4

Workforce Implications of Models of Care for Older Adults with Mental Health and Substance Use Conditions

Abstract: This chapter reviews nine models of care delivery for older adults who have depression, substance use conditions, serious mental illness, or psychiatric and behavioral symptoms related to dementia. Mental health and substance use (MH/SU) care—particularly for depression and at-risk drinking—is most effective for older adults when it includes systematic outreach and diagnosis, patient and family education and self-management support, provider accountability for outcomes, and close follow-up and monitoring to prevent relapse. These elements are best obtained when care is patient-centered, in an easily accessed location (e.g., in primary care, senior centers, or individuals’ homes), and coordinated by trained personnel with access to specialty consultation. These aims are not likely to be achieved, however, without significant practice redesign, critical changes in Medicare payment rules, and substantial efforts to train and retrain the workforce appropriately. Research on effective delivery of MH/SU care for individuals residing in nursing homes and other residential settings, prisoners, rurally isolated elders, and older adults with severe mental illnesses is urgently needed.

The previous chapters described the mental health and substance use (MH/SU) needs of older adults and the available information on the health care workforce that serves them. The messages of the chapters are



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 241
4 Workforce Implications of Models of Care for Older Adults with Mental Health and Substance Use Conditions Abstract: This chapter reviews nine models of care delivery for older adults who have depression, substance use conditions, serious mental ill- ness, or psychiatric and behavioral symptoms related to dementia. Men- tal health and substance use (MH/SU) care—particularly for depression and at-risk drinking—is most effective for older adults when it includes systematic outreach and diagnosis, patient and family education and self-management support, provider accountability for outcomes, and close follow-up and monitoring to prevent relapse. These elements are best obtained when care is patient-centered, in an easily accessed loca - tion (e.g., in primary care, senior centers, or individuals’ homes), and coordinated by trained personnel with access to specialty consultation. These aims are not likely to be achieved, however, without significant practice redesign, critical changes in Medicare payment rules, and sub - stantial efforts to train and retrain the workforce appropriately. Research on effective delivery of MH/SU care for individuals residing in nursing homes and other residential settings, prisoners, rurally isolated elders, and older adults with severe mental illnesses is urgently needed. The previous chapters described the mental health and substance use (MH/SU) needs of older adults and the available information on the health care workforce that serves them. The messages of the chapters are 241

OCR for page 241
242 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS clear. The MH/SU needs of older adults1 are complex, typically co-occur with other health problems, and are often inadequately addressed by today’s health care system. Moreover, the health care workforce is insuffi- ciently prepared to address the MH/SU needs of the geriatric population. The committee agreed early in its deliberations that the effectiveness and efficiency of the geriatric mental health workforce derives not only from the skills, knowledge, and size of the workforce, but also from how care is organized and delivered. The objective of this chapter is twofold: first, to review what is known about how to optimize the capacity of the workforce to yield better outcomes, especially in light of the chronic nature of geriatric MH/SU conditions and, second, to consider the impli - cations of such models for workforce training and deployment of health care workers. ORGANIZATION OF THE CHAPTER The chapter begins with a brief description of the chronic care model— the central framework for many promising innovations in MH/SU care delivery. The next section reviews nine models of care delivery for older adults who have MH/SU conditions (Table 4-1). The committee had nei - ther the resources nor the time to conduct a systematic review of model interventions. The nine models were selected to include common geriatric MH/SU conditions as well as the important settings where older adults often receive services. The models make clear that there is indeed an evi- dence base demonstrating that patient outcomes can improve with reor- ganization of care. Thus, the committee urges that workforce planners and policy makers should move beyond dismissive summaries that “nothing works for these patients” and consider the implications of the models for workforce education, training, credentialing, and licensure. However, the robustness of evidence does vary across care settings and older adult populations; some published evidence had to be avail - able in order to be included in this review. Research on effective delivery of MH/SU care is particularly lacking for older adults in nursing homes, residential treatment settings, and other congregate living arrangements as well as for prisoners, rurally isolated elders, and older adults with seri- ous mental illnesses. For settings with several intervention models, the committee chose the model that had the most robust evidence. For example, the Preven - tion of Suicide in Primary Care Elderly Collaborative Trial (PROSPECT) 1 Thisreport uses the term “older adults” to refer to adults age 65 and older. “Mental health workforce” refers to the full range of personnel providing services to older adults with mental health and substance use conditions.

