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.
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 be delivered by age-matched volunteers (Volunteer BA). The focus of BA is to guide clients to reengage in daily pleasant and rewarding activities, and reduce depressive symptoms. If we can show that the Volunteer BA delivery model is feasible, acceptable, safe, and has positive preliminary impact in comparison to MSW-delivered BA, we will have identified an effective adjunct intervention that can be used by a large untapped workforce of senior volunteers across the nation.
