Evidence-based Practices in Mental Health and Aging

June 22, 2010Cheryl Evans-Pryor, M.A.-G

Aging Resources of Central Iowa5835 Grand Avenue, Suite 106Des Moines, IA. 50312-1437

(515) 255-6714, ext.322Cheryl.pryor@agingresources.com

www.agingresources.com

Evidence-based Practices in Depression Care Management

• Goal: Present condensed overview of two models of depression care treatment.

• Objectives:1. Present model components.2. Present behavioral activation & problem-solving approaches.3. Discuss model outcomes/ success.

Evidence-based practices:• Offer brief treatment- time sensitive• Structured approach• Researched, proven to work• Flexible implementation – 1:1 or groups• Redefines issues/ current focus• Meets people where they are in life• Small, manageable steps• Cost-effective

Evidence-based practice model overview (PEARLS & HEALTHY IDEAS)

• Both models are grounded in Behavioral Activation & Change.

• PEARLS - Program to Encourage Active, Rewarding Lives for Seniors.

• Addresses Minor Depression & Dysthymia. Is not designed to address situational depression or grief issues.

• Built on Medical/Psychiatric foundation with team approach to chronic care.

PEARLS - Core Components:

1. Problem-solving Treatment

2. Social & Physical Activation

3. Pleasant Events Scheduling

• Patient-centered and patient directed, can participate in 1 or all 3 components.

• Serves persons 60+ with physical impairments and social isolation.

• Purpose= There is a direct connection between unresolved problems & depression.

PEARLS

• Theory= Depression has many causes, and failed attempts to solve problems leads to learned helplessness.

• Goal= Increase confidence and feelings of self-control.

• Increase understanding of causal link btw. symptoms and current problems.

• Increase pleasant, social, and physical activities.

Problem Solving Therapy

• Adopt attitude of goals being attainable=increased success.

• Decreases prolonged episodes/relapses.• Shift in thinking pattern that facilitates

change (contemplation to action).• Fosters a sense of HOPE.

Problem Solving Therapy – cont.

7 Steps of PST:1. Identifying problem-what does it look like/

how does it impact your life?2. Set realistic goals - attainable3. Generate possible solutions4. Consider Pro’s /Con’s of each solution5. Select a solution of choice6. Develop an action plan/steps to achieve

solutions7. Review & evaluate progress.

Problem Solving Therapy

Healthy Ideas=Identifying Depression, Empowering Activities

for Seniors• Reduce symptoms of depression in older

adults with chronic health conditions and functional limitations through existing community-based case management or counseling services.

Goal= to insure a systematic identification of depression through routine screenings (PHQ-2 & PHQ-9) from counselor or case managers.

• Utilizes case management staff that already have an existing relationship with the client.

• Screening and assessments occur at regular intervals/visits by case manager. Utilizes Behavioral Activation method.

• Behavioral Activation= Re-establishes routines, reinforces experiences, overcome avoidance patterns (Jacobson et al., U. Wash).

Healthy Ideas- cont.

Behavioral Model of Depression

Lowered Mood

Decreased Activity

Decreased Pleasant Activities

Depression results in behaviors that limit positive outcomes→ reduced pleasure, reduced accomplishment

HealthyIdeas

Behavioral Activation

Rewarding Activities

 

Improved Mood 

Decreased Depressive Symptoms

      

 

Improve mood by: Increasing frequency of behaviors that lead to positive outcomes Doing activities that “feel good” or are pleasurable or reduce stress (may involve a task, something social or an activity)

HealthyIdeas

HEALTHY IDEAS- Core Components:

• Screening and assessment• Helps clients examine own mood and relationship to

behavior by self monitoring symptoms.• Encourages clients to examine current and/or meaningful

activities.• Educates clients to recognize symptoms and how to

ask for help or talk to providers.• Referral, link to treatment as needed, follow-up• Empower through Behavioral Activation.• Accountability to engage in change by assessing

likelihood of follow-through. (Readiness Ruler)• Assess client progress

Outcomes

• Track and review data for each client.• Provide telephone follow-up btw. visits.• Brief intervention period= 6-9 months.• Examine both qualitative and quantitative

outcomes.

ResourcesPEARLS : http://depts.washington.edu/pearlspr/University of Washington Health Promotion Research Center, Seattle,

WA.

HEALTHY IDEAS : www.careforelders.org/healthyideasHuffington Center on Aging, Baylor College of Medicine, Houston, TX.

www.cdc.gov/aging and www.chronicdisease.org

SAMHSA National Registry of Evidence-Based Programs & Practiceshttp://mentalhealth.samhsa.gov