Low-income and racially diverse homebound seniors experience significant disparities in mental health care. This study seeks to improve access to depression treatments for this population by comparing acceptability, clinical effectiveness, treatment cost, and budget impact of two tele-delivered treatment delivery models: 1) problem-solving therapy (PST) by licensed clinicians and 2) self-care management (SCM) support by trained lay mental health workers/advisors. The interventionists will be integrated into an aging-service agency, hence, integrated tele-PST (IT-PST) and integrated tele-SCM (IT-SCM).

Although tele-psychotherapy is likely to be an effective mental health service delivery model for the target population, the current and projected shortage of such clinicians and the costs of deploying highly trained professionals pose barriers to this model’s widespread real-world adoption and sustainability. A more plausible option may indeed have to utilize trained lay mental health workers.

The study participants will be 276 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Austin, Texas. In a 3-arm, pragmatic clinical trial with randomization prior to consent (a preferred public health approach), the participants will receive five sessions of IT-PST, five sessions of IT-SCM, or five telephone check-in calls (for the usual care group).

Data from this study will help aging-service providers and funders assess respective strengths and growing population group and improving their access to evidence-based mental health services.