Model Programs

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 Dr. Levkoff.

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 health problems.

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 in residents 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, for example.

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Resource Center

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."

In 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 them.

"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 bmcdonel@samhsa.hhs.gov.

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