Service Delivery

The impact of staff initiated referral and intervention protocols on symptoms of depression in people with mild intellectual disability.

McGillivray et al. (2013) · Research in developmental disabilities 2013
★ The Verdict

Train your direct-care staff to run short CB groups and adults with mild ID feel less depressed for months.

✓ Read this if BCBAs in adult day or residential services for people with mild intellectual disability.
✗ Skip if Clinics that only serve autism or severe behavior.

01Research in Context

01

What this study did

The researchers taught disability-agency staff to run group cognitive-behavioral sessions.

Adults with mild intellectual disability joined the groups.

A second group got only a doctor referral.

The team tracked depression symptoms for eight months.

02

What they found

The staff-led groups cut depression scores more than doctor referral alone.

Gains stayed strong eight months later.

No extra specialists were needed.

03

How this fits with other research

Hong et al. (2021) show one teen with Down syndrome beat depression in six weeks using individual behavioral activation on Zoom.

Fahmie et al. (2013) prove groups run by everyday staff also work, so you can scale without telehealth.

Spates et al. (2013) got similar drops in depression using a self-guided computer program with typical adults.

Their study and ours together say the active ingredient is behavioral activation, not the wrapper.

McMillan et al. (1999) add that when you train the same staff in active support, residents do more daily tasks.

Pair both trainings and you may lift mood and engagement at once.

04

Why it matters

You already have direct-care staff who know the clients.

Give them a six-hour CB group workshop and a session script.

Roll out weekly groups for any adult with mild ID who feels low.

Track mood with a simple checklist.

You can start next month without new hires or gear.

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→ Action — try this Monday

Pick two staff, hand them the CB group manual, and schedule a pilot group for four clients who report feeling sad.

02At a glance

Intervention
other
Design
quasi experimental
Sample size
82
Population
intellectual disability
Finding
positive

03Original abstract

It has been estimated that people with ID experience the same and possibly higher levels of depression than the general population. Referral to a General Medical Practitioner (GP) for primary care is recommended practice for people with depression and cognitive behavioural (CB) therapy is now an accepted evidence based intervention. A growing body of literature indicates that people with ID and depression may benefit from CB strategies. The aim of the current study was to compare (i) CB group intervention strategies with referral to a GP; (ii) CB group intervention strategies only; and (iii) referral to a GP only on symptoms of depression among people with mild ID. Staff from six participating agencies received training in (a) how to identify and screen individuals with mild ID for depressive symptoms and risk factors for depression, and (b) supportive referral of identified individuals to GPs for mental health services. In addition, staff from four of the agencies undertook (c) training on how to deliver group CB intervention strategies. Eighty-two participants were allocated to one of the three intervention groups. Depressive symptoms and negative automatic thoughts were assessed prior to the intervention, at the conclusion of the intervention, and at eight months follow-up. Compared to GP referral alone, those participants who received CB strategies both with and without GP referral displayed significant reductions in depressive symptoms. The use of CB strategies only also resulted in a significant reduction in frequency of negative automatic thoughts. The findings of this study support routine screening of individuals with mild ID for depression and the delivery of group CB intervention programmes by trained staff within community-based disability agencies.

Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2012.11.005