Leveraging Adult Protective Service Interaction to Offer Evidence-Based Treatment for Depression in Elder Neglect/Self Neglect

The purpose of this study is to test the feasibility and acceptability of an evidence-based treatment for depression delivered over an ipad, computer, or smartphone can help Adult Protective Services (APS) clients with their activities of daily living to evaluate whether reductions on measures of depression and apathy (a) mediate reduced Elder Neglect/Self Neglect (EN/SN) behaviors; and (b) whether secondary posited mediating mechanisms are also active in impacting depression and apathy

Study Overview

• Status: Not yet recruiting
• Conditions: Depression in Old Age
• Intervention / Treatment: Behavioral: APS Treatment as Usual; Behavioral: Intervention-Behavioral Activation (BA)

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Leila Wood, PhD, MSSW; Phone Number: (713) 486-2700; Email: Leila.G.Wood@uth.tmc.edu
• Study Contact Backup: Name: Jason Burnett; Phone Number: (713) 873-4685; Email: Jason.Burnett@uth.tmc.edu

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • The University of Texas Health Science Center at Houston
      • Contact: Leila Wood, PhD, MSSW; Phone Number: (713) 486-2700; Email: Leila.G.Wood@uth.tmc.edu
      • Contact: Jason Burnett; Phone Number: (713) 873-4685; Email: Jason.Burnett@uth.tmc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• APS Case in APS Region VI- Must have open case
• PHQ 9 score- Must have score of nine (9) or more

Exclusion Criteria:

• Previous mental health diagnosis of bipolar disorder, psychotic disorders, and moderate to severe dementia
• Assessment of Consent Proxy- Those who need assessment of consent proxy
• Suicidal Intent (as indexed by PhQ-9 question 9)- Those scoring 2 or 3
• Current Alcohol and Drug Dependency- As evidenced by Cut down, Annoyed, Guilty, and Eye-opener (CAGE) score of 3 or more

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: APS Treatment as Usual	Behavioral: APS Treatment as Usual; APS agencies conduct in-home investigations of alleged abuse and neglect against disabled and older adults. Investigations result in short-term stop-gap measures, primarily brief case-management centering on referral linkage to community-based services and provision of resource allocation. No direct psychological services or treatments are provided by APS, however referral to other services is also standard.
Experimental: Intervention-Behavioral Activation (BA)	Behavioral: Intervention-Behavioral Activation (BA); Participants will be will be guided through 8 one-hour sessions via home telehealth by the study community health worker. Each weekly < 60 minute BA session will include modules focusing on 1) Psychoeducation for depression and techniques for self-management, including pharmacologic and psychosocial treatment options; 2) Introduction of BA and guided problem-solving techniques to enhance self efficacy for managing depression and other chronic illnesses; 3) BA and problem-solving techniques to support medication management and adherence strategies; 4) BA to develop strategies and techniques for communicating with health providers and/or support resources to foster positive mood and self management; and 5) Developing a relapse prevention plan, which includes identifying triggers for lower functioning, support resources, and practice of BA techniques.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in depression as assessed by the Patient Depression Questionnaire (PHQ-9)	This is 9 item questionnaire and each is scored from 0 (not at all) to 3 (nearly every day), for a maximum score of 27, higher score indicating more depression	baseline, post-treatment ( 8 weeks after baseline), and 3 months
Change in apathy as assessed by the Apathy Motivations Index (AMI)	This is an 18 item questionnaire and each item is scored on a scale from 0(completely true) to 4(completely untrue), for a maximum score of 72, with higher scores indicating greater apathy	baseline, post-treatment ( 8 weeks after baseline), and 3 months
Change in Elder Neglect/Self Neglect (EN/SN) as evidenced by study developed goal attainment scale	Participants will be given a list of 19 common daily activities and will be asked to pick one or more activities form the list that they would like to start doing or do more regularly each day or week.Each activity will be then scored based on the following scoring criteria, higher score indicating better outcome : (Much less than expected)-2 (Somewhat less than expected)-1 (Expected client outcome)0 (Somewhat better than expected)+1 (Much better than expected)+2	baseline, post-treatment ( 8 weeks after baseline), and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in social connection as assessed by the Lubben Social Network Scale	This is a 6 item questionnaire and each is scored from 0(none) to 5(none or more contacts) for a total score range of 0-30 higher scores indicating better outcome	baseline, post-treatment ( 8 weeks after baseline), and 3 months
Change in social isolation as assessed by Patient-Reported Outcomes Measurement Information System (PROMIS 8)	This is an 8 item questionnaire and each is cored from 1(never) -5 (always) for a maximum score of 40, higher score indicating worse outcome	baseline, post-treatment ( 8 weeks after baseline), and 3 months

Collaborators and Investigators

• Sponsor: The University of Texas Health Science Center, Houston
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Leila Wood, PhD, MSSW, The University of Texas Health Science Center, Houston

Study record dates

Study Major Dates

• Study Start (Estimated): July 21, 2025
• Primary Completion (Estimated): March 31, 2026
• Study Completion (Estimated): March 31, 2026

Study Registration Dates

• First Submitted: March 24, 2025
• First Submitted That Met QC Criteria: April 1, 2025
• First Posted (Actual): April 4, 2025

Study Record Updates

• Last Update Posted (Actual): July 2, 2025
• Last Update Submitted That Met QC Criteria: June 28, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Elder neglect; Self neglect
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Mood Disorders; Depression; Depressive Disorder
• Other Study ID Numbers: HSC-MS-24-1021; 1P30AG086563-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No