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Evidence-based Practices in Mental Health and Aging
June 22, 2010Cheryl Evans-Pryor, M.A.-G
Aging Resources of Central Iowa5835 Grand Avenue, Suite 106Des Moines, IA. 50312-1437
(515) 255-6714, [email protected]
www.agingresources.com
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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.
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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
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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.
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PEARLS - Core Components:
1. Problem-solving Treatment
2. Social & Physical Activation
3. Pleasant Events Scheduling
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• 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
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• 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
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• 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.
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7 Steps of PST:1. Identifying problem-what does it look like/
how does it impact your life?2. Set realistic goals - attainable3. Generate possible solutions4. Consider Pro’s /Con’s of each solution5. Select a solution of choice6. Develop an action plan/steps to achieve
solutions7. Review & evaluate progress.
Problem Solving Therapy
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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.
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• 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.
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Behavioral Model of Depression
Lowered Mood
Decreased Activity
Decreased Pleasant Activities
Depression results in behaviors that limit positive outcomes→ reduced pleasure, reduced accomplishment
HealthyIdeas
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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
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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
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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.
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ResourcesPEARLS : http://depts.washington.edu/pearlspr/University of Washington Health Promotion Research Center, Seattle,
WA.
HEALTHY IDEAS : www.careforelders.org/healthyideasHuffington Center on Aging, Baylor College of Medicine, Houston, TX.
www.cdc.gov/aging and www.chronicdisease.org
SAMHSA National Registry of Evidence-Based Programs & Practiceshttp://mentalhealth.samhsa.gov