2010 United Way Request for Application

Helping Seniors Be Safe and Healthy at Home Initiative

Community-Based Depression Screening and Intervention

Application Summary: Instructions

To complete this proposal, interested applicants must submit all of the following by 5p.m. on May 17, 2010:

  1. Cover Page
  2. Agency Questionnaire
  3. Evaluation Participation Agreement– Agencies must agree to comply with evaluation protocols as part of the pilot process to evaluate the effectiveness of the experience.

All submissions are to be made by attaching the completed documents to an email sent to .

Please include your agency name in the footer of each of the UW forms submitted.

If you have questions, contactJada Shirriel at 412-456-6740.

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Name:

Rev. 10/31/2018

2010 United Way Request for Application

Helping Seniors Be Safe and Healthy at Home Initiative

Community-Based Depression Screening and Intervention

Background

The goal of this depression screening and intervention pilot is to explore the impact of a standard

community-based model for depression screening and intervention for local adoption for frail and isolated seniors.

The University of Pittsburgh 2007 Needs Assessment Report: Building Community Partnerships to Reduce Disparities in Depression Recognition and Treatment identifies depression as a major impediment to wellness for Pittsburgh’s elderly population and provides insight into barriers to community-based depression screening and treatment through senior serving agencies and community health centers.

Some of those barriers include:

  • General staff issues (recruitment and retention, familiarity with and awareness of mental health issues, training—particularly training offered to frontline workers, diversity in types of senior serving agencies and their respective staff competencies, etc.)
  • Disparities in mental health screening and treatment services (great variation in the types and breadth of mental health services offered to seniors in-home—if any, insurance billing issues related to mental health services, accessibility, participant and family perception of mental health services, etc.)
  • Basic needs of seniors not being met (participants’ basic needs have to be met before they can engage in health care concerns or mental health care treatments)
  • Ethical concerns (privacy, confidentiality and autonomy)

Despite the potential challenges, implementation of a standardcommunity-based model for depression screening and intervention for frail and isolated seniors will give local senior serving agencies the opportunity for more meaningful interaction with seniors in their homes, to deter the potentially crippling effects of depression and add to the quality of life of participants, and to increase organizational capacity to better understand mental health issues.

Common depression co-morbidities in seniors include:

  • Heart disease
  • Cerebrovascular disease, stroke
  • Parkinson’s disease
  • Diabetes
  • Pancreatic and some other cancers
  • Dementia, including Alzheimer’s disease
  • Insomnia
  • Pain, including chronic arthritis

These co-morbidities commonly lead to increased need for institutionalization and use of prescription medications.

United Way of Allegheny County’s Helping Seniors Be Safe and Healthy at Home Initiative currently focuses on community-based supports such as volunteers to help seniors remain in their homes. Initiative efforts are informed by the United Way’s Senior Advisory Committee, composed of experts and leaders in services needed to support frail, isolated older adults. Upon completion of the needs assessment, the Senior Advisory Committee reviewed three evidence-based depression screening and intervention programs (HealthyIDEAS, PEARLS and IMPACT) and commissioned a survey of local senior service providers to ascertain local interest in and capacity for such a local depression-screening and intervention initiative.

The local study, a survey of 42 agencies, confirmed the need for this type of initiative. Over 85% of responding agencies reported a need to address mental health issues in older adults served. The survey also revealed that:

  • Most of the responding agencies have substantial contact with vulnerable seniors.
  • Most agencies have monthly contact with clients and follow these clients for more than 6 months.
  • Over two-thirds conduct multidimensionalassessments, and three-quarters document assessments, care plans, and follow-up. Only 39% reported use of computerized assessments).
  • Over three-quarters hold regular staff meetings to discuss each client.
  • While acknowledging the need, only about one in five of the agencies currently screen for depression using structured assessments.

