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Enabling lay providers to conduct CBT for older adults: key steps for expanding treatment capacity

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

The Institute of Medicine advocates the examination of innovative models of care to expand mental health services available for older adults. This article describes training and supervision procedures in a recent clinical trial of cognitive behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD) delivered by bachelor-level lay providers (BLPs) and to Ph.D.-level expert providers (PLPs). Supervision and training differences, ratings by treatment integrity raters (TIRs), treatment characteristics, and patient perceptions between BLPs and PLPs are examined. The training and supervision procedures for BLPs led to comparable integrity ratings, patient perceptions, and treatment characteristics compared with PLPs. These results support this training protocol as a model for future implementation and effectiveness trials of CBT for late-life GAD, with treatment delivered by lay providers supervised by a licensed provider in other practice settings.

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References

  1. Institute of Medicine. Mental Health and Substance Use Workforce for Older Adults. In Whose Hands? Washington, DC: Institute of Medicine; 2012.

    Google Scholar 

  2. Aréan PA, Raue PJ, Sirey J, et al. Implementing evidence-based psychotherapies in settings serving older adults: challenges and solutions. Psychiatr Serv. 2012; 63: 605-607.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bartels SJ, Naslund JA. The underside of the silver tsunami—older adults and mental health care. New Engl J Med. 2013; 368: 493-496.

    Article  CAS  PubMed  Google Scholar 

  4. Karlamangla A, Tinetti M, Guralnik J, Studenski S, Wetle T, Reuben D. Comorbidity in older adults: nosology of impairment, diseases, and conditions. J Gerontol A Biol Sci Med Sci. 2007; 62: 296-300.

    Article  PubMed  Google Scholar 

  5. Health Resources and Services Administration (HRSA) 2010. The registered nurse population: findings from the 2008 National Sample Survey of Registered Nurses. U.S. Department of Health and Human Services. http://bhpr.hrsa.gov/healthworkforce/reports/chwstudy2007.pdf (accessed October 20,2014).

  6. Kennedy Malone L, Penny J, Fleming ME. Clinical practice characteristics of gerontological nurse practitioners: a national study. J Am Acad Nurse Pract. 2008; 20(1): 17-27.

    Article  PubMed  Google Scholar 

  7. Papas RK, Sidle JE, Martino S, et al. Systematic cultural adaptation of cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in western Kenya. AIDS Behav. 2010; 14: 669-678.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Patel V, Weiss HA, Chowdhary N, et al. Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. Br J Psychiatry. 2011; 199: 459-466.

  9. Waltzkin H, Getrich C, Heying S, et al. Promotoras as mental health practitioners in primary care: a multi-method study of an intervention to address contextual sources of depression. J Commun Health. 2011; 36: 316-331.

    Article  Google Scholar 

  10. den Boer PC, Wiersma D, Russo S, van den Bosch RJ. Paraprofessionals for anxiety and depressive disorders. Cochrane Database Syst Rev. 2005; CD004688.

  11. Montgomery EC, Kunik ME, Wilson N, Stanley MA. Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? Bull Menn Clin. 2010; 74: 45-62.

    Article  Google Scholar 

  12. Aréan PA, Gum A, McCulloch CE, Bostrom A, Gallagher-Thompson D, Thompson L. Treatment of depression in low-income older adults. Psychol Aging. 2005; 20: 601-609.

    Article  PubMed  Google Scholar 

  13. Ciechanowski P, Wagner E, Schmaling K, et al. Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA. 2004; 291: 1569-1577.

    Article  CAS  PubMed  Google Scholar 

  14. Quijano LM, Stanley MA, Petersen NJ, et al. Healthy I.D.E.A.S.: a depression intervention delivered by community-based case managers serving older adults. J Appl Gerontol. 2007; 26: 139-156.

    Article  Google Scholar 

  15. Stanley MA, Wilson NL, Amspoker AB, et al. Lay providers can deliver effective cognitive behavior therapy for older adults with generalized anxiety disorder: a randomized trial. Depress Anxiety. 2014; 31: 391-401.

    Article  PubMed  Google Scholar 

  16. Fixsen DL, Blasé KA, Nacom SF, Wallace F. Core implementation components. Res Soc Work Pract. 2009; 19: 531-540.

    Article  Google Scholar 

  17. Glasgow RE. What types of evidence are most needed to advance behavioral medicine? Ann Behav Med. 2008; 25: 19-26.

    Article  Google Scholar 

  18. Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. JAMA. 1994; 272: 1749-1756.

