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OBJECTIVES

To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients.

DESIGN

Description of the important components of TRIAD, its implementation, and evaluation results from nurse surveys.

SETTING

Three certified home healthcare agencies in Westchester County, New York.

PARTICIPANTS

Thirty-six homecare nurses.

INTERVENTION

Participants randomly assigned to TRIAD (n=17) were provided with the opportunity to observe and practice patient interviewing. The approach focused on clinically meaningful identification of the two "gateway" symptoms of depression and is consistent with the newly revised Medicare mandatory Outcome and Assessment Information Set (OASIS-C). Control group participants (n=19) received no training beyond that which agencies may have provided routinely.

MEASUREMENTS

Baseline and 1-year nurse confidence in depression detection, and postintervention acceptability ratings of the TRIAD intervention.

RESULTS

Participants randomized to the TRIAD intervention reported a statistically significant increase in confidence in assessing for depression mood (P <.001), whereas the usual care group’s confidence remained unchanged (P=.34) 1 year later.

CONCLUSION

An educational program designed to improve depression detection by giving nurses the skills and confidence to integrate depression assessment into the context of routine care can be successfully implemented with homecare agency support. The authors discuss the intervention in terms of OASIS-C and the "real world" realities of intervention implementation.