Recruiting

PST-AidImplementation of Problem-Solving Treatment in Community Health Centers (PST-Aid)

Sponsor:

University of Washington

Code:

NCT06494384

Conditions

Depression

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Interventions

Problem Solving Treatment as usual (PST as usual)

Problem Solving Treatment Aid (PST-Aid)

Study Details

Brief summary:

Although evidence-based clinical interventions (CI) are a preferred treatment option for patients with depression, CIs are rarely available in community primary care settings. When available, CIs are often delivered with poor fidelity and abandoned by practitioners during the initial months post-training. Identifying effective implementation strategies to support the adoption, reach, and sustained use with fidelity of these CIs could enhance the effectiveness of primary care-based treatment of depression, as primary care is where most treatment for this disorder is delivered. Current models of primacy care practitioner training and supervision follow standard formal didactic procedures that might not be sufficient for successful adoption, high-fidelity delivery, and sustainment of CIs. Automated decision support tools and feedback systems embedded in health informatics technology have been found to be effective in supporting the use of best practices and hence might be useful for the transition from training to sustained CI use. In practice, however, these tools are ignored by practitioners, have mixed success on outcomes, and can hinder clinical care owing to poor design. Problem Solving Treatment Aid (PST-Aid), an educate and reorganize implementation strategy, is a web-based app that promotes practitioner-client collaboration in the use of PST for goal setting and action planning. A pilot randomized trial comparing Problem Solving Treatment (PST) training-as-usual to training plus PST-Aid found PST-Aid was deemed to be appropriate and usable to both practitioner and client users with preliminary support for benefits in depression outcomes.

Conditions

Depression

Study ID

NCT06494384

Start date

Nov 6, 2024

Status verified date

Sep, 2025

Completion date

Mar 31, 2028

Anticipated

Primary completion date

Mar 31, 2028

Anticipated

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Inclusion Criteria:

Practitioner Participants. (a) are employed by a clinic that is an OCHIN clinical network member;
Practitioner Participants. (b) hold a master's degree in social work, psychology, counseling, or a related field;
Practitioner Participants. (c) provide psychotherapeutic care in the OCHIN network;
Practitioner Participants. (d) have not previously received formal training in PST as defined by University of Washington Advancing Integrated Mental Health Solutions Center (AIMS) criteria;
Practitioner Participants. (e) are not currently receiving specialized training outside of standard clinic support to implement a depression-specific psychosocial intervention; and
Practitioner Participants. (f) are English-speaking.
Client Participants. a) 18+,
Client Participants. b) English-speaking,
Client Participants. c) have a diagnosis of unipolar depression per provider report, and
Client Participants. d) have a PHQ-9 score ≥ 10, which is above the clinical cutoff for depression symptoms.

Exclusion Criteria:

Client Participants. (a) history or presence of psychiatric diagnoses other than unipolar, nonpsychotic depression or anxiety disorders,
Client Participants. (b) active suicidal ideation,
Client Participants. (c) current alcohol or substance abuse disorders, or
Client Participants. (d) have dementia
Client Participants. (e) all exclusion criteria cannot be confirmed via provider report.
Practitioner Participants. Exclusion criteria are those that do not meet the inclusion criteria listed above.

Study Design

Enrollment

410 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Health Services Research

Interventions and Outcome Measures

Arms

active comparator: Problem Solving Treatment as usual (PST as usual)

Participants in this arm will receiving training in PST as usual.

experimental: Problem Solving Treatment Aid (PST-Aid)

Participants in this arm will receiving training in PST with PST-Aid.

Interventions

Problem Solving Treatment as usual (PST as usual)

PST is a skills-based intervention that teaches clients a 7-step approach in which they 1) select a specific problem and define it in concrete terms,2) select a goal that is feasible to reach before next session, 3) brainstorm various ways to accomplish the goal, 4) evaluate pros and cons of each solution, including the likelihood they can actually implement it, 5) select the best solution, 6) create a plan to implement the solution, and 7) evaluate the plan afterward to ascertain the effectiveness of the solution. Practitioners teach and illustrate the PST process to clients at each session and encourage clients to implement action plans developed using the PST process. Clients are also encouraged to practice the PST process with additional problems between sessions, in order to gain mastery over the PST skills, enhance behavioral activation and as a result improve their belief in their ability to solve problems on their own (self efficacy).

Problem Solving Treatment Aid (PST-Aid)

PST-Aid is an internet-based tool to support the delivery of PST. PST-Aid incorporates decision support for the practitioner as well as client and provides PST treatment support functions (i.e., scaffolding), including patient problem lists and session worksheets. PST-Aid was designed to be used during remote sessions, such that practitioners and clients can interact throughout the session while collaboratively viewing and editing worksheets on their own browsers.This system was developed into a prototype that was piloted and found to be acceptable and with adequate usability.

Primary outcome measure

Change in Implementation Strategy Usability Scale (ISUS) score [ Time Frame: Baseline, 3 months, 6 months ]
Change in Participant Responsiveness Scale (PRS) score [ Time Frame: Baseline, 3 months, 6 months ]
Change in Intervention Appropriateness Measure (IAM) score [ Time Frame: Baseline, 3 months, 6 months ]
Adoption over time [ Time Frame: Baseline, 7 months post-initial training in the intervention, and end of the individual's study participation period, assessed as the study withdrawal date or 24 months post-training, whichever is first ]
Reach over time [ Time Frame: Baseline, 7 months post-initial training in the intervention, and end of the individual's study participation period, assessed as the study withdrawal date or 24 months post-training, whichever is first ]
Change in Patient Health Questionnaire (PHQ-9) score [ Time Frame: Baseline, 4 weeks, 9 weeks ]
Client Satisfaction Questionnaire-16 [ Time Frame: 9 weeks ]
Change in Quality of Life in Neurological Disorders Social Relations scale (Neuro-QOL) score [ Time Frame: Baseline, 4 weeks, 9 weeks ]
Initial fidelity (PST Fidelity Scale) [ Time Frame: Expert clinicians review audiotapes of therapy sessions or mock interview for each clinician participant over a six-month period of time prior to certification in the intervention ]
Sustained fidelity [ Time Frame: Expert clinicians review audiotapes of therapy sessions or mock interview for each clinician participant over a six-month period of time after initial training ]

Central Contacts and Locations

Central contacts

Katie Osterhage, MMS

206-616-2129 katieost@uw.edu

Patrick Raue, PhD

206-543-3807 praue@uw.edu

Locations

OCHIN, Inc.

Recruiting

Portland, Oregon, United States, 97228-5426

Contacts

Frances Lynch, PhD

503-310-4691 frances.lynch@kpchr.org

Principal Investigator:

Frances Lynch, Ph.D.

More Information

Sponsor

University of Washington

Last update posted

Sep 15, 2025

Last verified

Sep, 2025

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-10. This information was provided to ClinicalTrials.gov by University of Washington on 2025-09-15.