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

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Evidence-based Practices in Mental Health and Aging

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  1. 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

  2. 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.

  3. 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

  4. 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.

  5. PEARLS - Core Components: 1. Problem-solving Treatment 2. Social & Physical Activation 3. Pleasant Events Scheduling

  6. 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 isa direct connectionbetween unresolved problems & depression.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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).

  12. 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

  13. 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 .

  14. 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

  15. 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.

  16. 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

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