Based on the survey results, United Way invited a group of providers that currently offer some formal or informal depression screening and/or treatment—as well as potential payors (i.e., insurance providers, county) —to discuss the feasibility of a community-wide pilot. The providers in attendance agreed that there is a call to action, that the most benefit can be gained from focusing on mild depression and that an initiative focused on a community-based model for standard implementation should be pursued. All participants were invited to submit program modelsthat would satisfy the objectives of this project for consideration as the depression screening and intervention initiative to pilot in Allegheny County. Three local models were submitted and included along with two evidence-based models for review by all interested participants. The provider group selectedand modified a University of Pittsburgh program model (model description is attached to this document).

A total of up to eight (8) senior service providers will be selected to implement this one-year pilot.

Program requirements include:

Criteria for selection include a commitment to helping seniors remain in the least restrictive environments for as long as possible, ability of agency to demonstrate the capacity to successfully participate in this pilot (including ability to be responsive to staffing and training needs) and ability of the agency to demonstrate a commitment to meeting the mental health needs of home-bound seniors. This pilot is targeted for agencies currently serving seniors in their homeswith established relationships of longer than 3 months with these potential participants.

Participating organizations will be providedresources to conduct this pilot based on the following scenarios:

Scenario 1: Pilot Agency Provides Intervention

In this scenario, the agency applying for funding has an LCSW on staff who can conduct the

PHQ-9 and implement with clients the Problem Solving Treatment (PST) or Brief Behavioral Trainingfor Insomnia (BBTI). If selected for the pilot, and if selected to use its own LCSW, reimbursement will be provided at the rate of $350 per series of PST or BBTI (usually six 30-minute sessions). This reimbursement figure also accounts for necessary data collection efforts over the course of the pilot year. This pilot will fund up to 40 interventions per funded agency.

Mental health referral sources will be provided for clients who may not be suitable for this pilot.

Scenario 2: Outside Contractor Provides Intervention

In this scenario, the agency applying for funding will utilize an outside contractor (LCSW) funded

by United Way to conduct the PHQ-9 and implement with clients the Problem Solving

Treatment (PST) or Brief Behavioral Training for Insomnia (BBTI). If selected for the pilot using a contracted LCSW, the agency will receive a flat rate of $1,500 to conduct necessary data collection efforts over the course of the pilot year. This pilot will fund up to 40 interventions per funded agency.

Mental health referral sources will be provided for clients who may not be suitable for this pilot.

Pilot participants will also be provided1) program orientation/training, 2) ongoing clinical and project support, 3) depression screening and data collection tools, 3) support in identifying referral sources, and 4) access to other pilot participants as a learning community. Grant awards will be paid in monthly installments from July 2010 throughJune 2011.

Specifically, participating agencies must:

  • Have appropriate staff participate in all required trainings (pre-program and field supervision)
  • Conduct screenings as part of assessment/reassessment process (training provided)
  • Provide the appropriate intervention (training provided, if applicable)
  • Be dutiful and accurate in data collection and reporting (training provided)
  • Commit staff needed for direct service delivery, project oversight and data management
  • Participate in monthly/bi-monthly project (learning community) meetings – to be scheduled after grantees are selected

Proposals must be submitted by 5p.m. on May 17, 2010.

United Way will host aninterestmeeting on Friday, April 30, 2010 at 9:00am at United Way of Allegheny County, 1250 Penn Avenue (Strip District)for interested organizations to learn more about the training and implementation of the pilot program as well as what is expected of participants. Programs will be notified of their selection on June 11, 2010.

