Reaching and Engaging Depressed Senior Center Clients (REDS): A Community Care Model

Weill Medical Coll Of Cornell Univ, New York NY

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Abstract

REDS ABSTRACT In response to the large numbers of senior center clients who suffer from untreated depression, we have partnered with the NYC Department for the Aging (DFTA) to develop SMART-MH, a community care model that can be embedded in senior centers to improve recognition, referral, and adherence to depression treatment. We also developed and tested Engage, a stepped-care therapy streamlined to use ?reward exposure? as its principal intervention based on the assumption that dysfunction of the reward networks is central to the pathogenesis of depression. With our senior center partners and our mobile technology team, we redesigned Engage-M so that it can be used in a group format by licensed clinical social workers (LCSWs) of Senior Centers. Mobile technology provides probes for client adherence and offers to therapists easy to review summary records of mood, activity, and social interaction that can be used to target their sessions. We have integrated SMART-MH and Engage-M into a comprehensive community care model ?Reaching and Engaging Depressed Senior Center Clients? (REDS). The specific aims of this developmental project are to: 1. Finalize the REDS protocol and assess feasibility of training; 2. Prepare an Operations' Manual; 3. Examine reach, feasibility, and acceptability of REDS; 4. Examine engagement of behavioral targets and preliminary effectiveness; and 5) Collect information on REDS cost, barriers to implementation, and potential savings in health care utilization. We will randomly assign four senior centers to offer either Engage-M (N=40), the treatment offered by REDS (1 individual and 8 weekly group sessions) or 8 group sessions ?Wellness in Mind and Body? plus mental health referral (W-MH; N=20). The participants will have clinically significant depressive symptoms (PHQ-9>10) and will be older and middle-aged adults (55+); 12.6% of the NYC senior center clients are aged 55-65 years. Clients will be identified by senior center staff trained in SMART-MH strategies. We will offer additional training to staff of all centers on SMART-MH outreach, depression screening, and treatment engagement. We will train and provide weekly supervision to 2 or more LCSWs per center of the two centers assigned to Engage-M. We will not offer training or supervision to senior center staff leading the groups of W-MH but we will provide oversight so that clients receive mental health referrals and are encouraged to attend weekly Wellness group meetings. Our findings will set be used in a R01 study to formally test the feasibility, acceptability, effectiveness, non- billable costs, and barriers of REDS beyond NYC. If proven effective, with administrative support, REDS can be extended nationally and supported by billable services.