OCR for page 241
243 WORKFORCE IMPLICATIONS OF MODELS OF CARE TABLE 4-1 Models Reviewed in This Chapter Model Target Population Depression Improving Mood-Promoting Older adult population with Access to Collaborative major depression, dysthymic Treatment (IMPACT) disorder, or both Kaiser Nurse Telehealth Care Adult population (all ages) Model starting antidepressant drug therapy Program to Encourage Active Older, community-residing and Rewarding Lives for Seniors adults with minor depression (PEARLS) and dysthymia who are receiving social services Substance Use Screening, Brief Intervention, and Older adult population at risk for Referral for Treatment (SBIRT) alcohol and substance misuse Primary Care Research in Older primary care patients with Substance Abuse and Mental symptoms of depression, anxiety, Health for the Elderly (PRISM-E) and at-risk drinking Serious Mental Illness (SMI) Helping Older People Experience Older adults with SMI residing in Success (HOPES) the community Psychogeriatric Assessment Older adults with SMI living in and Treatment in City Housing urban public housing (PATCH) Wellness Recovery Action Adults (all ages) with severe and Planning (WRAP) persistent mental illness Psychiatric and Behavioral Symptoms Related to Dementia Providing Resources Early to Older adults with Alzheimer’s Vulnerable Elders Needing and their caregivers Treatment (PREVENT)

OCR for page 241
244 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS was an effective intervention, but did not have as large a sample size or geographic diversity as the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial (Bruce et al., 2004). Similarly, the Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) trial of home-based depression treatment was not a random- ized controlled trial (RCT) like the PEARLS trial, although it did show some evidence of effectiveness (Casado et al., 2008; Quijano et al., 2007). The selected models include interventions for managing depression in primary care and in home care settings, for addressing substance use, for assisting older adults with severe and persistent mental illness, and for managing the psychiatric and behavioral symptoms of dementia in primary care. For additional research on models for delivering MH/SU interventions to older adults, see the following reviews: (Bruce et al., 2005; Chang-Quan et al., 2009; Eklund and Wilhelmson, 2009; Frederick et al., 2007; Skultety and Rodriguez, 2008; Skultety and Zeiss, 2006; Snowden et al., 2008; Steinman et al., 2007). The chapter concludes with a discussion on the implications of the models for developing the workforce. THE CHRONIC CARE MODEL U.S. health care delivery remains in a mode of care with origins in the early 20th century, when health care problems were typically acute and life expectancy was significantly shorter than today (Grumbach and Bodenheimer, 2002; IOM, 2001; Wagner et al., 1996). However, an acute care orientation is not appropriate for much of geriatric care (IOM, 2008). For the older adult, chronic illness is the norm, not the exception—for both mental and physical health conditions. An estimated 34 million of the 38 million older adults (89 percent) in the United States in 2009 had at least one chronic health condition (Alecxih et al., 2010). As a consequence, older adults most often seek medical care for chronic conditions such as diabetes or hypertension rather than acute problems such as respiratory infections or fractures. Yet most primary care practices that care for older adults continue to be designed to respond to the needs of patients with time-limited, acute health care problems (Berenson and Horvath, 2003; Grumbach and Bodenheimer, 2002). The gap between the type of care needed and the type of care available is particularly troublesome for older persons with mental illness (WHO, 2003). Research on treatment prefer- ences also suggests that older adults with some MH/SU conditions, such as depression, prefer to receive mental health services in a primary care setting rather than via referral to a psychiatric specialist (Gum et al., 2006). However, primary care physicians detect and adequately treat or refer only 40-50 percent of patients with MH problems (Speer and Schneider, 2003). Moreover, surveys of primary care physicians indicate that fewer

