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Kennedy MA, Stevens CJ, Pepin R, Lyons KD. Behavioral Activation: Values-Aligned Activity Engagement as a Transdiagnostic Intervention for Common Geriatric Conditions. THE GERONTOLOGIST 2024; 64:gnad046. [PMID: 37068017 PMCID: PMC10943502 DOI: 10.1093/geront/gnad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 04/18/2023] Open
Abstract
Scalable, transdiagnostic interventions are needed to meet the needs of a growing population of older adults experiencing multimorbidity and functional decline. Behavioral activation (BA) is a pragmatic, empirically supported treatment for depression that focuses on increasing engagement in values-aligned activities. We propose BA is an ideal transdiagnostic intervention approach for older adults because it (a) specifically targets activity restriction, a shared characteristic of common conditions of aging; and (b) has strong potential for scalability through delivery by a broad range of clinician and nonclinician interventionists and via telehealth. We describe the history of BA and review recent literature demonstrating impacts beyond depression including on cognition, social isolation, and disability. We also describe the feasibility of delivering BA across interventionists, settings, and modalities. Our approach advances scholarship by proposing BA as a scalable, transdiagnostic behavioral intervention to address functional decline in older adults with common geriatric conditions.
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Affiliation(s)
- Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medicine Center, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Renée Pepin
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen D Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
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Raue PJ. The Promise of Peer-Led Interventions for Older Adults. Am J Geriatr Psychiatry 2023; 31:596-597. [PMID: 36934066 DOI: 10.1016/j.jagp.2023.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Affiliation(s)
- Patrick J Raue
- University of Washington, Department of Psychiatry & Behavioral Sciences, 1959 NE Pacific St, Box 356560, Seattle WA 98195.
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Anvari MS, Hampton T, Tong MP, Kahn G, Triemstra JD, Magidson JF, Felton JW. Behavioral Activation Disseminated by Non-Mental Health Professionals, Paraprofessionals, and Peers: A Systematic Review. Behav Ther 2022; 54:524-538. [PMID: 37088508 DOI: 10.1016/j.beth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
There is a striking disparity between the number of individuals with significant mental health concerns and those who are able to access care globally. One promising solution to expanding the mental health taskforce is task-sharing, or employing nonspecialists in the delivery of evidence-based interventions. Behavioral activation (BA), a brief intervention that focuses on scheduling rewarding activities into one's daily life, may have promise for delivery using task-sharing approaches due to its straightforward, flexible nature. The aim of this systematic review was to examine the current state of the literature on non-specialist-delivered BA and evaluate the evidence base of this approach. Three databases (Pubmed, PsycInfo, and Cochrane) were searched, and all articles were screened for inclusion criteria by two research assistants, included the review of titles, abstracts, and full-text. The final dataset consisted of 13 research studies, represented through 15 articles. A meta-analysis was conducted to examine the overall pooled effects of peer-delivered BA on depressive symptoms (the most widely examined clinical outcome). Studies reported on effectiveness and implementation outcomes of non-specialist-delivered BA for depression, substance use, loneliness, trauma survivors, and individuals with comorbid physical health conditions. Results provide initial support for the effectiveness of BA utilizing a task-sharing approach, and highlight the feasibility and acceptability of using nonspecialists to deliver BA in a variety of contexts, including low-resource settings.
