Background: Our research has demonstrated that depression in elderly home health patients is highly prevalent, often mis-identified, and usually untreated. In developing our research infrastructure program, we worked with our partnering agencies to design and implement a staff "needs assessment" questionnaire to identify key areas for development to improve the treatment of depression in home health care. Methods: The questionnaire was completed by 134 clinicians during in-person meetings at four agency locations. Most were BA (32%) or MA (31%) nurses or social workers (19%) with over 20 years clinical experience. Results: Essentially all the clinicians knew the key symptoms of depression and reported routinely assessing for depression as part of the mandated OASIS. The questionnaire also identified key barriers to improving depression care. First, a significant proportion were uncertain about their abilities to recognize depression (35%) or suicide risk (62%) in patients. Second, many used the term "depression" nonspecifically, e.g., labeling phobia (57%), generalized anxiety (91%), and headaches (67%) as depressive symptoms. Third, most clinicians attributed depression to psychosocial causes such as loneliness (72%), disability (70%), and chronic medical illness (78%) but few acknowledged general biological causes (11%) or risks associated with cardiovascular disease (11%). Similarly, some (21%) did not believe that medication treatment was effective. Finally, many (28%) were unaware of that their agency had guidelines for depression care. These data did not differ substantially across locations or, generally, by profession training. Conclusion: Agency administrators and clinical supervisors expressed surprise at evidence that many of their clinical staff lacked knowledge about the biological aspects of depression, were not comfortable about its assessment, and were unaware of agency depression protocols. Because the data collection strategy was designed in collaboration with agency personnel, the findings have been very helpful in cementing the three agencies' commitment to partnership activities and in planning strategies to change their approach to depression and its care. Each agency is now participating in a formal evaluation of staff training in depression assessment, has involved our research group in designing and evaluating care protocols based on evidence-based models, and is planning pilot studies to test innovative approaches to care.
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