The Feasibility of Engage Therapy With Video Support for Homebound Older Adults

Not Applicable

Completed

Brief Summary: The primary aim in this pilot project is to test the feasibility, acceptability and impact (decreased depressive symptoms) of a brief behavioral treatment for depression (Engage) combined with video social support (PRISM 2.0) among socially isolated/lonely case management clients who endorse depressive symptoms. Eligible participants will be offered the combination of Engage and Prism 2.0, called Engage-Prism. The investigators hypothesize that the intervention (Engage Therapy With Video Support) will be accepted by participants, improve depressive symptom, and be feasible to complete.

Detailed Description: Engage is a brief therapy designed to offer a structured, stepped approach and interventions to reduce barriers to increased engagement with rewarding activities to improve depression (Alexopoulos et al, 2020). The goal is to increase participation in meaningful activities. Homebound older adults have limited social interaction given their restricted mobility and medical burden. In prior research with an intervention targeting social engagement with a technology intervention (PRISM 2.0), participants reported increased social support, decreased loneliness, increased feelings of well-being, more positive attitudes about computers, and gains in computer proficiency (Czaja et al., 2017).

Participants will be referrals from case management service. Clinicians will incorporate elements of the Prism system into therapy as appropriate, and participants will be instructed to use the Prism system at their leisure or as it pertains to their chosen "reward exposure" activities. There will be a post-therapy assessment and interview about their experience with the technology at week 9. The study will conclude with follow-up assessments at week 12.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Psychotic depression by SCID-V, i.e. presence of delusions
High suicide risk, i.e. intent or plan to attempt suicide in the near future
Presence of any Axis I psychiatric disorder
Presence of substance abuse other than unipolar major depression
History of psychiatric disorders, hypomania, are excluded
Acute or severe medical illness, i.e. delirium, metastatic cancer, decompensated cardiac, liver, or kidney failure, major surgery, stroke, or myocardial infarction during the three months prior to entry; or drugs often causing depression, e.g. steroids, reserpine, alpha- methyl-dopa, tamoxiphen, vincristine
Current involvement in psychotherapy
Cognitive impairment (i.e. telephone administered MoCA < 11)
Currently dwelling in non-community dwelling (e.g. prison, nursing home)
Hearing that would not allow participants to complete sessions with the RA/therapist
Vision impairment that would not allow the participant to use the study provided tablet
Inability to speak English
Aphasia interfering with communication
Literacy -assessed by reading a paragraph designed for those at 6th grade reading level

Arm && Interventions

Group	Intervention	Description
Engage Prism 2.0	Engage Prism (2.0)	Engage Prism is a 9-week program that integrates Engage- a form of behavioral talk therapy treating depression, and guided use of Prism technology- a software that aims to improve social support and interaction of older adults.

Primary Outcome Measures

Name	Time	Method
Feasibility: Client Enrollment	Baseline	Feasibility will be measured as the number of clients who are referred to the program, meet eligibility and accept the intervention (versus refuse).
Acceptability: Client Satisfaction Questionnaire (CSQ)	12 weeks (post treatment)	The CSQ is a 3 - item questionnaire assessing client satisfaction with the treatment provided assessed at 3 weeks post treatment (at 12 weeks) Scores range from 3 (least satisfied) to 12 (most satisfied).

Secondary Outcome Measures

Name	Time	Method
Hamilton Depression Rating Scale	Baseline, 12 weeks (post treatment)	Change in depression score from Baseline to 12 weeks post treatment. Scores range from 0 (no depression) to 54 (very severe depression).