Cover Sheet:

Helping Seniors be Safe and Healthy at Home Initiative–Community-Based Depression Screening and Intervention

Cover Page

Agency Name:

Address:

Website:

Executive Director:

Email:

Phone Number:

Primary contact name:

Email:

Phone number:

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Name:

Rev. 10/31/2018

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Budget Information(your current program budget)

Total cost of current program into which the pilot will be incorporated / Total number of participants currently served / Average cost per participant for current program
$ / $

Current Annual Agency Budget: $

Fiscal year / Amount of operating surplus if any / Amount of operating deficit if any / Total expenses
2008 / $ / $ / $
2009 / $ / $ / $
2010
(Actual or Budgeted) / $ / $ / $

Evaluation Participation Agreement

The ______agrees to comply with all evaluation requirements if selected to implement the pilot project. Specific elements of this evaluation will be decided by the United Wayin consultation with the selected cohort sites. An independent evaluator will assess the success of the program (with input from participating organizations) and give recommendations for improvement. Participating organizations will not bear the costs associated with implementing the evaluation components.

I understand that the evaluation information may be shared broadly to inform the replication of the pilot project in additional sites. I also understand that the dissemination strategy will not include any identifying information for specific participants.

______

Program Director (or other person responsible for Date

implementing this pilot)

______

Agency Executive DirectorDate

Agency Questionnaire

Organization:

Name of person completing this questionnaire:

Title:

  1. Do you have a LCSW on staff?

___ Yes

___ No

  1. Please indicate your preference of intervention scenario (see page 3):

___ Use our own LCSW (if applicable)

___Use contracted LCSW

  1. Please indicate if your organization has the following qualifications:

Yes / No
a. We are a case management care provider
b. We serve most of our participants by phone and home visit
c. We serve most of our participants over a period of at least 3-6 months
d. Most of our participants are able to participate in their own care planning
e. Most of our participants are able to communicate verbally

4. How central to your case management practice is each of the following functions?

Core function / Secondary function / Minimal function / Not a function of our practice
a. Refer and link participants in the
community without purchasing those
services
b. Arrange, manage and monitor
purchased services
c. Teach participants skills
d. Provide clinical counseling to
participants and/or caregivers
e. Provide crisis intervention

5. In the past year, what was the average caseload per case manager for the

program that would implement this depression screening pilot?

6. Do your case managers currently ask questions to determine if a new or continuing

participant may be experiencing depressive symptoms?

___ Yes, this is a part of our standard protocol and is used consistently by casemanagers

___ It is a part of our standard protocol but is used selectively by case managers

___ No, that is not part of our case management protocol

7. After initial assessment, what is your agency’s policy or standard for the maximum

time between case managers’ contacts with a client—by phone and in-home visits?

Weekly / Monthly / Quarterly / Semi-annually / Annually / N/A
In-home visit
(check one)
Phone contact
(check one)

8. Does your agency use any of the following with your participants? (Select all

that apply)

___ General screening questions about depression or mood

___ Standardized scales (e.g., the scale for Instrumental Activities of Daily Living)

___ Standardized depression scales (e.g., Geriatric Depression Scale [GDS], the

Patient Health Questionnaire [PHQ-9], etc.)

8. The following statements describe various organizational-level considerations for implementing this pilot program. Please indicate the degree of difficulty your organization would have if you were to participate in this pilot.

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Very difficult / 2 / 3 / 4 / 5
Not at all difficult
a. Identify appropriate sources of mental health care in the community
b. Modify assessment forms to include structured questions related to screening for depression symptoms
c. Modify client record keeping to track mental health referrals and their results
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Very difficult / 2 / 3 / 4 / 5
Not at all difficult
d. Seek alternative sources of financial support, if needed, to keep this community-based depression screening program running over time
e. Find time for frontline staff to complete training (a1/2 day seminar)
f. Find time for clinical staff (if applicable) to complete training (a day-long seminar and 4 weekly 20-minute in-field supervision calls)
g. Include success of this pilot as an element in performance evaluations
h. Develop or strengthen relationships with mental health providers to expand your case management practice
i. Allow supervisors time to provide program oversight

9. Please describe the nature of your interest in this pilot.

APPENDIX A

Allegheny County Depression Prevention Model

Steven M. Albert, PhD, Charles Reynolds, MD, Jennifer Morse, PhD, Shikha Iyengar, MS, MPH

