Social and Mental Health Program for Depression
Recruiting in Palo Alto (17 mi)
Age: 65+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: The University of Texas Health Science Center, Houston
Disqualifiers: Decision-making impairments, psychiatric illnesses, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The purpose of this study is to ascertain the feasibility and effectiveness of an 8-week social engagement program aimed at reducing depression and increasing social engagement among seniors who are transitioning out of Adult Protective Services (APS) for either elder abuse or self-neglect.
Will I have to stop taking my current medications?
The trial information does not specify whether participants need to stop taking their current medications.
What data supports the effectiveness of the treatment Stepped-care social and mental health engagement for depression?
Research shows that the stepped care model, which involves gradually increasing treatment intensity, is effective in treating anxiety disorders and can potentially improve the reach and availability of mental health services. However, its effectiveness in improving depressive symptoms compared to usual care is not significantly different.
12345Is the Stepped-care model safe for treating depression?
The Stepped-care model, used for treating depression and anxiety, has been studied in various trials and is generally considered safe for humans. It involves gradually increasing treatment intensity based on individual needs, and no significant safety concerns have been reported in the studies reviewed.
23678How is the Stepped-care model treatment for depression different from other treatments?
The Stepped-care model for depression is unique because it uses a sequential approach, starting with less intensive treatments and only moving to more intensive ones if needed, based on the severity of the individual's symptoms. This method aims to provide the right level of care at the right time, potentially making it more efficient and accessible, especially in communities with limited resources.
12789Eligibility Criteria
This trial is for seniors who have experienced depression or social isolation after elder abuse or self-neglect, and are transitioning out of Adult Protective Services. Details on specific inclusion or exclusion criteria were not provided.Inclusion Criteria
Student: college or university student, enrolled at one of the UTHealth graduate programs in Houston, University of Houston, Texas Southern University, Sam Houston State University, or Rice University, commit to making 8-weekly consecutive calls, complete the required 1-hour training and assessment.
I am an older adult, can consent, speak English or Spanish, live in a community, can use the phone, and am finishing with APS services.
Exclusion Criteria
Student: only engaging in the program to fulfill some educational requirement.
I am an older adult without severe mental health issues or the need for a proxy to make decisions for me.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants engage in an 8-week social engagement program aimed at reducing depression and increasing social engagement
8 weeks
Weekly sessions (in-person or virtual)
Follow-up
Participants are monitored for changes in depression, anxiety, loneliness, resilience, and social isolation
1 month
1 visit (in-person or virtual)
Participant Groups
The study tests an 8-week program designed to reduce depression and boost social engagement in seniors post-APS care. It compares the effectiveness of a stepped-care approach with usual APS care.
2Treatment groups
Experimental Treatment
Active Control
Group I: TreatmentExperimental Treatment2 Interventions
Group II: Usual CareActive Control1 Intervention
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
The University of Texas Health Science Center at HoustonHouston, TX
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Who Is Running the Clinical Trial?
The University of Texas Health Science Center, HoustonLead Sponsor
US Department of Health and Human Services, Administration on Community LivingCollaborator
Department of Health and Human ServicesCollaborator
References
Developing stepped care treatment for depression (STEPS): study protocol for a pilot randomised controlled trial. [2023]Stepped care is recommended and implemented as a means to organise depression treatment. Compared with alternative systems, it is assumed to achieve equivalent clinical effects and greater efficiency. However, no trials have examined these assumptions. A fully powered trial of stepped care compared with intensive psychological therapy is required but a number of methodological and procedural uncertainties associated with the conduct of a large trial need to be addressed first.
Stepped care for the treatment of depression: a systematic review and meta-analysis. [2021]The Stepped Care Model (SCM) proposes a sequential approach in the treatment of depression, applying interventions of increasing intensity according to the level of severity of the individual.
The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis. [2018]Stepped care is an increasingly popular treatment model for common mental health disorders, given the large discrepancy between the demand and supply of healthcare service available. In this review, we aim to compare the efficacy and cost-effectiveness of stepped care prevention and treatment with care-as-usual (CAU) or waiting-list control for depressive and/or anxiety disorders. 5 databases were utilized from its earliest available records up until April 2015. 10 randomized controlled trials were included in this review, of which 6 examined stepped care prevention and 4 examined stepped care treatment, specifically including ones regarding depressive and/or anxiety disorders. Only trials with self-help as a treatment component were included. Results showed stepped care treatment revealed a significantly better performance than CAU in reducing anxiety symptoms, and the treatment response rate of anxiety disorders was significantly higher in stepped care treatment than in CAU. No significant difference was found between stepped care prevention/treatment and CAU in preventing anxiety and/or depressive disorders and improving depressive symptoms. In conclusion, stepped care model appeared to be better than CAU in treating anxiety disorders. The model has the potential to reduce the burden on existing resources in mental health and increase the reach and availability of service.
The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials. [2021]Several care models have been developed to improve treatment for depression, all of which provide "enhanced" evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13-1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11-1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of -0.42 (95%CI: -0.61-(-0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94-1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668.
Delivering stepped care: an analysis of implementation in routine practice. [2021]In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type) increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management.
Graduate mental health worker case management of depression in UK primary care: a pilot study. [2021]Based on data from large multicentre US trials, the National Institute for Health and Clinical Excellence (NICE) is advocating a stepped-care model for the management of depression, with 'case management' or 'collaborative care' for selected patients in primary care.
The clinical effectiveness of stepped care systems for depression in working age adults: a systematic review. [2018]Stepped care service delivery models involve treatments that become increasingly intense through successive steps, with patients re-assigned via pre-defined decision criteria. This article reviews the clinical effectiveness of stepped care systems for depression in working age adults.
Preliminary results of adapting the stepped care model for depression management in Vietnam. [2022]Depression is the leading burden of mental disease, especially in low-and-middle-income countries like Vietnam. The Stepped Care Model is a promising approach to managing depression in the community with low resources. This is the first study that implemented the adapted Stepped Care Model for depression management in the Vietnamese context and evaluated the initial effectiveness of this community-based intervention in the Thai Nguyen community.
How do care providers evaluate collaboration? - qualitative process evaluation of a cluster-randomized controlled trial of collaborative and stepped care for patients with mental disorders. [2021]Collaborative and stepped care (CSC) models are recommended for mental disorders. Their successful implementation depends on effective collaboration between involved care providers from primary and specialist care. To gain insights into the collaboration experiences of care providers in CSC against the backdrop of usual mental health care, a qualitative process evaluation was realized as part of a cluster-randomized controlled trial (COMET) of a collaborative and stepped care model in Hamburg (Germany).