Cognitive-behavioral therapy for depressive symptoms in older adults living in residential aged care facilities: A cluster randomised-controlled trial in Australia

The intervention involves a multi-component approach for improving depressive symptoms. The approach comprises three components: (1) ELATE Resident, (3) ELATE Family/Friend and (3) ELATE Staff. Residential aged care facilities allocated to the intervention condition receive all three components, during the study period. Component 1: ELATE Resident: Interventions will be provided by mental health trainees (MHTs) enrolled in professional programs in counselling, social work or psychology. The MHTs meet face-to-face and one-on-one with the residents for 16 counselling sessions held every 1 – 2 weeks over 5 months (allowing for missed weeks due to ill health). Initial sessions (sessions 1 – 4) represent the engagement phase, where the focus is on the development of rapport with the resident (“client”) through conversation. The intermediate sessions (5 – 14) represent the problem clarification and treatment phase, where the counsellor and client discuss the presenting issues, background of the problem and impact of the problem on daily functioning. The final phase (sessions 15 -16) involves a review and consolidation of strategies for extending and/or maintaining treatment gains. Consistent with evidence-based protocols for improving mood in older adults, family members or friends or the resident, and staff may also attend resident treatment sessions if required, and collaboratively inform treatment planning and implementation. The program is individually tailored and paced according to the cognitive and physical capacity of the resident. The duration of counselling sessions is 30 to 60 minutes, depending on the needs and attention span of the client. The psychosocial interventions are based on CBT, behavioural activation, and reminiscence therapy. Component 2: ELATE Family/Friend: (1) Monthly support group: Family/friends of participating residents will be invited to join an on-site monthly support group. The group will provide family/friends a forum for peer support. It will also provide information on a range of strategies for supporting their relative or friend, which in turn can improve their sense of competence in interacting positively with their relative. The “beyondblue guide for carers” will be distributed to carers, and form the framework for the monthly groups. (2) Collateral activity: Family/friends will be invited to contribute to the administration of psychosocial interventions, by joining treatment sessions with the MHT and resident, and/or encouraging, reminding or helping relatives do therapeutic activities between sessions. Joint meetings will be facilitated as required between carers and staff to inform treatment planning and shared care agreements. (3) The Carer Information Workshop: Family/friends will be invited to attend a workshop (up to 4 hours) focused on understanding depression, anxiety and treatment strategies and how they can support their relative or friend living in residential care. Component 3: ELATE Staff: (1) Monthly consultative meetings: Information about a resident will be discussed in consultative meetings between MHTs and facility staff with the aim of tailoring interventions to suit the resident’s needs, preferences and capacity. MHTs and staff will collaboratively develop treatment plans for implementation during sessions and between sessions. (2) Collateral activity: Staff will be invited to assist with such activities if required. Staff will be encouraged to participate in sessions, and to assist residents implement, complete and record between-session therapeutic activities. (3) The Staff Information Workshop: A workshop (up to 4 hours) will be delivered to staff to assist them to assess and manage resident depression, anxiety and suicide ideation. Staff will be recommended to augment face-to-face training with follow-up online content (beyondblue’s online course “Professional Education to aged care”) and reading (beyondblue’s “What works for improving the emotional wellbeing in older adults”). The ELATE Carer and Staff Information Workshops will occur during the first 4 weeks of the ELATE Resident treatment. The ELATE monthly family support groups and staff consultative meetings will then be held towards the end of each month for the remainder of the treatment period (i.e. months 2-5). All MHTs will complete a purpose developed treatment Integrity self-report measure of each treatment module throughout treatment with each resident participant. Clinical supervisors will also complete treatment integrity measures for each treatment module per resident participant, as well as the Cognitive Therapy Ratings Scale for a random selection of treatment recordings.