Lay Coach-Supported Digital Mental Health Intervention In Community Aging Services: Early Findings from a Hybrid Randomized Trial

Background and Purpose:

Digital mental health interventions (DMHIs) are promising for reducing access barriers to mental healthcare, yet few are tailored for older adults and implemented within community aging service settings. Empower@Home is a cognitive behavioral therapy-based DMHI specifically designed for older adults with depression. A prior pilot randomized controlled trial (RCT) demonstrated its clinical efficacy when supported by undergraduate and graduate student coaches. This presentation discusses early findings from an ongoing Hybrid Type 1 implementation-effectiveness RCT of Empower@Home testing the intervention in a real-world setting, where coaching support is provided by non-clinician aging service providers.

Methods:

Participants aged 50 years or older with at least mild depressive symptoms (≥ 8 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited through community agency referrals and other outreach methods. Individuals with probable dementia, elevated suicide risk, psychotic disorders, or current substance use disorders were excluded.

Participants were randomized using block randomization stratified by community agency to either the treatment or control group. The treatment group received immediate access to Empower@Home and support from trained aging service provider coaches. The waitlist attention control group received usual care enhanced with biweekly friendly calls.

Outcomes were assessed at baseline, 12-week post-intervention, and at 24- and 36-week follow-ups. An implementation process evaluation guided by the Consolidated Framework for Implementation Research (CFIR) included qualitative interviews with a subset of treatment participants, coaches, agency leaders, and observations across participating agencies (n=6). This analysis focused on those who completed both baseline and post-intervention assessments as of April 2025 (n=124).

Results:

Participants had a mean age of 69.8 years (SD=7.4), were primarily female (86%) and non-Hispanic White (77.7%), and 61.5% reported an annual income under $50,000. Among participants assigned to the treatment group, 78.8% completed all nine program sessions. Additionally, 90.1% agreed that the program was easy to use, 95.0% agreed that the program is likely to be effective, and 96.7% indicated that they would recommend the program to others who experience depressed mood.

Compared to the control group, treated participants demonstrated a significantly greater reduction in depression symptoms at post-test as measured by the PHQ-9 (Cohen’s d =-.48) and a short form of the Hamilton Rating Scale for Depression (HAM-D; Cohen’s d =-.44). Between-group differences in anxiety and loneliness were not statistically significant at post-test but were in the expected direction. Despite these promising results, qualitative interviews and researcher observations highlighted important implementation challenges. There was substantial variation in how agencies implemented the program, with some integrating it relatively smoothly within their workflow and others encountering persistent difficulties related to client engagement, competing staff demands, and fidelity to coaching guidelines. Early observations point to the importance of leadership support, organizational culture, protected time, and incentives in shaping implementation.

Conclusions and Implications:

Early findings suggest the feasibility of training lay aging service providers to deliver support for a CBT-based DMHI and embedding this model within community aging service settings. However, these findings also reveal barriers to implementation that will need to be addressed to strengthen reach and long-term sustainability.