    Article  CAS  PubMed  Google Scholar 

  19. First MB, Spitzer RL, Miriam G, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Patient Edition with Psychotic. New York: Biometrics Research, New York State Psychiatric Institute; 1997.

    Google Scholar 

  20. Callahan CM, Unverzaqt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2007; 40: 771-781.

    Article  Google Scholar 

  21. Stanley MA, Wilson NL, Novy DM, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. JAMA. 2009; 301(14): 1460-1467.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol. 2003; 71: 31-40.

    Article  PubMed  Google Scholar 

  23. Borkovec TD, Nau SD. Credibility of analogue therapy rationales. J Behav Ther Exp Psychiatry. 1972; 3: 257-260.

    Article  Google Scholar 

  24. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval Prog Plan. 1979; 2: 197-207.

    Article  CAS  Google Scholar 

  25. Attkisson CC, Zwick R, The Client Satisfaction Questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Prog Plan. 1982; 5: 233-237.

    Article  CAS  Google Scholar 

  26. Derogatis LR, Lipman RS, Coci L. SCl-90: an outpatient psychiatric rating scale (preliminary report). Psychopharmocol Bull. 1973; 9: 13-28.

    CAS  Google Scholar 

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Acknowledgments

This research was supported by a grant from the National Institute of Mental Health (NIMH) (R01-MH53932) to the last author and by the facilities and resources of the Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (CIN13--413). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, the National Institutes of Health, the Veterans Administration, the US government, or Baylor College of Medicine. The NIMH had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review, or approval of the manuscript.

Conflict of interest

The authors report no conflicts of interest.

Ethical standards and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Mental Health Care Line (MHCL 116), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA

    Cynthia Kraus-Schuman PhD & Ellen Teng PhD

  2. Baylor College of Medicine, Houston, TX, USA

    Cynthia Kraus-Schuman PhD, Nancy L Wilson MSW, Amber B Amspoker PhD, Paula D Wagener BA, Jessica S Calleo PhD, Jeffrey A Cully PhD, Ellen Teng PhD, Mark E Kunik MD, MPH & Melinda A Stanley PhD

  3. Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Nancy L Wilson MSW, Amber B Amspoker PhD, Paula D Wagener BA, Jessica S Calleo PhD, Jeffrey A Cully PhD, Ellen Teng PhD, Mark E Kunik MD, MPH & Melinda A Stanley PhD

  4. The Institute of Living, 400 Washington St., Hartford, CT, 06106, USA

    Gretchen Diefenbach PhD

  5. Department of Psychology, University of Tennessee – Knoxville, 307 Austin Peay Bldg., Knoxville, TN, 37996-0900, USA

    Derek Hopko PhD

  6. VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA

    Jeffrey A Cully PhD, Ellen Teng PhD, Mark E Kunik MD, MPH & Melinda A Stanley PhD

  7. Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, P. O. Box 20249, Houston, TX, 77225-0249, USA

    Howard M Rhoades PhD

Authors
  1. Cynthia Kraus-Schuman PhD
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  2. Nancy L Wilson MSW
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  3. Amber B Amspoker PhD
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  4. Paula D Wagener BA
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  5. Jessica S Calleo PhD
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  6. Gretchen Diefenbach PhD
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  7. Derek Hopko PhD
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  8. Jeffrey A Cully PhD
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  9. Ellen Teng PhD
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  10. Howard M Rhoades PhD
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  11. Mark E Kunik MD, MPH
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  12. Melinda A Stanley PhD
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Corresponding author

Correspondence to Cynthia Kraus-Schuman PhD.

Additional information

Trial Registration: ClinicalTrials.gov. NCT00765219

Implications

Policy: Advancing regulatory guidance and reimbursement models for expert clinicians to function as trainers and supervisors of lay providers can address the current and projected shortage of geriatric mental health providers.

Research: Research is needed on models of training and practical competency assessment for diverse providers of mental health care for older adults.

Practice: Training and supervision of lay providers can expand the availability of CBT for older adults.

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Cite this article

Kraus-Schuman, C., Wilson, N.L., Amspoker, A.B. et al. Enabling lay providers to conduct CBT for older adults: key steps for expanding treatment capacity. Behav. Med. Pract. Policy Res. 5, 247–253 (2015). https://doi.org/10.1007/s13142-015-0306-3

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  • DOI: https://doi.org/10.1007/s13142-015-0306-3

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