Touching Lives Over 55: Behavioral Health Approach for Older Adults

Nature of the Problem

Despite attempts to raise awareness, depression in older adults remains a significant problem. The prevalence of clinically significant depressive symptoms in older adults can be as high as 14%. Depressive symptoms in older adults are a significant public health concern with their associated impairments in physical and cognitive functioning, which increases the risk for dementia, as well as increased mortality. As reported in Philadelphia Corporation for Aging’s 2013 Neighborhood Profiles, 34% of older Philadelphians report two or more symptoms of depression. According to a 2012 Public Health Management Corporation Household Health Survey, 65% of people age 60+ in Philadelphia report having had at least one depressive symptom during the week before the interview. Older adults with conditions that affect their daily living activities have higher reports of both depressive symptoms (88%) and feelings of social isolation (81%). Despite these high rates of depression, older adults are under-represented as clients of both publicly and privately funded behavioral health programs. Nationally, only 3% of all people seeking behavioral health services are older adults (US Surgeon General, 2010). The stigma of mental health problems means that older individuals rarely seek mental health treatment and depression among these individuals often goes undetected and untreated.

Program Description

Since 2006, Interact’s Touching Lives 55+ (TL55) has used a non-stigmatizing, peer counseling model in which well trained and supervised volunteers provide a 12-week depression education/prevention series called “The Next Chapter: Talking About Our Lives” in community locations. TL55 has successfully reached older adults who are at a greater risk of losing their independence because of poverty, advanced age, poor health, and/or a lack of access to needed supports and services. Due to the positive results received, Interact is committed to expanding the program and creating a more sustainable program. We propose to deliver the TL55 program to existing and new sites around Philadelphia using certified older adult peer specialists (COAPS). Certified peer specialist (CPS) supports are billable services under Pennsylvania’s Medical Assistance (MA). Approximately 20% of people 60+ are enrolled in MA. COAPS are certified peer specialists with additional older adult training. COAPS support older adults through developing, maintaining, and improving positive social supports and networks and addressing behavioral health problems through supporting recovery. Interact is the only agency in Philadelphia that has secured a mobile therapy license to ensure. We will be able to reach individuals anywhere, including at senior centers across the city and in their homes.

Disruption

Despite the research that tells us that older adults suffer significant symptoms of depression, there is little to no focus on geriatric behavioral health services. Interact is the only agency currently serving this population in the city of Philadelphia. Having provided similar services for over ten years, we have learned the obstacles and how to overcome the obstacles in serving older adults. We will be embedding our behavioral health services where individuals gather. We have the ability to bring the services to them, wherever they may need them. Recognizing it is difficult for older adults to arrange transportation, find appropriate services, and many other hurdles, we will bring the services to them, ultimately helping to decrease feelings of depression, isolation, and loneliness.

Leadership

For more than 25 years, JW has led by example – offering non-stigmatizing, readily accessible treatment options for older adults. JW staff serve as resources throughout the aging community. Staff provide free consultation to various referral sources (including senior centers, physician offices, congregational leaders), helping them identify older adults with behavioral health needs, engage elders and link them to services. In 2011, JW was awarded the Deirdre Johnson Award for Excellence in Innovation in Geriatric Mental Health from the American Association for Geriatric Psychiatry/Geriatric Mental Health Foundation. In 2012, JW was one of 10 agencies the Foundation invited for a national conference discussing best practices in behavioral health services for older people. JW staff present regularly at conferences and are part of this region’s on-going conversation around the behavioral health needs of elderly people.

Scalability

JW’s non-stigmatizing, community-based approach can be readily replicated by other organizations. In fact, its strategies for engaging hard to reach older adults through community networks, non-stigmatizing language and mobile therapy were cited as a “promising practice” by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). JW’s model was replicated in a SAMHSA-funded project in Arizona JW’s programs are well documented. JW’s peer counseling program, for example, documented its volunteer recruitment, training and supervision practices for peer leaders and developed curriculum modules for its sessions. This allows other agencies to create a similar program. JW staff regularly present information about the organization’s behavioral health programs and strategies at regional and national conferences.

Results/Outcomes

JW measures its outcomes based on improvements in older adults’ lives. Staff collect data on effectiveness in 1) reaching older adults and 2) addressing behavioral health problems. Staff use standardized, validated assessment tools as well as tools developed by consultants for JW. These include an assessment of impact across 5 domains of life for individual counseling clients and pre/post surveys that measure life satisfaction and socialization (important factors in depression) for participants in peer counseling programs. JW meets outcome targets, including having 80% of those completing individual treatment show improvement and having 80% of respondents to pre/post surveys show improvement or maintenance.