Hybrid Type II Implementation Trial

The goal of this hybrid type II implementation trial is to test a telehealth behavioral activation intervention delivered in Spanish by community health workers in Spanish speakers living in rural and frontier areas of Montana and New Mexico. The main questions it aims to answer are:

Does an adapted behavioral activation intervention reduce depressive symptoms? Is engagement in the intervention the primary mechanism by which depressive scores are reduced?

Researchers will compare depressive symptoms in the intervention group as compared to a waitlisted group.

Participants will receive a weekly behavioral activation session via telehealth and will be asked to complete weekly surveys and homework. They will complete the Beck Depression Inventory (21 items) at baseline, after 12 weeks, and after 32 weeks.

Inclusion Criteria:

• Age 18 years or older
• Spanish-speaking adult who prefers to receive services in Spanish

Resident of a rural or frontier community in Montana or New Mexico

Positive screen for depressive symptoms at or above study eligibility threshold on Spanish-language screening measure

Able and willing to participate in telehealth sessions

Able to provide informed consent

Exclusion Criteria:

• Active suicidal intent requiring immediate emergency intervention

Current psychosis or mania

Severe cognitive impairment that would prevent participation

Currently receiving intensive psychiatric treatment that would conflict with the intervention

Unable to participate in telehealth sessions

Unable to provide informed consent