Training to implement BE-ACTIV(VA), a behavioral intervention for depression in VA nursing homes: staff satisfaction and efficacy

Depression affects up to 40% of Veterans in Veterans Health Administration’s nursing homes, known as Community Living Centers (CLCs). We adapted an evidence-based intervention (Behavioral Activities Intervention; BE-ACTIV) to create BE-ACTIV(VA): a manualized behavioral activation intervention for CLC short-stay Veterans with depression. While BE-ACTIV relied on intensive in-person staff training, we developed online, self-paced trainings to fit staff members’ busy schedules. The goals of this article are to report on the creation and content of BE-ACTIV(VA) trainings and CLC staff perceptions of their efficacy, feasibility, and acceptability. We used data from post-training surveys (survey responses: All CLC Staff Training n = 13; Activity Facilitator Training n = 10; Mental Health Provider Training n = 18) and qualitative interviews (n = 16) with staff. Survey responses were summed and averaged to provide a mean score for each question. We conducted brief, semi-structured interviews with staff implementing BE-ACTIV(VA), coded transcripts, and employed a thematic analysis approach to identify salient themes from the coding output. Survey data showed that staff were satisfied with the trainings (100% were satisfied with the Mental Health Provider Training; 100% were satisfied with the Activity Facilitator Training; 85% were satisfied with the All CLC Staff Training) and found the content to be effective and useful for their practice. We identified four main themes related to staff perceptions of the efficacy of the training (staff were prepared to implement BE-ACTIV(VA) post trainings, and felt trainings were clear and useful), feasibility of the training (fit well into staff workflow), and suggestions for improvement (to add interactive components or knowledge checks). To our knowledge, this is the first study to show that behavioral activation intervention training can be successfully done in a brief, online format within a CLC setting among a range of staff. Findings suggest that this training approach can support the dissemination and scale-up of manualized behavioral activation interventions to reduce depression across long-term care settings.