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SAMHSA News - January/February 2007, Volume 15, Number 1

Treatment for Older Adults: What Works Best? (Part 2)

Policy Implications

These journal articles aren’t the kind that sit on the shelf unread. The PRISM-E results have real-life implications, said Steering Committee Chair Cynthia M. Zubritsky, Ph.D., Director of Integrated Care in the Department of Psychiatry at the University of Pennsylvania’s School of Medicine.

  • Consumers. The findings empower consumers to make whatever choice is best for them, said Dr. Krahn. “Some people are going to say, ‘I’ve got major depression and want to have the best psychiatrist I can have,’ ” he explained. “Others will say, ‘I don’t want to go to a shrink no matter what.’ ”

  • Providers. For providers, said Dr. Zubritsky, the message should be location, location, location. “Location is often the most important element in determining if someone is going to come for care,” she explained, noting that the farther away the services the less likely older people will make the trip. Primary care providers should expand their practices to include behavioral health care, she suggested.

    And specialty care providers should form collaborative relationships with their primary care colleagues and adopt such practices as reminder calls and transportation assistance. The findings also support the idea of using a triage system to determine which older people need specialized care, Dr. Zubritsky added.

  • Policymakers. The study identified policies that are barriers to putting the findings into practice, said Dr. Zubritsky. Training opportunities are scarce for providers interested in integrating behavioral and primary care, for example. Certain Medicare policies are also problematic, she added. There’s no parity between Medicare reimbursements for behavioral and physical health care, she pointed out.

    Health systems can’t bill Medicare for both a primary care visit and a same-day psychiatric visit. And Medicare makes it hard for providers to be reimbursed for administrative case management.

For one Federal partner, the results show that ongoing efforts are on the right track. The VA was already moving toward integration when the study began, explained William W. Van Stone, M.D., Associate Chief for Psychiatry in the Office of Mental Health Services at the VA Central Office in Washington, DC. “The main thing I got from the study is that it doesn’t seem to make much difference [in outcomes] whether we use an integrated or referral model, but more people do show up in the integrated model,” he said.

This is just the beginning, emphasized Dr. McDonel Herr. More papers are forthcoming, and there are more data for researchers to analyze. “The study produced multiple data sets,” she said. “They can be mined for years to come.”

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Bartels, S.J., et al. “Improving Access to Geriatric Mental Health Services: A Randomized Trial Comparing Treatment Engagement with Integrated Versus Enhanced Referral Care for Depression, Anxiety, and At-Risk Alcohol Use.” American Journal of Psychiatry, 2004. 161(8):1455-1462.

Bartels, S.J., et al. “Suicidal and Death Ideation in Older Primary Care Patients with Depression, Anxiety, and At-Risk Alcohol Use.” American Journal of Geriatric Psychiatry, 2002. 10:417-427.

Gallo, J.J., et al. “Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care for Older Adults: Results from a Multisite Effectiveness Trial (PRISM-E). Annals of Family Medicine, 2004. 2:305-309.

Krahn, D.D., et al. “PRISM-E: Comparison of Integrated Care and Enhanced Specialty Referral Models in Depression Outcomes.” Psychiatric Services, 2006. 57(7):946-953.

Oslin, D.W., et al. “PRISM-E: Comparison of Integrated Care and Enhanced Specialty Referral in Managing At-Risk Alcohol Use.” Psychiatric Services, 2006. 57(7):954-958.

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Resources on
Older Adults

Older adults are one of SAMHSA’s 12 priority program areas. For treatment providers, counselors, and other health care professionals, SAMHSA offers statistics and data, publications, initiatives, a technical assistance center, and specific programs to help older adults with issues that affect their lives.

For detailed information on SAMHSA’s services for older adults, visit

Do the Right Dose. SAMHSA, the Food and Drug Administration, and the Administration on Aging launched the “Do the Right Dose” campaign in May 2005. The program’s focus is the importance of safe and correct use of prescription pain medications.

Older adults are cautioned that misuse of these medications could lead to addiction or other problems. Elements of the campaign include two print ads, one television public service announcement (PSA), two radio PSAs, two posters, and an update of SAMHSA’s brochure, As You Age. Visit

As You Age brochure. This brochure provides a medication checklist so that people can keep track of the dose amount, intervals, and type of medication they need to take. It also points to the dangers of consuming alcohol with a medication that might have adverse effects due to negative interactions. Other materials include print ads, and radio and television public service announcements. Visit

Get Connected! toolkit. Developed in partnership with the National Council on Aging and supported by the Administration on Aging, this toolkit provides strategies to link providers with substance abuse and mental health experts/organizations in their area.

Contained in the kit is a program coordinators guide, fact sheets, self-screening tools, resource list, video on how to talk to older adults about alcohol and medication problems, brochures, and the promising practices publications Promoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health Problems and Substance Abuse Among Older Adults: A Guide for Social Services Providers.

More Publications

SAMHSA’s Office of Applied Studies offers statistics on older adults in a variety of reports on alcohol treatment admissions, overcoming stigma, and community integration for older adults with mental illnesses. For a complete list, visit

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