JASA S’Nami Program

1. JASAS’Nami Program JASA S’Nami: An Intensive Case Management Program for Russian Speaking Elders with Mental Illness:  A Collaborative Community Approach 

2. JASA- Mission Statement The Jewish Association for Services for the Aged (JASA) was established and incorporated in 1968 by the Federation of Jewish Philanthropies of New York to identify and respond to the needs of the frail, the poor and isolated elderly regardless of race, religion or ethnicity. JASA’s mission is to sustain and enrich the lives of the aging in the New York metropolitan area so that they can remain in the community with dignity and autonomy. JASA has developed a comprehensive, integrated network of services that provides a continuum of community care. JASA supports family and neighbor care-giving, links those in need to other sources of help, and engages in social policy and legal advocacy. Among JASA’s service divisions are case and group services, housing, legal services, mental health, and homecare. The agency sponsors over 80 different programs.

3. S’Nami • S’Nami, meaning “with us” in Russian, is an intensive case management program for Russian speaking elders residing in the JASA Housing Complex in Far Rockaway, Queens. • The S'Nami program was designed to identify individuals who need mental health services, refer them for treatment, and provide supportive services to help maintain them in the community.

4. S’Nami Program- Why Now? • JASA Brookdale Village Housing Development: • 1,203 Units with 1,700 residents (70%) are Russian speaking adults over the age of 60 • 5 suicides during 2002-2003 • 165 residents were identified as suffering from untreated mental illness • Barriers to quality care: • Patients referred to services didn’t keep appointments , low personal motivation, embarrassment and lack of understanding of the importance of the visit • Poor medication compliance • Cultural and linguistic difficulties • Risk of poor health, nutrition and home care because of untreated mental illness

5. Mental Health in the Elderly • The myth that mental health decline is inevitable with ageresults in a lag in treatment • Depression is associated with loss of useful social roles that happens with advanced age • Depressed elderly are more likely to be women, unmarried or widowed, of low socio economic status, to have experienced stressful life events, and to lack a strong social support network. • Older adults are less likely to use mental health services. More likely to feel responsible for their own psychological problems, and feel responsible for finding a solution to them on their own or through their social network

6. Cultural Issues & Immigrants • Culture informs attitudes about mental health and mental health services resulting in not discussing problems and/or verbalizing feelings • Research has linked immigrant status to depressive symptoms • In particular, living alone may have serious consequences for the mental health status of immigrants • Living alone acquires additional meanings • Extended family households are common within immigrant culture - the absence of this has more dire consequences.

7. Risk Factors for the Russian-American Population • Demonstrates high levels of demoralization and depression • Many moved into subsidized apartments upon arriving in the U.S. resulting in loneliness and isolation • Living alone leads to higher use of mental health services and greater risk of suicide • Variables predicting depression in elderly Russian immigrants: - Age - Ability to speak English - Education - Number of years in the U.S. - Gender

8. Community Outreach Community education program at Brookdale Village Senior Center: • To reach out and discuss JASA S’Nami • Geared towards Russian speakers • Goal: • To dispel myths, fears, shame regarding self-referrals or referring others

9. Individual Counseling Depending on client needs, an individualized comprehensive service plan includes: • Sessions with Intensive Case Management (ICM) Social Worker • Weekly home visits • Coordination of supports and services necessary to maintain the client in the community.

10. Support Groups • Socialization: • Discussion of situations that take place in the immediate community and/or current events that impact the participants’ lives, movies, parties. • Encouragement of socialization through participation in local senior centers, visiting neighbors • Music • Anger Management

11. Support Groups (Cont’d) • Groups based on the “ Warm Homes” (Israeli JDC-Eshel) model, of 8-10 participants- meeting for 12 sessions in 1 or more groups in a volunteer’s home • Content of meetings is determined by the interests of the group members; includes lectures, discussions, movie screenings, parties, etc. Brings group work services to clients in a safe and comfortable setting

12. Medical Needs • Social work staff provide weekly reminders to take medication • Linkage to services: • Psychiatric and medical appointment reminders and escorts are provided • Social workers monitor symptom and functioning levels of clients

