Statewide Behavioral Activation Training in Texas

Before scaling statewide, EMPOWER first evaluated the digital training program with non-specialist providers at Baylor Scott & White Health System - one of the largest health networks in Texas.

The Aim

To pilot test the preliminary effectiveness, feasibility, acceptability, and satisfaction of a newly developed digital program training frontline workers to deliver Behavioral Activation for adult depression.

The Training Program

The EMPOWER BA program consists of two digital courses, each requiring a participant's time commitment of 10 hours:

• Foundational Skills (FS): Core mental health and counseling concepts, including what mental health is, creating effective counseling relationships, supervision, and self-care for providers
• Behavioral Activation (BA): Specific skills to deliver a brief evidence-based intervention for depression, including understanding depression, behavioral strategies, and linking activity to mood

Both courses are self-paced, available on any device, and include video lectures, knowledge checks, role-plays, and evidence-based resources.

Participants also received coaching support, including weekly motivational emails and virtual office hours. The course completion was followed by a 26-item multiple-choice knowledge assessment.

Findings

73 participants were recruited by the Baylor Scott & White and EMPOWER teams and included nurses, medical assistants, community health workers, social workers, pharmacists, and researchers. 90.4% identified as female, 34.2% as Hispanic or Latino, and 100% had no prior training in CBT or BA.

Of the 73 non-specialist providers enrolled, 42 completed both the courses - including nurses, medical assistants, and community health workers. The findings demonstrated:

• A significant improvement in knowledge scores from pre- to post-training (mean difference: 5.4 points; 95% CI: 1.6-9.2; p = 0.006)
• Providers who fully completed both courses showed an even stronger gain (mean difference: 6.8 points; p = 0.001)
• Focus group feedback confirmed the training was informative, well-structured, self-paced, and directly relevant to frontline community health work in Texas

These results - published in Psychiatric Research and Clinical Practice (Taha et al., 2025) - established that the digital BA training program could meaningfully build the skills and knowledge of non-specialist providers, and provided the foundation for EMPOWER's statewide expansion.

Collaborations and Training

Funded by Lyda Hill Philanthropies through the $10 million Lone Star Prize and housed at the Meadows Mental Health Policy Institute, the Lone Star Depression Challenge aimed to reduce the burden of depression in Texas through early detection, community-based support, and sustainable care delivery.

EMPOWER’s role focused on training non-specialists, including Community Health Workers, case managers, volunteers, and other frontline providers, to deliver Behavioral Activation for depression using culturally adapted, bilingual digital tools, between 2022 - 2025.

Statewide impact

As part of the Lone Star Prize project, EMPOWER expanded access to depression care training across urban and rural communities.

• The training spanned over 60 cities in Texas 
• EMPOWER trained 380 frontline providers, including Community Health Workers, case managers, nurse practitioners, and volunteers.
• The 20-hour Behavioral Activation training was culturally and contextually adapted and offered in both English and Spanish for greater reach.
• EMPOWER supported professional development for Community Health Workers through continuing education units linked to training completion.

The Lone Star Prize project showed strong demand for accessible, culturally responsive depression care training across Texas. It also helped build the partnerships, digital infrastructure, and workforce development model needed to move from training to supervised delivery of care.

EMPOWER is now building on this foundation through community and faith-based implementation efforts.

EMPOWER is partnering with the Congregational Collective, the NOW Clinic at the University of Texas Health Science Center at San Antonio, and the Program for the Future Church at Baylor University to equip congregations as community leaders in mental health and wellness.

Through this initiative, members of congregations in the greater San Antonio area are trained in the EMPOWER Behavioral Activation curriculum. These equipped individuals, known as navigators, are often elders, ministry leaders, or trusted members of their church communities. These navigators, once trained, play an integral role in their respective congregations in identifying those struggling with depressive symptoms, and providing them with the first line of support. 

Supporting depression care in churches

The project is currently engaging 18 churches. Navigators are being trained to recognize depressive symptoms, speak with care and confidence about mental health, and support members of their congregations who may be experiencing depression.

Navigators receive supervision from the NOW Clinic as they begin delivering Behavioral Activation support in their communities. The study will assess the quality of care delivered by non-specialists, clinical outcomes, implementation outcomes, and the costs of delivering the program.

As of June 2026, 12 congregation members had received at least one BA session by an EMPOWER-trained Navigator, with 35 total sessions delivered within faith settings. Early observations show meaningful reductions in depressive symptoms on the PHQ-9, with all individuals moving from moderate depression to minimal or very low symptom levels (PHQ-9 < 5).

Partners and funders

This work is being carried out in partnership with the Congregational Collective, the NOW Clinic at the University of Texas Health Science Center at San Antonio, and Baylor University.
The initiative is supported by the H. E. Butt Foundation and the John Templeton Foundation.

EMPOWER’s work in Texas is moving from statewide training to community-based delivery of care. By supporting trusted local providers and faith leaders, EMPOWER is helping build a sustainable pathway for expanding depression care across communities.