adults and other disabled persons.
The public health significance of this study lies in the fact that telehealth PST (tele-PST) may have potential to significantly reduce access barriers not only among homebound older adults but among other disabled persons. Given the current and projected shortage in the mental health workforce, tele-PST holds promise as the most practical and accessible depression treatment for homebound older adults and other disabled persons.
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