13. Partnership with St. John’s Hospital Out-patient Clinic JASA staff includes- • Far Rockaway Director of Social Services • Provides weekly supervision to ensure all polices and procedures are correctly implemented • One full-time clinical social worker- Russian-speaking • Conducts initial assessment and develops Intensive Case Management treatment plan • Refers client to medical and psychiatric treatment • Collaborates with medical professionals • Client counseling, monitoring of symptoms, monitoring of medication compliance

14. Partnership with St. John’s Hospital Out-patient Clinic (Cont’d) • One part-time social worker- Russian speaking • Facilitates Warm Homes counseling groups • Escorts clients to appointments • Conducts in-home evaluations • One part-time secretary • Gathers and compiles statistics, maintains files • Arranges clients’ appointments and transportation • Assists with referrals

15. Partnership with St. John’s Hospital Out-patient Clinic (Cont’d) St. John’s staff provides- • Russian-speaking psychiatrists, and a Russian-speaking social worker • Monthly case conferences • To ensure best possible care for clients • Utilization reviews, discussions of cases and referrals

16. Challenges • Improving access to services for homebound clients • Clinics are restricted from providing in-home psychiatric treatment • Mental illness and Memory Impairment with Chemical Dependencies • Impairment in insight abilities hinder engagement in psychotherapy, which is a requirement in order to receive medication • Medication efficacy

17. Program Evaluation • Assessments of individual at baseline and at 6 month intervals during intervention • Scales include: • The Physical Maintenance Scale (ADL) • The Global Assessment of Functioning (GAF) • The Zung Self-Rating Depression Scale • The Beck Inventory Depression Scale • Monthly evaluation of assessments, service plans, referrals, and terminations

18. Outcomes

19. Outcomes (Cont’d) Impact on empowering community for successful aging- • Concerned community/staff contact program Support from unexpected places- • ADCC’s, local MD’s, NH’s, HC agencies Most important lessons – • Clients with symptoms of depression should receive treatment immediately

20. Outcomes (Cont’d) Incentive for replication by other communities- • Key to supporting the frail elderly in the community is access to services – not just for the ‘wellderly’. Most pivotal step/action- • Physical/mental health problems- multiple needs necessitating coordination of aging network services • Failure to do so- can result in breakdown of community care and subsequent institutionalization

21. References: • Chong, A.M. (2007) Promoting the Psychosocial Health of the Elderly- The Role of Social Workers. Social Work in Health Care, 44(1/2), 99-109. • Heller, K. (1993) Prevention Activities for Older Adults: Social Structures and Personal Competencies That Maintain Useful Social Roles. Journal of Counseling and Development, 72, 124-130. • Ray, D.C., Raciti, M.A., MacLean, W.E. (1992) Effects of Perceived Responsibility on Help-Seeking Decisions Among Elderly Persons Journal of Gerontology, 47B (3), 199-205. • Ron, P. (2002) Depression and Suicide Among Community Elderly. Journal of Gerontological Social Work, 38(3), 53-70. • Sullivan, M.P., Kessler, L., Le Clair, J.K., Stolee, P., Berta, W. (2004) Defining Best Practices for Specialty Geriatric Mental Health Outreach Services: Lessons for Implementing Mental Health Reform. Canadian Journal of Psychiatry, 49(7), 45-466. • Tran, T.V., Khatutsky, G., Aroian, K., Balsam, A., Conway, K. (2000) Living Arrangements, Depression, and Health Status Among Elderly Russian-Speaking Immigrants. Journal of Gerontological Social Work, 33, 63-77. • Turvey, C.L., Conwell, Y., Jones, M.P., Phillips, C., Simonsick, E., Pearson, J.L., Wallace, R. (2002) Risk Factors for Late-Life Suicide. American Journal for Geriatric Psychiatry, 10(4), 398-406. • Wykle, M.L., Musil, C.M. (1993) Mental Health of Older Persons: Social and Cultural Factors. Generations, 17(1), 7-12.

22. Thank You! Mara Schecter, LCSW Queens District Director Director of Elder Abuse Programs mschecter@jasa.org 718-286-1540