Dialing Down Depression: Delivering Tele-Mental Health Treatments with Lay Counselors

Researchers at the University of Texas at Austin looked at the effect of telehealth treatment by lay counselors vs. clinicians on depression among homebound older adults. Researchers believe that the findings of this study could have real-world effectiveness as a sustainable and scalable service that can easily be delivered to homebound older adults. Utilizing lay counselors and co-locating them in aging service agencies for care coordination, and using real-time video conferenced treatment sessions, would result in cost saving and easier accessibility. This study earned a Silver 2021 Innovative Research on Aging Award from Mather Institute.

The researchers conducted a randomized clinical trial with 277 participants who identified as having moderately severe to severe depressive symptoms. Aging service case managers referred eligible individuals to the study, where they were randomly assigned to receive five sessions of: (1) Telehealth counseling sessions by trained lay counselors where the focus was behavioral activation (i.e., a method designed to decrease behaviors that maintain depression), (2) Telehealth counseling sessions with licensed clinicians where the focus was problem-solving therapy (i.e., a method designed to discover problem solving skills to tackle depression), (3) Non-specific telephone support calls by research assistants without any training where the focus was attention control, which was the control group in the study.

The researchers then had follow-up assessments at 12, 24, and 36 weeks after baseline. They found that both lay counselors and certified clinicians were significantly more effective at reducing depressive symptoms than telephone support calls done by research assistants without any training. Other symptoms also improved in the lay counselors and clinicians groups, including clinically meaningful changes in disability (i.e., cognition, mobility, self-care, life activities), social engagement/activities, and satisfaction with participation in social roles.

Researchers believe this means that lay counselors can effectively deliver depression treatment for older adults with mobility impairment. This allows for the opportunity that senior living industries can provide mental health services without relying on licensed clinicians, thereby resulting in health and social care cost-savings.


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Choi, NG, Marti, CN, Wilson, NL, Chen, GJ, Sirrianni. L, Hegel, MT, Bruce, ML, & Kunik, ME. Effect of telehealth treatment by lay counselors vs clinicians on depressive symptoms among older adults who are homebound: A randomized clinical trial. JAMA Network Open: Geriatrics. August 31, 2020;3(8):e2015648. doi:10.1001/jamanetworkopen.2020.15648.

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