OCR for page 241
245 WORKFORCE IMPLICATIONS OF MODELS OF CARE than half of the patients they refer for mental health treatment actually receive services (Callahan et al., 1994; Lindley et al., 2010). Thus the committee agreed that its assessment of how to strengthen the geriatric MH/SU workforce should assume a chronic care framework for delivering services. The committee also agreed that the Chronic Care Model (CCM), developed by Wagner and colleagues (2001), is an appro- priate conceptual framework for integrating geriatric MH/SU services into primary care (Bodenheimer et al., 2002a,b; McDonald et al., 2007). While the research on the CCM has limitations, the model has been demonstrated to lead to better outcomes across a variety of patient popu - lations and care settings (Coleman et al., 2009; McDonald et al., 2007). 2 Moreover, the model is flexible by design so that it can vary across orga - nizations, settings, and time. Nevertheless, successful implementation requires fundamental changes in provider behavior and practice redesign to support the longitudinal, coordinated care of populations. The commit- tee believes that a CCM approach has far more potential to reach more older adults more effectively and efficiently than today’s usual approach of referral to specialists and separation—sometimes carving out individu- als’ mental health concerns—from other aspects of their care. Care Coordination The overarching principle of the CCM is that chronic illness care is best delivered with coordinated teams of providers working in systems and within communities that support the care of populations (Coleman et al., 2009; Epping-Jordan et al., 2004; McDonald et al., 2007; Wagner, 1998; Wagner et al., 2001). Care coordination, sometimes referred to as “disease management” or “care management,” is at the heart of most of the MH/SU models reviewed in this chapter. Numerous definitions of care coordination have been suggested. The committee adopted the fol- lowing definition proposed by McDonald and colleagues (2007, p. 6) in a systematic review of quality-improvement strategies: the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to 2 For example, most of the research on chronic care management focuses on single chronic conditions in limited types of settings for only short periods of time. As a result, the findings may not be generalizable to real-world settings with more limited resources, motivation, or expertise. Evidence to support the cost-effectiveness of CCM-based interventions is also lim- ited (Katon et al., 2005; Peikes et al., 2009). Given that most persons with chronic conditions, including those with mental illness, suffer from more than one chronic condition, there is a need for testing the broader model among populations with multiple chronic conditions. This may be particularly true for older adults who are more likely to suffer from multiple chronic conditions (Boult et al., 2010).

OCR for page 241
246 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care. In the context of models of care for geriatric MH/SU, the essential components of care coordination with respect to workforce roles, skills, and competencies are • A patient-centered approach that recognizes the goals, culture, lan- guage, communication level, and needs of the individual patient or client. • Team-based care with each team member having the appropriate skills and resources as well as understanding of his or her role on the team. The team is led by a primary care provider (e.g., general- ist physician or nurse practitioner). A critical focus of the team’s efforts is on engaging patients and clients in their care by helping them set goals and solve problems for improved self-management. • Stepped care; simpler interventions are tried first, more intensive interventions are considered if a good outcome is not achieved. Inherent in the stepped-care approach is the understanding that some patients will require input, comanagement, or management by specialist physicians. • Longitudinal tracking of the patient’s care and outcomes. Continu- ous follow-up of care is integral to stepped care, relapse preven- tion, and team members’ accountability for patient outcomes. • Access to specialty care or other exceptional resources for those patients whose goals cannot be met with the earlier steps in the stepped-care approach. CCM does not eliminate the need for spe- cialists. Rather, it seeks to improve the appropriate use of this limited resource. These components are clearly interrelated and suggest other key resources that should be available to the care team such as an infrastructure to support communication with the patient and among other health care providers; the capacity to tailor the treatment to individual patient needs; information technology to allow tracking of the process and outcomes of care and decision support; and access to appropriately trained human resources. For most primary care practices, implementing care coordi - nation requires system-level practice redesign and personnel retraining programs as well as electronic health records for shared access to patients’ clinical data, individualized decision support, and easy communication between providers.

