Volunteer-Delivery of Behavioral Activation

Senior centers provide social, health, nutritional, and recreational services to older
adults. Ten percent of older adults in these settings experience clinically significant
depression. Although many aging services now screen for depressive symptoms, an IOM report
indicates that the number of geriatric mental health providers nationally is insufficient.
Further complicating treatment delivery is the reluctance of depressed elders to accept a
mental health referral or pursue treatment. It has been proposed that lay workers may be able
to offer psychosocial interventions for geriatric mental health disorders. Lay
volunteer-delivered interventions may improve depression outcomes, may do so by engaging the
same target variables as professionally-delivered interventions, and may be both more cost
effective and acceptable to seniors. Limitations include uncertainties about training and
supervision needs, reliable methods to assure intervention fidelity and patient safety, and
comparability of outcomes to those attained by professionally- delivered interventions.
Building on senior centers' volunteer programs, this proposal utilizes senior volunteers to
meet the mental health needs of depressed urban clients. To this end, the investigators
simplified Behavioral Activation (BA) to match the skill set of lay senior volunteers
(Volunteer BA). The investigators chose BA because it is an effective treatment for late-life
depression, can be administered by paraprofessionals, and its primary mechanism (target) of
action has been validated by efficacy studies. Based on preliminary data, the investigators
aim to test the feasibility and acceptability of Volunteer BA for an underserved and
difficult to engage population. The investigators propose further developmental work on the
delivery of Volunteer BA in senior centers, so as to arrive at a sustainable intervention
with standardized procedures. The investigators propose a small RCT testing the impact of
Volunteer BA versus MSW-delivered standard BA on increased client activity (the target) and
reduced depressive symptoms (clinical outcome). The Volunteer BA delivery model: 1. Makes use
of existing volunteer resources; 2. has potential for being an acceptable and sustainable
intervention; and 3. is expected to engage BA targets. However, its capacity to yield
comparable outcomes to MSW-delivered BA is yet to be determined.

Inclusion Criteria:

Referral to study (stage 1):

1. Age ≥ 60 years.

2. Attends one of 4 participating Seattle senior centers.

3. PHQ-9 score of ≥10 via routine screening.

Research assessment (stage 2):

1. Mini Mental State Exam (MMSE) ≥ 24.

2. Capacity to provide written consent for both research assessment and the BA
intervention.

Exclusion Criteria:

1. Current passive or active suicidal ideation (SCID-V or HAM-D).

2. Presence of psychiatric diagnoses other than unipolar, non-psychotic major depression
or anxiety disorder by SCID-V.

3. Severe or life-threatening medical illness (e.g., end stage organ failure).

4. Inability to speak English.