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 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
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
• 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
HealthyIdeas
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)
HealthyIdeas
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