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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 Cheryl.pryor@agingresources.com www.agingresources.com.

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Evidence based practices in mental health and aging
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



Evidence based practices in depression care management
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 in mental health and aging

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


Evidence based practice model overview pearls healthy ideas
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
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 isa direct connectionbetween unresolved problems & depression.

Problem solving therapy
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
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 therapy1
Problem Solving Therapy

7 Steps of PST:

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

  • Set realistic goals - attainable

  • Generate possible solutions

  • Consider Pro’s /Con’s of each solution

  • Select a solution of choice

  • Develop an action plan/steps to achieve solutions

  • Review & evaluate progress.

Healthy ideas identifying depression empowering activities for seniors
HealthyIdeas=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
HealthyIdeas- 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= Re-establishes routines, reinforces experiences, overcome avoidance patterns (Jacobson et al., U. Wash).

Behavioral model of depression
Behavioral Model of Depression

Depression results in behaviors that limit positive outcomes

→reduced pleasure, reduced accomplishment

Lowered Mood

Decreased Pleasant Activities

Decreased Activity



Behavioral activation
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)



Decreased Depressive Symptoms

Improved Mood




Evidence based practices in mental health and aging

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


  • 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.


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