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
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
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 is a direct connection
between unresolved problems &
depression.
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.
• 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
1.
2.
3.
4.
5.
6.
7.
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
• 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.
• 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
Depression results in behaviors that limit positive outcomes
→ reduced pleasure, reduced accomplishment
Lowered
Mood
Decreased
Pleasant
Activities
Decreased
Activity
Healthy
Ideas
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
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