Collaborative Stepped Care and Peer Support Programme for Older People At-Risk of or With Depression

Study Overview
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Brief Summary
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To develop a viable and sustainable best practice model to promote elderly mental wellness and prevent elderly depression for Hong Kong, the Hong Kong Jockey Club Charities Trust has initiated a pilot holistic support project entitled JC JoyAge: Holistic Support Project for Elderly Mental Wellness. Commenced in October 2016, this 3-year project will deliver six programmes: (1) social services staff training; (2) peer supporters certificate training; (3) outreach and engagement activities for at-risk older adults; (4) standardized prevention and early intervention service; (5) community education programmes; and (6) public awareness and public education activities in four pilot districts in Hong Kong, namely Kwun Tong, Sham Shui Po, Kwai Chung, and Tseung Kwan O. The project aims specifically to: Evaluate the effectiveness of a collaborative stepped care and peer support programme in engaging older people at-risk of or with depression; Evaluate the efficacy of the programme in reducing symptoms/risks and promoting wellbeing in older people at-risk of or with depression; Investigate the impact of the programme on care resources utilization in these older adults.

Detailed Description
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Elderly depression is a neglected problem affecting our entire society with grave consequences and high societal costs. Early intervention and prevention can be effective in addressing the problem. The challenges in implementing early intervention and prevention within the existing service platforms, however, are threefold: (1) fragmented services; (2) reactive services; and (3) stigma and low awareness. These challenges resulted in the current service overload and mismatch, which will be compounded by rapid population ageing and mental health workforce shrinkage. The study can address these challenges by (1) realigning existing mental health and elderly services; (2) productive ageing for outreach and engagement; and (3) building up capacity of a preventive network in the neighbourhood. This pilot project therefore combines models of collaborative stepped care and productive ageing, with systematic education programmes, to empower the neighbourhood in providing effective early intervention and prevention for elderly depression. In the four representative pilot districts of Kwun Tong, Sham Shui Po, Kwai Chung, and Tseung Kwan O, community mental health and elderly services will collaborate to deliver a stepped care service protocol for preventing and detecting elderly depression. In 3 years, this project will deliver six programmes: (1) social services staff training; (2) peer supporters certificate training; (3) outreach and engagement activities for at-risk older adults; (4) standardized prevention and early intervention service; (5) community education programmes; and (6) public awareness and public education activities. This will produce a mature service model tested in one-fifth of the districts in Hong Kong with different demographic and service characteristics; create a strong team of Peer Supporters and Social Workers in Elderly Mental Health with clinical competence in preventing elderly depression and promoting elderly mental wellness; significantly raise public and neighbourhood awareness and care for elderly mental wellness; reach out and serve 2,880 at-risk older adults and 960 depressed older adults; and provide evidence on the social impact of the model for further service rollout.

Official Title
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Jockey Club JoyAge: Holistic Support Project for Elderly Mental Wellness

Conditions
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Depressive Symptoms

Intervention / Treatment
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* Behavioral: Collaborative stepped care and peer support programme
* Other: Treatment as usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: residing in Kwun Tong, Kwai Chung, Tseung Kwan O, or Sham Shui Po; and have one or more known risk factor(s) for developing depression; and/or have depressive symptoms of mild level or above; and able to give informed consent to participate Exclusion Criteria: known history of autism, intellectual disability, schizophrenia-spectrum disorder, bipolar disorder, Parkinson's disease, or dementia; and imminent suicidal risk; and difficulty in communication

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The intervention group will receive a collaborative stepped care programme provided by registered social workers and trained peer supporters from elderly or mental health service units (NGOs) according to level of risks, symptom severity, and intervention response. Home visits or other format of contact will be delivered by trained peer supporters employed by NGOs to detect and engage hidden cases. The control group will receive treatment as usual, which will be determined by the responsible worker from NGO units.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>The intervention group will receive a collaborative stepped care programme provided by registered social workers and trained peer supporters from elderly or mental health service units (NGOs) according to level of risks, symptom severity, and intervention response. Home visits or other format of contact will be delivered by trained peer supporters employed by NGOs to detect and engage hidden cases. | Behavioral: Collaborative stepped care and peer support programme<br>* For at-risk group, 4 weeks of selective prevention group sessions will be provided at the elderly service level by trained peer supporters with registered social worker supervision, on wellness topics tailored to the person's concern as entry point, packaged with mental health information, followed by a review. For mild group, 6-8 weeks of indicated prevention with psychoeducation or low-intensity psychotherapy would be provided. For moderate group, 6-8 weeks high-intensity cognitive behavioral therapy (CBT) would be provided. All intervention for depressed elderly would be conducted by registered social workers. The trained peer supporters will be matched to individual older adults to walk them through the process with regular follow-up for 1 year.<br>|
| Other: Control group<br>The control group will receive treatment as usual, which will be determined by the responsible worker from NGO units. | Other: Treatment as usual<br>* The control group will receive treatment as usual, which will be determined by the responsible workers from NGO units.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline depression at 12 months | Depression will be measured by the Patient Health Questionnaire (PHQ-9). The total score will be used, ranging from 0 to 27. Higher scores indicate higher levels of depressive symptoms. | Baseline and 12-month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline loneliness at 12 months | Loneliness will be measured by the UCLA loneliness scale (UCLA-3). The total score will be used, ranging from 0 to 9. Higher scores indicate greater loneliness. | Baseline and 12-month follow-up | 
| Change from baseline life engagement at 12 months | Life engagement will be assessed using the typical day interview - a semi-structured interview asking clients about their typical day activities | Baseline and 12-month follow-up | 
| Change from baseline self-harm risk at 12 months | Self-harm risk will be measured by the self-harm risk assessment checklist. | Baseline and 12-month follow-up | 
| Change from baseline anxiety at 12 months | Anxiety will be measured by the Generalized Anxiety Disorder scale (GAD-7). The total score will be used, ranging from 0 to 21. Higher scores indicate higher levels of anxiety symptoms. | Baseline and 12-month follow-up | 
| Change from baseline cognitive function at 12 months | Cognitive function will be measured by the Hong Kong Montreal Cognitive Assessment 5-Minute Protocol (HK-MoCA 5-Min). The total score will be used, ranging from 0 to 30. Higher scores indicate higher levels of cognitive function. | Baseline and 12-month follow-up | 
| Change from baseline social capital at 12 months | Participants will be asked to list out names of people who they would turn to when they feel down, and when they need help for trivial things. | Baseline and 12-month follow-up | 
| Change from baseline health-related quality of life at 12 months | Health-related quality of life will be measured by the EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L). | Baseline and 12-month follow-up | 
| Change from baseline service utilization at 12 months | Service utilization will be measured by the Client Service Receipt Inventory (CSRI). | Baseline and 12-month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Collaborative stepped care, Peer support, Early identification, Selective prevention, Indicated prevention