Enabling lay providers to conduct CBT for older adults: key steps for expanding treatment capacity.
The Institute of Medicine advocates the examination of innovative models of care to expand mental health services available for older adults. This article describes training and supervision procedures in a recent clinical trial of cognitive behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD) delivered by bachelor-level lay providers (BLPs) and to Ph.D.-level expert providers (PLPs). Supervision and training differences, ratings by treatment integrity raters (TIRs), treatment characteristics, and patient perceptions between BLPs and PLPs are examined. The training and supervision procedures for BLPs led to comparable integrity ratings, patient perceptions, and treatment characteristics compared with PLPs. These results support this training protocol as a model for future implementation and effectiveness trials of CBT for late-life GAD, with treatment delivered by lay providers supervised by a licensed provider in other practice settings.
Mental Health Care Line (MHCL 116), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA.
Cynthia
C
Kraus-Schuman
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA.
Nancy L
NL
Wilson
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA.
Amber B
AB
Amspoker
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA.
Paula D
PD
Wagener
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA.
Jessica S
JS
Calleo
The Institute of Living, 400 Washington St., Hartford, CT 06106 USA.
Gretchen
G
Diefenbach
Department of Psychology, University of Tennessee - Knoxville, 307 Austin Peay Bldg., Knoxville, TN 37996-0900 USA.
Derek
D
Hopko
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA.
Jeffrey A
JA
Cully
Mental Health Care Line (MHCL 116), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA.
Ellen
E
Teng
Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, P. O. Box 20249, Houston, TX 77225-0249 USA.
Howard M
HM
Rhoades
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA.
Mark E
ME
Kunik
Houston VA HSR&D Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA.
Melinda A
MA
Stanley
Lay providers; Older adults; Psychotherapy