LISTEN - Low Intensity mental health Support via a Telehealth Enabled Network for adults with diabetes and CVD: Effectiveness and scalability

The LISTEN intervention: The intervention group will receive up to four x 45-60 minute LISTEN sessions, once per week (for a maximum of four weeks). The sessions are delivered via telehealth (telephone or videoconference) by a trained diabetes allied health professional (AHPs; diabetes educators, nurses, and dietitians) who have a minimum of 12 months experience working in a diabetes setting. The number of sessions that participants receive will be mutually agreed upon by the participant and the AHP and will be guided by the ease at which participants are able to develop the problem solving skills and the suitability of the intervention to meet participants needs. At its core, the LISTEN intervention provides individuals with diabetes (and cardiovascular disease) with practical skills in problem-solving using brief Problem-Solving Therapy (PST). Adapted for an Australian population of adults with diabetes, this low-intensity version is suitable for delivery by non-specialist mental health professionals and has the advantage of fewer and shorter sessions in order to meet the pressing time and resource issues in busy clinical settings. Participants receive guidance and support to identify problems that may be contributing to their mental health issues, including distress and anxiety about living with diabetes. The participant is guided through seven steps: (1) defining the problem; (2) setting an achievable goal; (3) brainstorming solutions; (4) assessing pros and cons of solutions; (5) choosing the preferred solution; (6) creating an action plan; (7) evaluating outcomes. Strategies for working through problems that cannot be ‘solved’ will also be addressed. Participants will receive information and worksheets that will help support them between sessions and plan meaningful and enjoyable activities during the week. The worksheets have been adapted from the 'Problem-Solving Treatment Manual for Primary Care (PST-PC): A treatment Manual for Depression' (Hegel & Arean, 2011) and developed specifically for this context. In addition, AHPs will encourage support-seeking behaviours. They will discuss how and when to seek support from mental health services, and how address their barriers for seeking support from a general practitioner or mental health professional. The LISTEN Training: Between 4 and 10 diabetes allied health professionals will be invited to participate in the training. The LISTEN training consists of: (1) participation in four-day online workshops and (2) delivery under supervision. The four-day workshops are derived from an established training program which has demonstrated high-level performance results among trainees (i.e. nurses, social workers, and psychologists). Adapted from an established PST training program, the workshops comprise learning modules that both explain the theory of PST and provid practical skills for facilitating LISTEN sessions, including opportunities to role play a session. Training resources are provided (i.e. session narratives, worksheets, checklists, client resources, and the treatment manual adapted for diabetes AHPs in Australia). The worksheets have been adapted from the 'Problem-Solving Treatment Manual for Primary Care (PST-PC): A treatment Manual for Depression' (Hegel & Arean, 2011) and developed specifically for this context. The workshops and training also focus on strategies to strengthen AHPs skills in empathic listening and encouraging support-seeking behaviour. AHPs are guided on how to address barriers that people with diabetes may experience in seeking support from a general practitioner (GP) or mental health professional. AHPs are familiarised with the mental health referral pathways and processes. The workshops will be delivered by two experienced research fellows with knowledge and expertise in: a) psychological therapies, including PST; b) training health professionals in mental health and emotional support strategies; c) providing supervision; and d) the psychosocial aspects of diabetes. Workshops will be conducted online (via Zoom). The training is scheduled to be completed at least two months in advance of commencing the RCT. Following completion of the workshops, AHPs are allocated a minimum of two and a maximum of four training cases. Training cases are adults with diabetes who meet the inclusion criteria for the RCT and consent to be a training case. LISTEN will be delivered via telehealth (phone or videoconference) and participants are offered <4 sessions of 45- to 60-min duration. With participants’ consent, all training sessions will be audio-recorded. The recorded sessions will be reviewed by the research psychologist and a second member of the research team using the PST-Adherence and Competence Scale (PST-PAC). The PST-PAC examines fidelity to technical skills, adherence to the problem-solving steps, process tasks, communication and interpersonal effectiveness, and global competence based on the complexity of the client presentation. Fidelity is rated from 0 (not completed) to 5 (well above standard), and detailed feedback and supervision for the AHPs will be provided on their ratings via videoconference (45- to 60-min duration). To be deemed competent to deliver LISTEN, the AHP will be required to have completed a minimum of two training cases and achieved an overall score of at least 3 (satisfactory) on the PST-PAC for three consecutively rated sessions to be deemed competent in the delivery of LISTEN and progress to delivery for the RCT. The training cases will be completed prior to commencing the RCT. During the RCT, AHPs will have access to individual monthly supervision/support sessions and ad hoc group supervision sessions, facilitated by the research psychologist. AHPs will audio-record 25% of their sessions with RCT participants and these sessions will be reviewed against the PST-PAC scale to evaluate intervention fidelity.