Department of Behavioral and Community Health Sciences,

Department of Psychiatry, Institute on Aging

University of Pittsburgh

Overview

This model relies on home health aides (or other frontline staff) to assess subthreshold depressive symptoms as part of their routine assessments, reassessments, and observations of participants using a very simple screening tool. This short, formal assessment is then passed on to the supervising RN/LPN or LCSW social worker, who follows up with client contact using a more detailed screening tool. If subthreshold symptoms are confirmed, the consumer will receive a brief depression prevention intervention from an on-site agency counselor, who will be trained in problem solving therapy (PST) and Brief Behavioral Treatment for Insomnia (BBTI). This model builds on the current UPMC Staying at Home program (Iyengar), a randomized controlled trial of PST to prevent depression currently in the field (Reynolds, Morse), and experience with the delivery of services to this population (Albert).

Program Delivery:

Over the next 12 months, agencies funded under this pilot will receive the following:

  • Train home health nurses and other staff who provide services to seniors in their homes in brief formal depression screening. We will use the UPMC I AM HERE program, Interventions for Assessment of Mental Health in Elders with Resources and Education. This involves a manual and DVD that home care staff can view on their own and provides complete instructions for completing the Patient Health Questionnaire-2 (PHQ-2), a brief depression screening instrument. Results from the PHQ-2 assessments will be reviewed by a social worker or nurse at the agencies for follow-up. PHQ-2 assessments will be completed every 3 months or whenever participants experience major health events (i.e., after hospitalization).
  • Train one social worker or nurse at each agency (or provide a trained “floating” social worker) in the full Patient Health Questionnaire (PHQ-9), Problem Solving Therapy (PST), and Brief Behavioral Training for Insomnia (BBTI). Training in the assessment and interventions will involve a day-long workshop, led by Dr. Jennifer Morse, along with telephone “in-field supervision” with Dr. Morse over 6 weeks. Participants screening positive on the PHQ-2 will be contacted by the trained social worker or nurse at the agency to complete the PHQ-9. Based on this assessment, participants may be referred for depression care (PHQ-9 > 9) or receive PST (0 < PHQ < 9). If PST is not successful, the social worker or nurse will implement BBTI, which has been shown to be effective in depression prevention. Anne Germain, PhD, developer of BBTI, will lead this component of training. PST and BBTI are each completely manualized brief interventions with a strong evidence base.
  • Provide data system for monitoring depression prevention effort. The data system will record results from PHQ-2 and PHQ-9 assessments, basic demographic and health indicators for participants, and ratings from therapists on uptake of therapy. Follow-up PHQ-9 assessments will be conducted by agency staff not involved with therapy at 6-8 weeks post-therapy and 3, 6, and 12 months.
  • Supervise depression prevention effort. Dr. Reynolds will provide clinical oversight. Dr. Albert will provide research oversight and assure quality of data, study recruitment, and human subjects protection. Both will contribute effort to the program without compensation as part of this collaborative effort between United Way of Allegheny County and the University of Pittsburgh Institute on Aging.

Intervention

PST is similar to the behavioral activation and cognitive-behavioral therapy used in Healthy IDEAS and PEARLS. A description of PST is attached. One advantage of PST is its effectiveness in reducing distress in several physical and mental health conditions, including depression. It is also well-suited for mental health care settings because it can be learned quickly and offered in individual or group formats with short appointments.

Home health aides or other frontline staff will be trained to screen participants using the Patient Health Questionnaire-2 (PHQ-2), which records the frequency of lost interest in pleasurable pursuits and how often participants feel down or hopeless. The completed form will be passed on to a supervising RN/LPN or LCSW social worker. These staff will follow up with telephone or in-person contact when participants report either symptom at potentially clinically-significant levels. The RN/LPN or social worker will query participants on additional depressive symptoms using the PHQ-9 (i.e., insomnia, agitation, suicidality, lack of appetite).