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Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Older Adults with Depression

Award Number: R01MD009675
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Depression and falls are significantly higher in low-income, racially diverse homebound seniors than in the general older-adult population; however, the existing systems of care are not equipped to address disparities in mental health and fall prevention services for these vulnerable older adults. The long-term objective of the proposed study is to improve access to depression treatment and fall prevention for growing numbers of low- income homebound seniors. Specific aims are to compare clinical and cost effectiveness of integrated tele- delivered behavioral activation (Tele-BA) and fall prevention (FP) by bachelor’s-level lay counselors/coaches to Tele-BA or FP alone and attention control (AC). The current and projected shortages of licensed clinicians and the costs of deploying highly trained professionals pose barriers to providing services to older adults in general and low-income homebound seniors in particular. A more scalable option is to utilize lay counselors/coaches, and our recent clinical trial (1R01MD009675) and a FP pilot study show that lay counselors/coaches are as effective as licensed clinicians. The study participants will be 320 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Central Texas. The lay counselors/coaches will be co-located in the HDM program for seamless referral and care coordination. In a 4-arm, pragmatic clinical trial with randomization prior to consent (a preferred public health approach), the participants in the integrated Tele-BA and FP (TBF hereafter) arm will receive 5 Tele-BA sessions and 4 in-home FP sessions. Those in the Tele-BA or FP alone arms will receive the respective intervention and 4 bimonthly telephone check-in (booster) calls, and those in the AC arm will receive 5 weekly telephone check-in calls followed by 4 bimonthly follow-up calls. Study hypotheses are: At 12, 24, and 36 weeks after baseline, (1) TBF will be more effective than Tele-BA or FP alone, and Tele-BA or FP alone will be more effective than AC in reducing depression (the 24-item Hamilton Rating Scale for Depression), falls, and fall injuries; (2) TBF than Tele-BA alone or FP alone will be more effective in reducing disability (WHODAS 2.0) and healthcare and social service use; and (3) TBF will be more cost effective than Tele-BA alone or FP alone. Cost-effectiveness analysis (CEA) will be based on depression free days, prevented falls, and health-related quality adjusted life-year measured by EuroQol-5 (EQ-5D). We will also conduct budget impact analysis (BIA) of TBF relative to Tele-BA or FP. Both CEA and BIA will employ a hybrid public program perspective of the Administration for Community Living and the Centers for Medicare and Medicaid. Public health significance of this study is that it will provide empirical data needed for real-world adoption of an intervention delivery model that targets to intervene for the two most frequent sources of disability acceleration and healthcare use among a rapidly growing, underserved population. (We use the terms older adults and seniors interchangeably because the latter term is frequently used in aging services.)


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $546,501 )
2024	2024	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	10	3/22/2024	NON-COMPETING CONTINUATION	$546,501
														Subtotal = $546,501

Issue Date FY: 2023 ( Subtotal = $619,012 )
2023	2023	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	002	9	3/16/2023	NON-COMPETING CONTINUATION	$619,012
2023	2021	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	7	12/2/2022	COMPETING CONTINUATION	$12,182
2023	2020	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	6	12/2/2022	NON-COMPETING CONTINUATION	-$12,182
														Subtotal = $619,012

Issue Date FY: 2022 ( Subtotal = $633,908 )
2022	2022	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	003	8	5/26/2022	NON-COMPETING CONTINUATION	$633,908
2022	2021	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	002	7	3/11/2022	COMPETING CONTINUATION	$0
2022	2021	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	7	3/3/2022	COMPETING CONTINUATION	$83,964
2022	2020	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	6	3/3/2022	NON-COMPETING CONTINUATION	-$83,964
														Subtotal = $633,908

Issue Date FY: 2021 ( Subtotal = $640,977 )
2021	2021	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	7	7/2/2021	COMPETING CONTINUATION	$640,977
2021	2021	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	003	7	7/26/2021	COMPETING CONTINUATION	$0
2021	2020	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	6	7/2/2021	NON-COMPETING CONTINUATION	$0
2021	2020	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	002	6	7/26/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $640,977

Issue Date FY: 2020 ( Subtotal = $309,115 )
2020	2020	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	6	12/17/2019	NON-COMPETING CONTINUATION	$278,204
2020	2020	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	6	1/3/2020	NON-COMPETING CONTINUATION	$30,911
														Subtotal = $309,115

Issue Date FY: 2019 ( Subtotal = $309,115 )
2019	2019	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR, MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	5	7/23/2019	NON-COMPETING CONTINUATION	$0
2019	2019	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR, MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	5	12/26/2018	NON-COMPETING CONTINUATION	$309,115
														Subtotal = $309,115

Issue Date FY: 2018 ( Subtotal = $494,411 )
2018	2018	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR, MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	4	6/13/2018	NON-COMPETING CONTINUATION	$49,442
2018	2018	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR, MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	4	12/19/2017	NON-COMPETING CONTINUATION	$444,969
														Subtotal = $494,411

Issue Date FY: 2017 ( Subtotal = $451,612 )
2017	2017	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR, MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	001	3	6/28/2017	NON-COMPETING CONTINUATION	$45,162
2017	2017	UNIVERSITY OF TEXAS AT AUSTIN	110 INNER CAMPUS DR, MN 13	AUSTIN	TX	78712	TRAVIS	USA	Minority Health and Health Disparities Research	000	3	12/12/2016	NON-COMPETING CONTINUATION	$406,450
														Subtotal = $451,612

Issue Date FY: 2016 ( Subtotal = $460,408 )
2016	2016	UNIVERSITY OF TEXAS AT AUSTIN	P.O. BOX 7159	AUSTIN	TX	78713	TRAVIS	USA	Minority Health and Health Disparities Research	000	2	12/14/2015	NON-COMPETING CONTINUATION	$414,367
2016	2016	UNIVERSITY OF TEXAS AT AUSTIN	P.O. BOX 7159	AUSTIN	TX	78713	TRAVIS	USA	Minority Health and Health Disparities Research	001	2	3/7/2016	NON-COMPETING CONTINUATION	$46,041
														Subtotal = $460,408

Issue Date FY: 2015 ( Subtotal = $484,689 )
2015	2015	UNIVERSITY OF TEXAS AT AUSTIN	P.O. BOX 7159	AUSTIN	TX	78713	TRAVIS	USA	Minority Health and Health Disparities Research	000	1	6/26/2015	NEW	$484,689
														Subtotal = $484,689

Grand Total All Awards = $4,949,748

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Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Older Adults with Depression

Award Number: R01MD009675

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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