Engaging Depressed Low-Income Seniors in Mental Health Services (ENGAGE)
This two-stage research study will
- train caseworkers in three participating New York City Neighborhood Houses to screen their clients for depression, and
- examine the usefulness of training these caseworkers in an intervention that targets barriers seniors face in receiving mental health services. In this intervention, called ENGAGE, Case Workers will: 1. identify and address seniors' barriers to receiving mental health services; 2. include the seniors' preferences in deciding which treatment options to choose; and 3. help seniors connect with affordable mental health services of their choice.
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
|Official Title:||Engaging Depressed Low-Income Seniors in Mental Health Services|
- Feasibility of ENGAGE intervention [ Time Frame: Measured at Baseline, 4, 8, and 12 weeks ] [ Designated as safety issue: No ]Examine the feasibility of training case workers in 3 Neighborhood Houses in ENGAGE - an intervention that identifies and addresses attitudinal and concrete barriers to pursuing evaluation and care; incorporates shared decision making in service and treatment options; and facilitates connection to affordable mental health services.
- Increase in referrals for mental health evaluation [ Time Frame: Measured at Baseline, 4, 8, and 12 weeks ] [ Designated as safety issue: No ]Conduct a preliminary study to evaluate whether ENGAGE can increase the number of seniors (with symptoms of depression on a screen) who follow through with a referral for mental health evaluation.
|Study Start Date:||March 2010|
|Estimated Study Completion Date:||March 2014|
|Estimated Primary Completion Date:||March 2014 (Final data collection date for primary outcome measure)|
In stage 1, study investigators will train Neighborhood House caseworkers to screen their clients for depressive symptoms.
In stage 2, study investigators will train Neighborhood House caseworkers to use the ENGAGE intervention in referring their clients to mental health services
During Stage 1, study investigators will work with three Neighborhood Houses in implementing research assessments, referral patterns, and connections to mental health evaluation among their depressed senior clients. Investigators will train caseworkers to administer a brief depression screen and will also instruct caseworkers to refer depressed seniors to local community-based mental health or medical clinics. Data on successful connections to mental health evaluation will serve as the comparison to that achieved during Stage 2.
During Stage 2, study investigators will train Neighborhood House caseworkers to 1. provide psychoeducation that addresses client-specific barriers to evaluation and care; 2. use shared decision-making strategies to engage seniors and arrive at a decision about where and from whom to receive an evaluation and possible care; and 3. provide connections to preferred mental health services (primary care physician, local mental health clinic).
In this research study, study investigators are partnering with United Neighborhood Houses of New York, the umbrella membership organization of the 34 New York City Neighborhood Houses. Due to the limited scope of this feasibility study, we have selected three Houses to serve as recruitment sites. These three house approximate the gender and racial characteristics of the larger group.
During Stage 1, investigators will work with the three Houses in implementing systematic research assessments to identify level of psychopathology, referral patterns, and connections to mental health evaluation among their depressed senior clients. Investigators will train caseworkers to screen their clients for depression and will also instruct caseworkers to refer any senior scoring endorsing depressive symptoms to their partnering community-based mental health or medical clinic. Data on successful connections to mental health evaluation will serve as the comparison to that achieved by Stage 2, the ENGAGE intervention.
During Stage 2 study investigators will train all caseworkers from each Neighborhood House to use the ENGAGE intervention. For eligible depressed seniors, the caseworker will:
- provide psychoeducation that addresses client-specific barriers to evaluation and care (e.g., stigma, transportation);
- use shared decision-making strategies to engage seniors and arrive at a decision about where and from whom to receive an evaluation and possible care; and
- provide connections to preferred mental health services. Mental health service options will include referral to the senior's primary care physician or local community mental health clinic for further evaluation.
In two subsequent sessions 2 and 4 weeks later, the caseworker will assess success in receiving a mental health evaluation, and in initiating treatment:
- If the senior has not yet pursued an evaluation, the caseworker will continue to address his/her individual barriers and will re-engage in shared decision-making if necessary.
- If the senior did receive an evaluation that confirms a depressive diagnosis, but remains undecided about treatment, the case worker will empower and help the senior to select an appropriate treatment of his/her choice and will encourage ongoing engagement in this treatment.
- If an evaluation revealed the absence of a depressive disorder and no treatment recommendations, the caseworker will re-assess to ensure that depression did not emerge.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01094951
|United States, New York|
|United Neighborhood Houses|
|New York, New York, United States|
|Principal Investigator:||Patrick J. Raue, Ph.D.||Weill Medical College of Cornell University|
|Study Director:||George S. Alexopoulos, M.D.||Weill Medical College of Cornell University|