Phase 1 Study of Using Peers to Deliver Depression Care to Older Adults

Recruitment of peer mentors. We will recruit peer mentors from a community organization who are in recovery and are recommended by the organization and have had basic training in supportive listening and experience working with persons in the community in need of mental health support. We will recruit 10 peer mentors, striving for a balance of men and women, and accounting for attrition, so that at least 5 peer mentors will participate in the project. The study doctor will meet and interview interested peers to screen for eligibility criteria, motivation and aptitude. Persons who do not meet criteria for continued participation in the study will be referred to other volunteer opportunities when appropriate.

Recruitment of patients. Twenty patient participants will be recruited through the internal medicine and psychiatry clinics at Johns Hopkins Bayview Medical Center as well as the community. A research assistant will screen patients for depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). Patients meeting eligibility criteria will give written informed consent. Eligible patients will be scheduled for another appointment to meet with the study doctor in a private room at offices in the clinical campus.

Training of peer mentors. The PI and research assistant will conduct 5 sessions totaling 20 hours of training for the peer mentors. Training will refine the peer mentor's social support behaviors, which include the use of effective communication skills, rapport building, active listening, and sharing of experiential knowledge, and expression of empathy. Issues of cultural interviewing, cultural competence, patient confidentiality, DSM-IV diagnosis, differentiation of peer and professional roles and patient safety will be addressed. Knowledge regarding how mental health and illness presents itself in old age and the specific developmental problems older adults face will be provided. Training will include review of written materials, lectures, discussion of case studies and role play. Upon completion of the training, peer mentors will be assessed for mental health knowledge and interpersonal skills and those who pass muster will be matched with patients.

The peer mentor role: Activities of the peer mentor with the patient will be structured by the following principles which are derived from important elements of both peer support and psychotherapy and our preliminary work:

Principles to structure peer mentor interactions with patients