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Affiliation(s)
| | - Tessa Hampton
- Center for Health Policy & Health Services Research, Henry Ford Health
| | | | - Geoffrey Kahn
- Center for Health Policy & Health Services Research, Henry Ford Health
| | - Justin D Triemstra
- Spectrum Health, Helen DeVos Children's Hospital; College of Medicine, Michigan State University
| | | | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit
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Raue PJ, Sirey JA, Gum A, Hawrilenko M, Fisher DM. Protocol for a collaborative randomised effectiveness trial of lay-delivered versus clinician-delivered behavioural activation in senior centres. BMJ Open 2022; 12:e066497. [PMID: 35998966 PMCID: PMC9403148 DOI: 10.1136/bmjopen-2022-066497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Depression is common among community-dwelling older adults who make use of senior centre services yet remains undertreated due to a lack of acceptable and available treatments. Emerging evidence suggests that lay health providers can offer psychosocial interventions for mental health disorders experienced by older adults. We developed a streamlined Behavioural Activation intervention (called 'Do More, Feel Better'; DMFB) to be delivered by older adult volunteers and propose to compare its effectiveness to that of clinician-delivered behavioural activation (BA). METHODS AND ANALYSIS This study is a type I collaborative randomised effectiveness trial testing the effect of DMFB in comparison to BA among 288 senior centre clients (aged 60+). Participant clients will be recruited from 6 Seattle, 6 New York City and 6 Tampa area senior centres serving economically and ethnically diverse communities. Primary outcomes will be increased activity level (target) and decreased depressive symptoms. Secondary outcomes will be functioning and client satisfaction, and an exploratory outcome will be treatment fidelity. ETHICS AND DISSEMINATION The study received ethics approval from the University of Washington Institutional Review Board (STUDY00011434). Client, volunteer and clinician participants will all provide informed consent for study procedures through in-person or remote contact with investigators. Results of this study will be presented in peer-reviewed journals and at professional conferences. TRIAL REGISTRATION NUMBER NCT04621877; ClinicalTrials.gov.
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Affiliation(s)
- Patrick J Raue
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington State, USA
| | - Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Amber Gum
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
| | | | - Dylan M Fisher
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington State, USA
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Cluley V, Ziemann A, Feeley C, Olander EK, Shamah S, Stavropoulou C. Mapping the role of patient and public involvement during the different stages of healthcare innovation: A scoping review. Health Expect 2022; 25:840-855. [PMID: 35174585 DOI: 10.1111/hex.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) has become increasingly important in the development, delivery and improvement of healthcare. PPI is used in healthcare innovation; yet, how it is used has been under-reported. The aim of this scoping review is to identify and map the current available empirical evidence on the role of PPI during different stages of healthcare innovation. METHODS The scoping review was conducted in accordance with PRISMAScR and included any study published in a peer-reviewed journal between 2004 and 2021 that reported on PPI in healthcare innovation within any healthcare setting or context in any country. The following databases were searched: Medline, EMBASE, CINAHL, PsycInfo, HMIC and Google Scholar. We included any study type, including quantitative, qualitative and mixed-method studies. We excluded theoretical frameworks, conceptual, scientific or grey literature as well as discussion and opinion papers. RESULTS Of the 87 included studies, 81 (93%) focused on or were conducted by authors in developed countries. A wide range of conditions were considered, with more studies focusing on mental health (n = 18, 21%) and cancer care (n = 8, 9%). The vast majority of the studies focused on process and service innovations (n = 62, 71%). Seven studies focused on technological and clinical innovations (8%), while 12 looked at both technological and service innovations (14%). Only five studies examined systems innovation (5%) and one study looked across all types of innovations (1%). PPI is more common in the earlier stages of innovation, particularly problem identification and invention, in comparison to adoption and diffusion. CONCLUSION Healthcare innovation tends to be a lengthy process. Yet, our study highlights that PPI is more common across earlier stages of innovation and focuses mostly on service innovation. Stronger PPI in later stages could support the adoption and diffusion of innovation. PATIENT OR PUBLIC CONTRIBUTION One of the coauthors of the paper (S. S.) is a service user with extensive experience in PPI research. S. S. supported the analysis and writing up of the paper.
