Who this is for
Adults with mild to moderate depression (PHQ-9 10-19). PHQ-9 >=20 or active suicidal ideation triggers immediate LCSW co-management - the pathway continues alongside clinical care. Bipolar suspected (ASRM screen positive) triggers psychiatry referral before pathway start.
What brings people here
PHQ-9 >=10 on Functional Medicine Assessment; self-report of low mood, anhedonia, or sleep/appetite change >2 weeks; PCP referral after starting antidepressant; member returning after a depressive episode.
Clinical framework
OneVillage-developed; aligned with APA depression guidelines and behavioral activation evidence base.
How the 8 weeks run
Baseline assessments, your first SMART goal, and the 1:1 that sets up everything after it.
Specialist coaches rotate in, and sessions come thickest here. One change at a time, in the domains your baseline flagged.
Re-score, refresh the care plan, and check in 1:1 on what is and is not working.
The remaining domains, at a lighter cadence, and the work of making the early weeks hold under pressure.
Final re-score, relapse prevention, and the plan for what happens next.
When your sessions fall
The program is built in four-week modules. Sessions come thickest at the start, when what you decide matters most, and step down as things settle. That is 5 sessions of 45 minutes across 8 weeks, counting the visit before week 1.
| Module | Weeks | Sessions | Cadence |
|---|---|---|---|
| Module 1 | Weeks 1 to 4 | 2 | every other week |
| Module 2 | Weeks 5 to 8 | 2 | every other week |
Week by week
- Before you beginBefore you begin
This is the reading before your first visit. It explains what we measure, what this program can do, and the parts of your care that have to come from a licensed clinician rather than from a coach.
- Week 1Doing comes before wanting to
The single most useful thing in this document is a reversal. Most people wait to feel like doing something before they do it. In depression that wait does not end, because the machinery that produces wanting is part of what is affected.
- Week 2Sleep, first
This week you meet Kelly Day O'Brien, NBC-HWC, your sleep coach, for 45 minutes. Sleep is second in this pathway rather than fifth for one reason: in depression it is not only a symptom. It is also one of the things keeping the illness in place.
- Week 3Movement, and what it can and cannot do
Exercise has genuine antidepressant evidence, which is why it is in this pathway. It is also routinely oversold to people who need a clinician. This week is about holding both of those at once.
- Week 4Halfway, and the medication conversation
This week you see Cindy Cathcart again for 45 minutes, and you complete the same PHQ-9 you completed at week 0. The purpose of a midpoint is to catch a plan that is not working while there is still time to change it.
- Week 5Food, alcohol and mood
This is the week most likely to be misrepresented to you elsewhere. There is real evidence that diet affects mood. There is also a large market selling far more than the evidence supports. Both halves are below.
- Week 6The stories depression tells
This week you meet Kimberly Macon, your mindset coach, for 45 minutes. Depression does not only lower mood. It edits the account you give of yourself, and it does it convincingly enough that the edits read as insight.
- Week 7Other people
Depression withdraws people, and withdrawal deepens depression. This week is about interrupting that loop deliberately, and about the fact that being coordinated with is itself associated with getting better.
- Week 8Making it hold
This is the last session with Cindy, 45 minutes, and it is a handover rather than a finish. Depression is a recurring condition for many people, and the plan that matters most is the one for the weeks after this document.
Who you will work with
Your Whole Health Coach takes your first visit and closes every module, so it is the same person from the first session to the last. The specialists below lead the weeks where their work is the focus.
Professionally, Cindy has been a clinical nurse for nearly a decade. She served in both clinical and administrative capacities throughout her career and holds a Master's degree in Nursing Leadership. As a staff nurse, nurse leader, and quality improvement specialist, she led multidisciplinary teams in academic medical settings throughout Boston, New York, and Ohio to deliver high-quality care to patients across complex diagnoses.
Kelly is a sleep behavior expert who connects to clients with genuine curiosity and compassion to unlock their potential for positive change. Sleep is a universal need AND is completely unique to the individual. No two sleep profiles are the same and Kelly uses multi-faceted and science-based approaches to support an understanding of the client’s desired outcome.
