Using health educators and behavioral activation to enhance collaborative depression screening programs in primary care settings

Issues: Depression is a serious public health threat given its high prevalence and substantial personal, social and economic costs. The US Preventive Services Task Force recommends “staff-assisted” depression screening in primary care clinics, yet sustained implementation of such collaborative programs has not occurred. A need exists to identify programs that address cost and complexity, common barriers to implementation. Description: Four diverse primary care clinics are pilot-testing a collaborative depression screening program that differs from previous programs in two innovative ways, 1) cost-efficient health educators, rather than nurses or counselors, conduct screening and provide basic case management as guided by protocols, and (2) health educators are trained to provide a protocol-driven behavioral activation intervention to help patients engage in behaviors that mitigate depressive symptoms. Behavioral activation interventions are simple and effective and have not been emphasized in previous programs. Lessons Learned: Preliminary results suggest that health educators can efficiently administer collaborative depression screening programs and effectively provide behavioral activation interventions, and that such interventions reduce depressive symptoms for patient with sub-threshold or major depression. The flexibility of combining screening with behavioral activation interventions and/or care management accommodates secondary and tertiary prevention of depression in primary care clinics. Recommendations: Using health educators and focusing on behavioral activation interventions has the potential to improve effectiveness, decrease costs, and enhance implementation of collaborative depression screening programs in primary care settings.