Improving Mental Health Services (Part 2)
That's where the TCE program can help. "The program highlights
nine sites that are successfully implementing evidence-based practices,
so that they can become models for other organizations," said
Some sites focus on screening. The City of El Paso, for example,
has Project FOCUS (For the Optimal Care of Underserved Seniors).
The city knew that older adults receiving home-delivered meals through
a nutrition program were at high risk for depression and other mental
A TCE grant allowed the city to develop a mental health screening
instrument that nutrition staffers now incorporate into their annual
assessments. Depending on client scores, they are referred to a
prevention-oriented case management program, a community mental
health center, or a more intensive program that uses lay community
workers to address medical and social needs of homebound elders.
"We provide services that aren't perceived as mental health
services," said principal investigator Robert A. Salinas, M.S.W.,
social services administrator for the city. "People are more
receptive to them."
Other sites focus on treatment. In Madison, WI, for instance,
language barriers, transportation difficulties, and stigma kept
many older Hmong refugees from seeking help for the depression,
anxiety, and post-traumatic stress disorder they've developed in
response to war, refugee camps, and resettlement.
"They were very isolated," explained principal investigator
Linda Keys, M.S.S.W., program director at Kajsiab House at the Mental
Health Center of Dane County, Inc. "Family members who were
connected with services would bring home psychotropic medications
to share with their elders."
A TCE grant allowed Kajsiab House to increase the number of older
adults in its programs, make its services more age appropriate,
and create a mobile program. In the latter, a psychiatrist, psychologist,
and Hmong staff members assisting as "culture brokers"
provide therapy and other services in the homes of elders who can't
or won't come to Kajsiab House.
The center incorporates Hmong cultural beliefs with Western concepts.
For example, many Hmong view mental illness as an invasion of bad
spirits. Diagnoses are often made by a shaman who interprets the
curling of boiled chicken feet.
"Like all immigrant cultures, things are changing quickly
for the Hmong," said Ms. Keys. "But for the older folks,
those beliefs are still there."
Another site is enhancing treatment of depression and agitation
of nursing homes and board-and-care homes. "Facility managers
were telling us, 'We're tired of overmedicating our patients
in order to control their behavior,'" said principal investigator
Patricia A. Arean, Ph.D., associate professor of psychiatry at
the University of California San Francisco.
A TCE grant led to the creation of Project Renewal, a collaborative
effort in which a social worker, psychologist, and psychiatrist
train facility staff, offer assistance to other treatment providers,
and provide direct services to clients when needed. Some interventions
are remarkably straightforward, Dr. Arean added. A woman who threw
food during mealtimes turned out to need more appetizing meals,
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Guiding all the grantee sites is the Positive Aging Resource Center,
which provides training, teleconferences, and a listserv. The center
also matched each site with an "implementation coach."
addition to assisting grantees, the center offers Web-based training
on specific conditions and service settings through a collaboration
with the American Society on Aging.
The center's new Web site offers information to older people,
caregivers, and health and social service providers. While professionals
can use the site to learn more about evidence-based practices, older
people can find helpful information too. Designed with input from
older consumers, the highly interactive site features checklists,
an "Ask the Experts" column, and even chat rooms. "We
want to offer one-stop shopping," said Dr. Levkoff.
The center also plans to produce two books: One is a compendium
of evidence-based practices for working with older adults; the other
is a look at the nine model programs and strategies for replicating
"We don't just focus on mental illness and treatment,"
said Dr. Levkoff. "We focus on positive aging—how to
stay connected, exercise, eat right, and do everything else the
literature tells us is essential for maintaining mental and emotional
health into old age."
Contact Betsy McDonel Herr for more information at firstname.lastname@example.org.
Part 1: Older Adults: Improving Mental Health Services
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