Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) A Depression Management Program for Elderly Adults Illinois Governor s Conference on Aging Chicago, IL December 13, 2012 Amanda Timm Planning & Program Specialist East Central Illinois Area Agency on Aging, Inc. Kathryn Johnson Assistant Director PATH, Inc.
Integrating PEARLS into OAA Title III-D Counseling ECIAAA has awarded federal OAA Title III-D grant assistance to Family Service and PATH, Inc. for FY2013 to integrate PEARLS, an evidenced based program into their senior counseling programs. Providers have experience providing other evidenced based programs such as: Chronic Disease Self-Management Program (Take Charge of Your Health: Live Well, Be Well) Diabetes Self-Management Healthy Ideas (Identifying Depression, Empowering Activities for Seniors) Strong for Life
Integrating PEARLS into OAA Title III-D Counseling Gerontological Counseling Programs already in place: PATH, Inc., Bloomington, IL Family Services, Champaign, IL Family Services, PATH, Inc. & East Central Illinois Area Agency on Aging staff went through PEARLS training August 27 & 28, 2012. Implementation of PEARLS program began before the end of FY2012.
Integrating PEARLS into OAA Title III-D Counseling PEARLS Partners in Area 05 include: Sheila Greuel and Charlotte Kauffman, PEARLS Instructors Cindy Kerber, PhD., APRN, Clinical Consultant Dr. Uday Deoskar, MD, Medical Advisor Rosanna McLain, Pat Babich-Smith, and Rebecca Spake at Family Service (providing Senior Counseling in Champaign County) Kathryn Johnson and Elizabeth Morgan at PATH (providing Senior Counseling in Livingston and McLean Counties) Mike O Donnell and Amanda Timm ECIAAA providing grant administration and project coordination
3 Fundamental Principles of this Community-Based Program are: 1. What a participant is experiencing are symptoms - and they are due to depression. 2. There is a close link between depression and unsolved problems. 3. Increasing participation in social, physical and other pleasant activities leads to a decrease in depressive symptoms.
Program Designed for Individuals: With different types of depression: Minor Depression: Individuals have some of the symptoms of depression, but do not meet the DSM criteria for major depression or dysthymia. Dysthymia: Individuals have an ongoing, low-grade depression of 2 or more years in which depressive symptoms are present more days than not. Major Depression: Individuals have enough symptoms over the past 2 weeks to meet the criteria for a major depressive episode. (If the person is psychotic they are not eligible if you are not sure use your consultant to determine if the program will be beneficial). PEARLS is now being used with adults with epilepsy to reduce depression severity.
Program Not Designed for: Persons diagnosed with manic-depressive illness or dipolar or if they are taking medication for this Persons diagnosed with schizophrenia or schizoaffective disorder if one of the following: Currently taking psychotropic medications for this Have experienced auditory hallucinations Have ever taken prescription psychotropic medications for schizophrenia or schizoaffective disorder
Program Not Designed for (continued): If client reports currently drinking alcohol and: Has felt in the last 3 months they should cut down Has felt annoyed by criticism of drinking in the last 3 months Has felt bad or guilty about drinking in the last 3 months Has had a drink first thing in the morning to steady nerves or get rid of a hangover in the last 3 months Persons with cognitive decline A person who scores less than three out of a possible score of six on a brief memory cognition screen
Basic Components 1. Problem Solving Treatment 2. Social and Physical Activation 3. Pleasant Activity Scheduling Psychiatric Supervision and Consultation: Support for PEARLS Counselor
Basic Components 1. Problem Solving Treatment (PST) the core element of PEARLS Overview & Benefits of PST: Common sense approach Brief implementation period Focus on the here and now Broad application High participant acceptance and satisfaction
Basic Components 1. Problem Solving Treatment (continued): Goals of PST: Increasing an individual s understanding of the link between their current symptoms and their current problems. Increasing an individual s ability to clearly define their problems and set concrete and realistic goals. Teaching individuals a specific, structured problem solving procedure. Producing positive experiences of individuals through their ability to solve problems, and thereby increasing their confidence and sense of control.
Basic Components 1. Problem Solving Treatment (PST) Seven Steps (continued): Clarify and define the problem Set realistic goals Generate multiple solutions Evaluate and compare solutions Select a feasible solution Implement the solution, and Evaluate the outcome
Basic Components 1. Problem Solving Treatment (PST) Success Factors (continued): Go from To Do More Feel Better
Basic Components 2. Social and Physical Activation Increase engagement in social and physical activities Participants develop a program of social and recreational activities inside or outside the home, using existing community resources Participants develop a regular physical activity program, with activities consistent with their physical capabilities and preferences
Basic Components 3. Pleasant Activity Scheduling Each week, participant selects an activity they would enjoy (PEARLS Training Workbook includes a list of 200 possible activities). Pleasant activity may involve other people or going places. Counselor may encourage participant to consider doing a pleasant activity on their own.
