Notation of Depression in Case Records of Older Adults in Community Long-Term Care

Abstract

Although significant numbers of social service clients experience mental health problems, virtually no research has examined the responsiveness of social service agencies to mental disorder. This article examines the extent to which client depression is reflected in records of a public social service agency, community long-term care (CLTC). Researchers assessed new, consenting CLTC clients for depression using standardized research criteria in a telephone interview. Agency case records were abstracted to determine the extent to which client depression was noted. Sensitivity and specificity of depression notation were 25.21 percent and 92.80 percent, respectively, indicating that agency records reflected depression for about one in four clients meeting depression criteria. Factors associated with accurate depression notation included cognitive impairments, low social support, psychotropic medications, and mental health treatment. The depression notation rates found are comparable to those in medical settings. Structured screening and assessment might enhance detection of mental disorder for social service clients.

Depression in Public Community Long-Term Care: Implications for Intervention Development

“…Yet, given that symptoms did not persist for many of the clients who were assessed as depressed at baseline, some strategy for triaging via fuller assessment of severity and duration may be necessary. Given that case managers in public CLTC report a need for more knowledge about depression 43 and that depression often goes unnoted in agency records, 44 more systematic training in assessment is needed. Perhaps the co-location of a mental health specialist would be a more effective strategy to identify and target depressed older adults for treatment.…”

Adapting Collaborative Depression Care for Public Community Long-Term Care: Using Research–Practice Partnerships

“…Despite the potential to reach vulnerable, isolated older adults at high risk of depression, CLTC services system typically identifies depression in one out of four clients with depression (Proctor, Morrow-Howell, Choi, & Lawrence, 2008). In most states’ CLTC systems, caseworkers (usually bachelor-level social workers or other human service workers) have large caseloads, lack in-depth mental health training, and have minimal access to clinical staff internally (Munson, Proctor, Morrow-Howell, Fedoravicius, & Ware, 2008).…”

“…The research agenda began in response to the state’s administrator’s interest in foundational service systems research and clinical epidemiology to understand the prevalence, associative factors, and implications of clients’ depression on service use (Morrow-Howell, et al, 2008; Hasche, Morrow-Howell, Proctor, 2010; Proctor, Morrow-Howell, et al, 2008). Epidemiologic and services research informed subsequent pre-implementation and intervention developmental work, such as focus groups with stakeholders (Munson et al 2007) and in-depth client interviews (Proctor, Hasche, et al, 2008).…”