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PEARLS: Reducing Symptoms of Depression Home-based Counseling Services Available

By Jan Klingberg

As older adults, we go through a lot of changes—retirement, loss of a life partner, chronic or acute medical issues, or a major move. And each of us feels highly stressed on occasion. We experience fatigue and lack energy at times. We can be sad or our mood decidedly blue. These are common reactions to life changes or upheaval. But it’s not a normal part of aging when these symptoms of depression endure or interfere with daily life. Minor to severe depression affects more than 6.5 million of the 35 million Americans ages 65 and older (The National Alliance on Mental Illness, Depression in Older Persons Fact Sheet). Interventions are crucial because an individual with untreated depression often has “poorer overall health status, which may make both the depression and the other health conditions more difficult to treat” (PEARLS Program).

To address the need for services locally, North Shore Senior Center has launched a program to provide mental health support for older adults with depression. Though the Center’s CareOptions program now offers office-based psychotherapy, no other program currently addresses mental health issues through formal counseling. So Elizabeth “Liz” Gordon, Ph.D., director of CareOptions, was pleased to discover the Program to Encourage Active and Rewarding Lives for Seniors (PEARLS) (Program to Encourage Active and Rewarding Lives for Seniors), a depression-management program for seniors with depression or dysthymia (moderate but persistent symptoms). The program empowers the client to take action and make changes that can reduce symptoms and improve quality of life. An important distinction of the PEARLS program is that counseling is provided in the home, so transportation and mobility barriers are eliminated.

PEARLS grew out of a late-1990s research study at the University of Washington that was funded by the Centers for Disease Control and Prevention. The research showed that recipients of treatment outlined in the PEARLS program were more likely to experience a 50 percent-plus reduction of symptoms of depression and experience an improved quality of life (University of Washington School of Public Health, Healthy Aging and Depression, Action Brief). First implemented in 2000, the program has been successfully replicated by a number of community-based organizations across the country. The Center is the first organization in this area, though, that has embraced the program. PEARLS, with a track record of effectiveness, seemed to be the best of all possible options. “Research about the effectiveness of the program already has been done,” commented Liz, “and the PEARLS program developers present it in a structured format that we can follow that is evidence-based.”

Under the leadership of Terri McHugh, LCSW, clinical supervisor in CareOptions, the Center has taken the PEARLS model and is implementing locally. Terri had been with Senior and Family Services for nine years prior to joining CareOptions, working with people who have age-related issues and need a lot of support. She has been trained in the PEARLS methodology and has completed further training, including being certified in Cognitive Behavioral Therapy. All counselors will be licensed clinical social workers. Two outside professionals will complete the treatment team: a psychiatric nurse or physician to address medical and medication issues and a psychotherapist to provide case consultation.

As part of the planning process for adjusting the PEARLS program for the Center, Terri is setting up the referral system and defining the screening process and protocols. The next steps include working with a few clients, evaluating how the process and structure are working, and making any necessary adjustments. Initially, clients will be referred from the Center’s Senior and Family Services Department; in time, the program will accept referrals from the wider community.

Terri explained that the three components of the PEARLS program help participants manage their depression. Clients are guided and encouraged to:

  • Identify a particular problem and implement steps toward solving it, thereby building problem-solving skills.
  • Incorporate more physical and social activity into a daily regimen.
  • Identify a pleasurable activity to engage in weekly.

Independence. Well-being. Dignity. Selfrespect. These core concepts of the Center’s mission are reinforced in the PEARLS program, which supports and empowers seniors facing the challenges of depression. The intent in adopting the PEARLS program is mission-driven. Liz explained, “We just ask the question, ‘Can we do this and improve the lives of those we serve?’” The program is approved for reimbursement by Medicare through authorized providers like Terri and, ultimately, all PEARLS counselors. But the Center doesn’t expect reimbursement to cover the full costs of initiating the program. “It certainly isn’t covering the cost of program development and implementation,” commented Liz, “so private funding is crucial.” 

By adopting an evidence-based program that has been successfully implemented nationwide, the Center will be positioned to support hundreds of older adults in the area who are dealing with depression. Program staff also will be able to share outcome data with other participating organizations. So evaluation and quality improvement—hallmarks of the Center’s services—will be at the forefront in order to continue to meet the mental health needs of seniors in our community.

 

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