Assisted living facility administrator and direct care staff views of resident mental health concerns and staff training needs.

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.

Healthy IDEAS: implementation of a depression program through community-based case management.

PURPOSE: Healthy IDEAS (HIDEAS; IDEAS stands for Identifying Depression, Empowering Activities for Seniors) is an evidence-based depression program addressing commonly recognized barriers to mental health care for older adults. The purpose of this study was to describe the implementation of HIDEAS and assess its feasibility. DESIGN AND METHODS: Three community agencies implemented the program with 94 eligible older adults who were identified from 348 screened older adults. We assessed program implementation by using the Core Implementation Component framework, using a client-tracking database, written survey of case managers, focus-group interview with coaches, and agency and project progress reports. RESULTS: We identified several challenges: clients' reluctance to acknowledge depressive symptoms and difficulty in engaging in behavioral changes; differences among case managers' mental health knowledge, skills, and "buy-in" and difficulty managing limited time; and differences in agency culture that foster in-agency supervision. IMPLICATIONS: Successful adoption and sustainability of HIDEAS are more likely when essential elements of the Core Implementation Component framework are addressed to bring about behavioral changes at all treatment-implementation levels-clients, practitioners, and organizations.

Satisfaction with mental health services in older primary care patients.

OBJECTIVE: This study examines whether older adult primary care patients are satisfied with two intervention models designed to ameliorate their behavioral health problems. METHODS: A total of 1,052 primary care patients aged 65 and older with depression, anxiety, or at-risk drinking were randomly assigned to and participated in either integrated care (IC) or enhanced specialty referral (ESR) model and completed the Client Satisfaction Questionnaire (CSQ) administered at three-month follow-up assessment. RESULTS: Older adult patients' satisfaction with IC (mean: 3.4, standard deviation [SD]: 0.60) was significantly higher than that with ESR (mean: 3.2, SD: 0.78), but the absolute difference was modest. Regression results showed that patients who used the IC model, attended the treatment service twice or more, or showed clinical improvement were more likely to express greater satisfaction. Stigma toward mental illness was negatively associated with satisfaction with mental health services. CONCLUSIONS: Older adults are more likely to have greater satisfaction with mental health services integrated in primary care settings than through enhanced referrals to specialty mental health and substance abuse clinics.

Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: results from a multisite effectiveness trial (PRISM-e).

BACKGROUND: Recent studies have shown that integrated behavioral health services for older adults in primary care improves health outcomes. No study, however, has asked the opinions of clinicians whose patients actually experienced integrated rather than enhanced referral care for depression and other conditions. METHOD: The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings across the United States. Primary care clinicians at each participating site were asked whether integrated or enhanced referral care was preferred across a variety of components of care. Managers also completed questionnaires related to the process of care at each site. RESULTS: Almost all primary care clinicians (n = 127) stated that integrated care led to better communication between primary care clinicians and mental health specialists (93%), less stigma for patients (93%), and better coordination of mental and physical care (92%). Fewer thought that integrated care led to better management of depression (64%), anxiety (76%), or alcohol problems (66%). At sites in which the clinicians were rated as participating in mental health care, integrated care was highly rated as improving communication between specialists in mental health and primary care. CONCLUSIONS: Among primary care clinicians who cared for patients that received integrated care or enhanced referral care, integrated care was preferred for many aspects of mental health care.