title: Staff-focused interventions to increase referrals for depression in aged care facilities: a cluster randomized controlled trial.
abstract: OBJECTIVE
  While there is evidence that depression training can improve the knowledge of staff in residential care facilities, there is an absence of research determining whether such training translates into practice change. This study aimed to evaluate the impact of staff training and the introduction of a protocol for routine screening and referral for depression on the numbers of residents detected and referred by care staff for further assessment.
  
  
  METHODS
  A cluster randomized controlled design was used to compare the referral rates for residents in seven facilities randomly allocated into one of three conditions: staff training, staff training plus a screening and referral protocol and wait-list control. Participants were 216 aged care residents (M age = 87 years), who agreed to a 12-month audit of their facility file.
  
  
  RESULTS
  Staff training on its own did not increase the rate of referrals for depression; however, staff training plus the screening protocol and referral guidelines did lead to a significant increase in the number of residents who were referred to a medical practitioner for further assessment. However, this increase in care staff referrals did not result in substantial changes in the treatment prescribed for residents.
  
  
  CONCLUSIONS
  Staff training in depression, supplemented with a protocol for routine screening and guidelines on referring residents, can improve pathways to care. However, strategies to overcome barriers to appropriate subsequent treatment of depression are required for staff-focused initiatives to translate into better outcomes for depressed older adults. Methodological limitations of this study are discussed.
authors.affiliation: Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia. tanya.davison@monash.edu
authors.forename: Tanya E
authors.initials: TE
authors.lastname: Davison
authors.forename: Gery
authors.initials: G
authors.lastname: Karantzas
authors.forename: David
authors.initials: D
authors.lastname: Mellor
authors.forename: Marita P
authors.initials: MP
authors.lastname: McCabe
authors.forename: Dejan
authors.initials: D
authors.lastname: Mrkic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D016000:Cluster Analysis; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration; D012017:Referral and Consultation / Q000706:statistics & numerical data*