Implementation of an Evidence-Based Depression Care Management Program (PEARLS): Perspectives From Staff and Former Clients

Abstract

Introduction Although researchers develop evidence-based programs for public health practice, rates of adoption and implementation are often low. This qualitative study aimed to better understand implementation of the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), a depression care management program at a Seattle-King County area agency on aging.

Race, Stigma, and Mental Health Referrals Among Clients of Aging Services Who Screened Positive for Depression

“…The ASN case management and home meal programs serve older adults with high rates of depression, disability and suicidal ideation (2, 3). However, the implementation of evidence-based mental health screening, referrals and interventions is not without challenges such as client stigma, and the increase in staff workloads (4). …”

“…Reluctance to engage in treatment among older African Americans may also reflect the history of abuses in science and medicine, and the double consequences of racism and mental health stigma (8). Knowing that individuals worry about being stigmatized, physicians and providers in non-mental health settings, like primary care and aging services, report stigma as a barrier to mental health referrals (4, 9) with some men perceived as especially vulnerable to the ‘cultural meaning’ of depression (9). To avoid stigma some physicians reported deliberately misdiagnosing major depression to avoid patient stigma (10).…”

Translating PEARLS: Lessons Learned from Providers and Participants

“…Immigrant elders that participate in PEARLS have overcome loneliness and homesickness, feel more self-sufficient, independent, an overall sense of dignity, and at “peace-of-mind,” and acculturate more quickly into their new community through social contacts and physical fitness. PEARLS participants have also identified how the PEARLS process and worksheet helped them to improve their focus on certain issues and their ability to prioritize and plan, thus, feeling more control over things that had once seemed quite scattered ( 15 ).…”

A Multi-Stakeholder Process to Transform a Community-based Screening and Referral Program to Implement Evidence-Based Depression Care

“…In contrast, the effectiveness of community-based mental health interventions for depression in older adults is supported by numerous randomized trials (Bartels et al, 2003; Bruce, Van Citters, & Bartels, 2005; Van Citters & Bartels, 2004). For example, PEARLS (the Program to Encourage Active, Rewarding Lives for Seniors) has been shown to reduce depressive symptoms and has been successfully implemented in community-based settings (Ciechanowski et al, 2004; Steinman, Cristofalo, & Snowden, 2012). Yet depression treatments for older adults are rarely implemented in community-based settings (Eden et al, 2012).…”