Meet Kimberly Macon, Professional Certified Coach (PCC), wife, mother, and a cancer survivor specialized in helping OneVillage members build mental resilience in the face of difficult situations and life changing events. Kimberly spent more than 15 years working in various roles across the Consumer Packaged Goods Industry within Marketing, Brand Management, Sales and Business Development.
What we work on
| Domain | What this pathway does |
|---|---|
| Nutrition & Metabolism | Mood-supportive: Mediterranean pattern, omega-3 (fish 2x/wk or supplement), B12 and iron screened, blood-sugar regulation. Limit alcohol. |
| Movement & Mobility | Behavioral activation via movement - the highest-leverage intervention in mild-moderate depression. 150 min/wk MVPA goal, but start with daily 10-min walk. |
| Sleep & Recovery | Sleep regularization comes first. Consistent wake time, light exposure morning, no naps >20 min. Sleep is both symptom and driver. |
| Stress & Resilience | Stress + depression coupling. Daily relaxation practice; relaxation that does NOT include alcohol or screen-scroll. |
| Mind & Mood | PHQ-9 every 2 weeks. C-SSRS at any positive PHQ-9 item 9. Treatment response measured at Week 6 - if no movement, step up. |
| Relationships & Purpose | Connection is protective. Schedule one social touch per week; values clarification; meaning. |
How progress is measured
These are the validated tools this pathway uses: at your first visit, at the mid-program review, and at the end.
| Tool | Cadence | Owned by |
|---|---|---|
| PHQ-9 | Onboard, every 2 weeks during Build, q4 weeks Maintain | WHC; LCSW reads |
| C-SSRS | When PHQ-9 item 9 >=1 or any concern | WHC; LCSW for safety planning |
| GAD-7 | Onboard, q4 weeks | WHC |
| ASRM | If bipolar suspected at intake | LCSW |
| ISI | Onboard, q4 weeks | Sleep Coach |
| PSS-10 | Onboard, q4 weeks | Stress / BH Coach |
| AUDIT/DAST | Onboard, quarterly | WHC |
| URICA | Onboard, PRN | WHC |
The research behind this pathway
Your clinician playbook was built from the guidelines and studies below. They are listed so you can read them yourself: every one is a real, published paper and the number at the end of each line is its PubMed ID.
Guidelines this pathway follows
- APA depression treatment guidance and the behavioral activation evidence base · American Psychological Association
The pathway is a coaching program alongside treatment, not a substitute for it.
- Collaborative care · Cochrane review of the model
The coach, primary care and mental health specialist working as one team. PMID 23076925
- PHQ-9 · Kroenke and colleagues
The depression measure repeated through the program. PMID 11556941
Key studies
- Kroenke K et al. (2001). J Gen Intern MedThe PHQ-9: validity of a brief depression severity measure
Validated the PHQ-9, the nine-question depression measure this pathway repeats so you can see a trajectory rather than a single reading. PMID 11556941
- Richards DA et al. (2016). LancetCost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial
COBRA randomized 440 adults with depression to behavioral activation delivered by junior mental health workers or to full cognitive behavioral therapy. The simpler, cheaper therapy was not worse. PMID 27461440
- Uphoff E et al. (2020). Cochrane Database Syst RevBehavioural activation therapy for depression in adults
Cochrane's review of behavioral activation for adults: it works about as well as cognitive behavioral therapy and better than doing nothing. PMID 32628293
- Noetel M et al. (2024). BMJEffect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials
Pooled 218 trials and 14,170 people. Walking, jogging, strength training and yoga all reduced depression, and the more vigorous the exercise the larger the effect. PMID 38355154
- Archer J et al. (2012). Cochrane Database Syst RevCollaborative care for depression and anxiety problems
Cochrane's review of collaborative care, the model where a coach, a primary care clinician and a mental health specialist work as one team. It beats usual care on depression and anxiety. PMID 23076925