Basic Components Support for PEARLS Counselor Psychiatric Supervision and Consultation An equivalent level of supervision and consultation from a psychologist paired with a medical doctor. The psychiatric provides: Recommendations about psychiatric medications Consultant to discern when medical issues, drug side effects, or other organic issues are contributing to depression or other medical or mental health symptoms
Basic Components Support for PEARLS Counselor Psychiatric Supervision and Consultation The supervisor: Reviews all cases and the course of PEARLS counseling during weekly or biweekly case supervision meetings with the PEARLS counselor. The psychiatric is also available to contact the client s physician and medical team to recommend initiating or adjusting antidepressant medications, or to assess for potential medical and substance abuse causes for depression.
Implementation: A Collaborative Effort Organizational Leader- A person in a leadership role who must buy into implementing PEARLS. Provides Infrastructure Supports program Implementation PEARLS Manager- Person in charge of managing the PEARLS program Supervises PEARLS staff Data Coordinator- Persons responsible for managing the data collected from sessions etc. Clinical Supervisor- The persons providing the clinical supervision to the counselor(s). Meets regularly Reviews client cases Provides guidance on the sessions PEARLS Counselor Individual working directly with the clients Recruits, screens Conducts sessions and follow up
A Collaborative Effort (Continued) Case Managers are also instrumental to the success of PEARLS Key Roles Recruitment - referring their clients as potential PEARLS participants Remember the Case Manager CANNOT be the PEARLS Counselor for the same participant The Case Manager could complete the screening process
Implementation: The Specifics Counselors background may vary - social work, mental health or a related field Conducted in the participant home 8 sessions over a 19 week period May end in less than 8 sessions if the participant has mastered the problem solving method Follow up calls conducted once a month for 3-4 months
Implementation: The Specifics (continued) Record keeping (data elements): Participants demographics, aggregated recruitment and participation data, outcome data Program data to track and report: Depression screen positive, referral, ineligible, declined program participation, enrolled, disenrolled, in-person sessions, follow up phone sessions, total active cases, completed program
Implementation: The Specifics (continued) Outcome data: PHQ-9 Scores (from the PEARLS Tracking Chart, Baseline and Final Questionnaires) General Health (from the Baseline and Final Questionnaires) Social Activity (from the Baseline and Final Questionnaires) Physical Activity (from the Baseline and Final Questionnaires) Pleasant Activity (from the Baseline and Final Questionnaires)
Implementation: The Specifics (continued) Reporting from the tracked program and outcome data, different reports can be created: Status Reports Ad-hoc Reporting Outcome Analysis
Program Implementation Barriers Exclusion of non-english speaking clients was recently identified as a major barrier to PEARLS program implementation. However, a study has shown that with an interpreter, non-english speaking clients do benefit from PEARLS. In some agencies, case managers with high case loads have indicated that referring to PEARLS can become burdensome because of work load. Lack of funding and limited staff can reduce number of participants. Cost to provide PEARLS counseling to a client averages $630. PEARLS training is not always readily available and can be cost prohibited. Availability and cost of psychiatric services to provide support to counselor.
Progress Report Staffing plans and operational protocols completed by 9-30-12 Since 10-1-12, Family Service case workers have referred 5 eligible seniors to the Counselor; one declined, one dropped out and 3 currently participate (on PST week #2). FS case workers have referred an additional 4 clients to the Counselor. Since 10-1-12, PATH has screened 16 of its counseling clients. Four (4) are participating in PEARLS. Of the 12 who do not participate, some refused, some did not qualify due to other mental health diagnoses. PATH has received 5 new referrals. Success Story: PATH reports a PEARLS client who is actively meeting people at church and walking to her brother s home to visit. Her mood is elevated and PHQ-9 scores improved.
Participant Barriers Having too few depressive symptoms or too many Having co-morbid psychiatric conditions (e.g., schizophrenia) Having substance abuse disorders Having cognitive impairment Clients disappointed if determined to be ineligible for the program Stress or embarrassment because of the stigma of mental illness
Reasons Given by Participants Who Declined Program Client preferred to participate in counseling provided in a place other than their home Client reported that they were no longer interested Client did not feel that their depressive symptoms were related to problem-solving issues Client felt they were doing okay solving problems on their own Client preferred to participate in a less structured program Client preferred to participate in a program on a CD
Strategies to Overcome Barriers The PEARLS program is designed to be part of existing communitybased programs that already deliver care and provide resources to clients. The Chronic Care Model advocates the use of educational materials, patient registries, tracking tools and system integration in order to empower individuals and ensure the most comprehensive care possible. Clarify referral procedures, roles and responsibilities. Potential participant may believe that eligibility criteria is rigid. Provide additional staff training to streamline appropriate referrals.
Contact Information Amanda Timm, Program and Planning Specialist East Central Illinois Area Agency on Aging, Inc. 1003 Maple Hill Road Bloomington, IL 61705 Phone: (309) 829-6018 E-mail: atimm@eciaaa.org Kathryn Johnson, Assistant Director PATH, Inc. 210 E. Grove St. Bloomington, IL 61701 Phone: (309) 834-0586 E-mail: kjohnson@pathcrisis.org