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 (515) , ext.322

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 - 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. 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 Healthy Ideas

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) 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 : University of Washington Health Promotion Research Center, Seattle, WA. HEALTHY IDEAS : Huffington Center on Aging, Baylor College of Medicine, Houston, TX. and SAMHSA National Registry of Evidence-Based Programs & Practices