Engaging Depressed Low-Income Seniors in Mental Health Services

In this research study, study investigators are partnering with United Neighborhood Houses
of New York, the umbrella membership organization of the 34 New York City Neighborhood
Houses. Due to the limited scope of this feasibility study, we have selected three Houses to
serve as recruitment sites. These three house approximate the gender and racial
characteristics of the larger group.

During Stage 1, investigators will work with the three Houses in implementing systematic
research assessments to identify level of psychopathology, referral patterns, and
connections to mental health evaluation among their depressed senior clients. Investigators
will train caseworkers to screen their clients for depression and will also instruct
caseworkers to refer any senior scoring endorsing depressive symptoms to their partnering
community-based mental health or medical clinic. Data on successful connections to mental
health evaluation will serve as the comparison to that achieved by Stage 2, the ENGAGE
intervention.

During Stage 2 study investigators will train all caseworkers from each Neighborhood House
to use the ENGAGE intervention. For eligible depressed seniors, the caseworker will:

1. provide psychoeducation that addresses client-specific barriers to evaluation and care
(e.g., stigma, transportation);

2. use shared decision-making strategies to engage seniors and arrive at a decision about
where and from whom to receive an evaluation and possible care; and

3. provide connections to preferred mental health services. Mental health service options
will include referral to the senior's primary care physician or local community mental
health clinic for further evaluation.

In two subsequent sessions 2 and 4 weeks later, the caseworker will assess success in
receiving a mental health evaluation, and in initiating treatment:

- If the senior has not yet pursued an evaluation, the caseworker will continue to
address his/her individual barriers and will re-engage in shared decision-making if
necessary.

- If the senior did receive an evaluation that confirms a depressive diagnosis, but
remains undecided about treatment, the case worker will empower and help the senior to
select an appropriate treatment of his/her choice and will encourage ongoing engagement
in this treatment.

- If an evaluation revealed the absence of a depressive disorder and no treatment
recommendations, the caseworker will re-assess to ensure that depression did not
emerge.