The major challenge in caring for geriatric depression lies in the implementation and delivery of evidence based treatments. Numerous efficacious treatments exist for late-life depression, yet many elders with depression remain untreated. This is partly due to the fact that there is limited knowledge about how to implement evidence-based interventions in real-world settings. This proposal seeks to develop strategies for implementation of interventions with demonstrated effectiveness for translation into clinical practice. Healthy IDEAS is a nationally recognized intervention, designed for community-based case managers, and with demonstrated effectiveness in reducing depression in older adults. The treatment developers are eager to partner with our research team to improve implementation. The overall goal of the study is to use cutting-edge methods to capture and understand stakeholder perspectives on implementation strategies in order to embed Healthy IDEAS in case management programs in more efficient and effective ways. This two-year study, conducted by academic and community research partners will "jump start" a subsequent R01 comparative effectiveness study by accomplishing the following four aims:
Aim 1: Examine existing implementation strategies to identify dimensions that can be modified in order to better "fit" aging case management programs. This will be accomplished through document collection, consultation with treatment developers, and key informant interviews with agencies that have implemented Healthy IDEAS, or considered but did not implement the program.
Aim 2: Quantify stakeholders' preferences for attributes of the implementation strategy. Web-based conjoint analysis will be used to elicit stakeholders' preferences and priorities for implementation attributes identified in Aim 1.
Aim 3: Conduct group model building with stakeholders to build an enhanced implementation strategy for use with case management programs serving older adults. The goal is to develop an enhanced implementation strategy that will be acceptable and feasibly for agencies serving older adults. This strategy will reflect stakeholders' preferences regarding efficiency and cost, and thus enhance sustainability of Healthy IDEAS.
Aim 4: Compare stakeholder perspectives of the enhanced implementation strategy versus the usual strategy in terms of acceptability and feasibility and readiness to adopt. Administrators, supervisors, and case managers who are considering the implementation of Healthy IDEAS will comparatively evaluate the enhanced strategy to the usual strategy, yielding preliminary data regarding the extent to which the enhanced strategy is more acceptable and feasible.
This project will accelerate the movement of scientific findings into clinical practice by informing implementation strategies. Acceleration of scientific findings benefits the scientific community, service agencies and professionals, service recipients, and taxpayers investing in science, all of who pay a price when evidence-based practices languish on the shelf for 15-20 years before they are incorporated into usual care. Ultimately, this project will improve depression care for older adults, thus alleviating a condition known to cause great suffering and disability.