Effectiveness and Implementation of Brief Cognitive Behavioral Therapy in CBOCs

Not Applicable

Completed

Brief Summary: The purpose of this study is to determine the effectiveness of a brief cognitive behavioral therapy (bCBT) intervention for Veterans with depression delivered by mental health providers located at VA Community Based Outpatient Clinics (CBOC's) associated with the Houston and Oklahoma City VAMCs.

Detailed Description: Depression is a serious health condition that places tremendous burden on patients and healthcare systems and is especially prevalent in Veterans. In 2008, the VHA released the Uniform Mental Health Services Handbook (Handbook 1160.01) in an effort to expand services for Veterans with depression, including those in primary care and CBOC settings.

The VA remains a national leader in mental health services, but the provision of psychotherapy within VA is limited, especially for rural Veterans and those cared for in CBOCs. The VA has invested significant resources to improve access to high-quality mental health care, including a rapid expansion into CBOCs. Currently, there is a need to work with clinicians and stakeholders to address practice barriers related to mental health practices in CBOCs. A recent survey of 4,200 mental health providers in VA found that, although robust expansion and improved quality of mental health care services has occurred, access to proven effective psychotherapies in CBOCs remains a focused area for improvement. The study will examine whether existing VA CBOC mental health clinicians, with training and support, can effectively administer a structured brief cognitive behavioral therapy (bCBT) intervention for Veterans with clinically elevated symptoms of depression.

Recruitment & Eligibility

Inclusion Criteria

must have clinically significant symptoms of depression;
must be current recipients of services at CBOCs associated with the Houston and Oklahoma City VAMCs.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
bCBT/Direct Referral	bCBT	A brief cognitive behavioral therapy intervention that offers 6 active- treatment sessions, each lasting 30 to 40 minutes, and telephone booster sessions to maintain changes.

Primary Outcome Measures

Name	Time	Method
Patient Health Questionnaire (PHQ-9); Change in Depression Scores Taken at 4-, 8-, and 12-month Follow Ups as Compared to Baseline.	Baseline, 4-month (immediate post treatment), and 8- and 12-month follow up.	The PHQ-9 is used to measure a person's level of depression. Scores on the measure can range from 0 to 27. The higher the score the higher level of depression someone is experiencing.

Secondary Outcome Measures

Name	Time	Method
Beck Depression Inventory (BDI) - Change is Being Assessed Using a 4 Timepoint Process	Baseline, 4-month (immediate post treatment), and 8- and 12-month follow up.	The measure will be used a s a second assessment to measure depression. Scores on the measure can range from 0 to 63. The higher the score the higher level of depression someone is experiencing.
Health Survey for Veterans (SF-12) - Change is Being Assessed Using a 4 Timepoint Process	Baseline, 4-month (immediate post treatment), and 8- and 12-month follow up.	SF-12 will be used to measure a participant's functional status. The SF-12V measures 8 concepts of health and can be summarized into summary component scores for physical (PCS) and mental (MCS) functioning. Scores can range from 0 - 100 and higher scores mean better functioning and quality of life.

Locations (2): Michael E. DeBakey VA Medical Center, Houston, TX
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Houston, Texas, United States
Oklahoma City VA Medical Center, Oklahoma City, OK
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Oklahoma City, Oklahoma, United States