Reaching and Engaging Depressed Senior Center Clients (REDS)
Condition: Depression, Unipolar; Mental Health Disorder
MeSH terms: Mental Disorders; Depressive Disorder
Study type: Interventional

Summary: 
      The purpose of this study is to test the feasibility of two types of group therapy sessions.
      The research is being done because the researchers are trying to learn if these approaches
      could be used by therapist in the community social service agencies to treat older adults
      with depression. There are two study groups. One group is a form of group therapy called
      "Engage-M", which encourages subjects to engage in physical and social activities that they
      find pleasurable or rewarding. One group is another form of group therapy called, "Wellness
      in Mind and Body", which focuses on education and de-stigmatization of health and mental
      health conditions.
    

Detailed description: 
      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. The investigators 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 senior center partners and a mobile
      technology team, the investigators 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. The
      investigators 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.

      The investigators 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. The investigators will
      offer additional training to staff of all centers on SMART-MH outreach, depression screening,
      and treatment engagement. The investigators will train and provide weekly supervision to 2 or
      more LCSWs per center of the two centers assigned to Engage-M. The investigators will not
      offer training or supervision to senior center staff leading the groups of W-MH but will
      provide oversight so that clients receive mental health referrals and are encouraged to
      attend weekly Wellness group meetings.
    

Intervention name(s): Engage-M; Wellness in Mind and Body
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Engage is a stepped care psychotherapy based on what is known about how older adults respond to depression interventions. Stepped care is a model of treatment that starts with the minimum effective therapeutic techniques first, and then based on how well people respond to treatment, additional therapeutic techniques are added until people are recovered from their depression.; An active intervention focusing on psychoeducation and de-stigmatization of health and mental health conditions. These sessions are commonly part of senior centers programs. W-MH will offer mental health referral to a clinic or primary care physician as part of senior center procedures for clients with positive PHQ-9s.
Other intervention name(s): W-MH
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Investigators 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). Participants will have clinically significant depressive symptoms (PHQ-9>10) and will be older and middle-aged adults (55+). Clients will be identified by senior center staff trained in SMART-MH strategies. Investigators will offer additional training to staff of all centers on SMART-MH outreach, depression screening, and treatment engagement. Investigators will train and provide weekly supervision to 2 or more LCSWs per center of the two centers assigned to Engage-M. Investigators will not offer training or supervision to senior center staff leading the groups of W-MH but will provide oversight so that clients receive mental health referrals and are encouraged to attend weekly Wellness group meetings.
Masking: None (Open Label)
Primary purpose: Treatment