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Affiliation(s)
- Victoria Cluley
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alexandra Ziemann
- Centre for Healthcare Innovation Research, City, University of London, London, UK
| | - Claire Feeley
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Shani Shamah
- Service-User, Research (Public Patient Involvement) Consultant, Independent, London, UK
| | - Charitini Stavropoulou
- Centre for Healthcare Innovation Research, City, University of London, London, UK.,School of Health Sciences, City, University of London, London, UK
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Lee H, Moon S, Song G, Nam EW. Associations of the related factors of depression, social support and social participation in kyungro-dang among older adults in South Korea: A structural equation modelling analysis. Nurs Open 2021; 8:562-571. [PMID: 33570295 PMCID: PMC7877153 DOI: 10.1002/nop2.661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to investigate the correlations between depression, social support and social participation among older adults in farming villages and identify their associations with the use of senior leisure and welfare facilities, called kyungro-dang, so as to provide foundational data for promoting community care in rural farming communities. DESIGN A cross-sectional design was used to identify kyungro-dang use among the 156 participants-older adults aged 65. METHODS Data were analysed using descriptive statistics, Pearson's correlation analysis, factor analysis and structural equation modelling. RESULTS Older adults with high social support and social participation tended to use kyungro-dang less. Our findings contribute foundational data to promote community care through kyungro-dang. Ministry of Health and Welfare (MoHW) plans to enforce to "Comprehensive community care plan" through kyungro-dang in rural area. The result of this study shows the relation between Kyungro-dang and social support, social participation, depression. This study recommends that MoHW in Korea focuses on enhance social support and social participation to gather before policy implications.
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Affiliation(s)
- Hocheol Lee
- Department of Health AdministrationYonsei University Graduate SchoolWonjuKorea
| | - Seokjun Moon
- Department of Health AdministrationYonsei University Graduate SchoolWonjuKorea
| | - Geurum Song
- Public Health Network and Quality Enhancement TeamCenter for Public HealthcareNational Medical CenterSeoulKorea
| | - Eun Woo Nam
- Department of Health AdministrationCollege of Health Science Yonsei UniversityWonjuKorea
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Raue PJ, Dawson A, Hoeft T, Russo J, Ferguson D, Green L, Petersky C, Kaplan C. Acceptability of a lay-delivered intervention for depression in senior centers. Aging Ment Health 2021; 25:445-452. [PMID: 31799880 PMCID: PMC7269871 DOI: 10.1080/13607863.2019.1698515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We examined: 1. depression rates among senior center clients; and 2. the acceptability of a lay-delivered intervention for depression ("Do More, Feel Better") from the perspective of key stakeholders prior to its implementation. METHOD We conducted cross-sectional surveys at four Seattle-area senior centers of 140 clients, 124 volunteers, and 12 administrators and staff. Client measures included the Patient Health Questionnaire-9 (PHQ-9) to determine depression severity, and items assessing depression treatment preferences. Following description of "Do More, Feel Better" as a lay-delivered intervention focused on increasing participation in rewarding activities, we used quantitative and qualitative items to assess acceptability to: 1. clients participating in; 2. volunteers administering; and 3. administrators and staff supporting the intervention. RESULTS 25% of senior center clients (35/140) endorsed elevated depressive symptoms (PHQ-9 ≥ 10). 81% of clients (114/140) reported that they would consider participating in "Do More, Feel Better," and 59% percent of volunteers (73/123) expressed interest in learning how to assist others using the intervention. Administrators and staff reported high comfort levels with proposed volunteer training procedures, and they identified funding and staffing considerations as challenges to sustaining the intervention. CONCLUSION Findings indicate high depression rates among senior center clients and support the acceptability of lay-delivered behavioral interventions for depression from a variety of stakeholders. Further investigation of the feasibility, effectiveness, and implementation of "Do More, Feel Better" is warranted, particularly in the context of a lack of health care professionals available to meet the mental health needs of older adults.
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Affiliation(s)
| | | | | | - Joan Russo
- University of Washington School of Medicine
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Renn BN, Areán PA, Raue PJ, Aisenberg E, Friedman EC, Popović Z. Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept. RESEARCH ON SOCIAL WORK PRACTICE 2021; 31:90-100. [PMID: 34321858 PMCID: PMC8315227 DOI: 10.1177/1049731520964854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies. METHODS We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays. We also examined time spent using ITS and relation with competency. RESULTS The majority of students (81.8%) in Wave 1 and all of the students who submitted role-plays in Wave 2 passed the clinical skills role-play. Students advancing through the ITS more quickly had better tCBT competency ratings than those progressing more slowly. DISCUSSION One of the most challenging aspects of training is how to competently deliver evidence-based practices. ITS has the potential to streamline and scale such training.
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Affiliation(s)
- Brenna N. Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Eugene Aisenberg
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Emily C. Friedman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Zoran Popović
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
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