Targeted Capacity Expansion (TCE) Grant Program: Implementing Evidence-Based Mental Health Services for Older Adults

In FY 2002, the Center for Mental Health Services (CMHS) announced the availability of $5 million in funding for increasing service capacity for older persons with mental health needs.  The three overall goals of the program are:

• To increase existing services, or to develop and implement new mental health prevention, early intervention, and/or treatment services targeted to persons 65 years and older.  
• To improve the quality and accessibility of mental health services to older persons
• To engage in the building of system infrastructure that will support the increased amount, quality, and accessibility of services to older persons. Expanded infrastructure can include consensus building among key stakeholders, community outreach and education, quality improvement activities, social marketing, the inclusion of consumer and family participation in service development and evaluation activities, and the building of service linkages among providers. 

There were two groups of awards made.

Group I Awards:  Nine TCE grants were made to help communities provide direct services and to build the necessary infrastructure to support expanded services for meeting the diverse mental health needs of older persons.  Each grantee was awarded no more than $400,000 in total costs (direct and indirect) per year, for up to three years.  Between 10 and 15 percent of the total award was to be used to conduct a local evaluation of the services expansion program.

The nine TCE grantees are:

• COTTAGE Expanded Elder Services Program, Tucson, AZ
• ElderLynk Expansion Program, Kirksville, MO
• Project Focus, City of El Paso, El Paso, TX
• Senior Behavioral Health Service Program, University of California, San Francisco, San Francisco, CA
• Health Improvement Program for the Elderly, Jewish Family and Children’s Service of Southern Arizona, Inc., Tucson, AZ
• Kajsiab House, Madison, WI
• La Clinica del Pueblo, Washington DC
• Tiempo de Oro, Valle del Sol, Phoenix, AZ
• Senior Outreach Program, Unity Health System, Rochester, NY

In order to achieve the above program goals, Group I applicants must build service capacity, using elements from each of the four following activity areas known to yield sustainable results.  These four capacity expansion activity areas are:

Expand the capacity to implement evidence-based outreach, prevention, early intervention, and/or treatment services.  Activities include increasing direct services provision, accurate identification of persons needing treatment through assessment, increased outreach, staffing, training and cross-training for staff, and sustainability planning.

Create service linkages between individuals and groups that serve the targeted population (e.g., mental health providers who specialize in geriatric mental heath and primary health care providers).  The building of service networks will ensure that outreach, assessment, prevention, early intervention, and/or treatment will take place within the target service systems or via linkages to specialty mental health services. 

Provide community outreach to communicate to the larger community the importance of mental health and the capacity of well-executed preventive, early interventions, and treatments for older persons with mental health needs.  Community outreach includes consensus building by communities and mental health organizations for the adoption of evidence-based services. 

Conduct program evaluation to confirm results and to provide program feedback that will serve to enhance the efficiency and effectiveness of further service expansion efforts. Group I applicants must engage in local evaluation activities to demonstrate program outcomes and the quality and completeness of the service implementation. 

Group II Award: One cooperative agreement of $ 900,000 per year was awarded to implement the National Technical Assistance Center.  Named the Positive Aging Resource Center (PARC), the overall mission of the center is to improve the mental health of older adults by providing assistance in the implementation and evaluation of innovative and evidence-based practices to increase the quality of mental health services and to expand access for all older adults including underserved, rural and ethnically diverse persons and their families.