Evidence-based Practices in Mental Health and Aging

June 22, 2010 Cheryl Evans-Pryor, M.A.-G Aging Resources of Central Iowa 5835 Grand Avenue, Suite 106 Des Moines, IA. 50312-1437 (515) 255-6714, ext.322

[email protected]

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

PEARLS

• 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

.

Problem Solving Therapy

• 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 – cont.

• 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

7 Steps of PST:

1. Identifying problem-what does it look like/ how does it impact your life?

2. Set realistic goals - attainable 3. Generate possible solutions 4.

Consider Pro’s /Con’s of each solution 5. Select a solution of choice 6. Develop an action plan/steps to achieve solutions 7. Review & evaluate progress.

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.

Healthy Ideas- cont.

• 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=

et al., U. Wash).

Re-establishes routines, reinforces experiences, overcome avoidance patterns (Jacobson

Behavioral Model of Depression

Depression results in behaviors that limit positive outcomes → reduced pleasure, reduced accomplishment Lowered Mood Decreased Pleasant Activities Decreased Activity

Healthy Ideas

Behavioral Activation



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) Rewarding Activities Decreased Depressive Symptoms Improved Mood

Healthy Ideas

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.

Resources

PEARLS

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

HEALTHY IDEAS

: www.careforelders.org/healthyideas Huffington Center on Aging, Baylor College of Medicine, Houston, TX.

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

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