OCR for page 241
247 WORKFORCE IMPLICATIONS OF MODELS OF CARE CARE DELIVERY MODELS FOR GERIATRIC MH/SU This section of the chapter reviews nine models for providing MH/SU services to older adults (Table 4-1). It includes a brief review of MH/SU services in nursing home residents (despite the dearth of research on this very vulnerable population). As noted earlier, the mod - els presented here reflect a variety of interventions (with variable levels of evidence) for depression, substance use, serious mental illness, and psychiatric and behavioral symptoms related to dementia. Several of the models began as RCTs, which yielded clinically significant results and have since been implemented in numerous sites around the country. Models for Managing Depression As Chapter 2 describes, depression during later life is prevalent and adversely affects many aspects of the person’s life, including physical health, disability, quality of life, health services usage, and mortality (Blazer, 2003, 2009; Hybels et al., 2009).3 Nevertheless, only a minority of older adults affected by depression receive adequate care (Garrido et al., 2011). This is despite more than two decades of research demonstrating the effectiveness of certain depression treatments such as antidepressant medications and some forms of psychotherapy for older adults (Blazer, 2009). More recent research—including well-executed RCTs—has also shown that there are effective models of care for delivering these treat - ments to ensure good outcomes for a variety of diverse, older adult populations (Arean et al., 2005a,b; Cavanagh et al., 2006; Ciechanowski et al., 2004; Frederick et al., 2007; Hunkeler et al., 2000, 2006; Katon et al., 2006; Proudfoot et al., 2003; Schonfeld et al., 2010; Steinman et al., 2007; Unützer et al., 2003; Williams et al., 2004). This body of evidence clearly suggests that the integration of mental health services into the primary care setting—where older adults receive the majority of their medical care—is an effective and efficient approach to improving the outcomes for older adults who have depression at the population level. Compared with usual care, these innovations have been shown to improve older adults’ treatment outcomes and satisfaction with care. In addition, primary care physicians report greater satisfaction with their ability to meet the needs of patients with depression. 3 See Chapter 2 for detailed epidemiological data.

OCR for page 241
248 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) IMPACT was one of the most robust trials ever conducted to assess the effect of collaborative depression care for older adults (Unützer et al., 2002). The RCT, funded by several foundations, compared usual care with a collaborative, stepped-care treatment model for 1,801 older adults who met DSM-IV-TR criteria4 for major depression or dysthymia. Eighteen primary care clinics in urban and semi-rural settings representing eight health care organizations in five states5 participated in the trial (IMPACT, 2011a). The clinics included a wide variety of health care delivery systems, including several health maintenance organizations (HMOs), traditional fee-for-service clinics, an Independent Provider Association (IPA), an inner-city public health clinic, and two Veterans Affairs (VA) clinics. Fol- lowing the intervention, IMPACT patients reported greater improvement in depression, greater remission rates, improved quality of life, and satis - faction with care. An analysis of study participants in two HMO settings found that the model reduced total health care costs by about $3,300 per person over a 4-year period (Unützer et al., 2008).6 The IMPACT model has been replicated in other trials, demonstrat- ing its generalizability, effectiveness, and suitability for introduction into primary care practices nationwide (Ell et al., 2008, 2010; Gilmer et al., 2008; Grypma et al., 2006; Katon et al., 2004). The program has been either implemented or implementation is under way in 38 states (not all of the programs target the older adult population). Nevertheless, barriers such as Medicare payment policy, lack of infrastructure, and a dearth of trained personnel have prevented widespread implementation for older adults. Intervention In the IMPACT model, potential patients are either referred to treatment by their primary care provider (PCP) or are identified via routine depression screening. During the initial treatment visit, a depres- sion care manager (DCM) completes an assessment, provides education about treatments, and asks the participant about his or her preference for depression treatment: antidepressant medications or psychotherapy. The DCM is supervised by a psychiatrist. All patients are encouraged to engage in some form of behavioral activation, such as physical activity or scheduling pleasant events. The IMPACT treatment algorithm suggests an initial choice of an antidepressant medication made by the psychiatrist 4 DSM, or DSM-IV-TR, refers to the Diagnostic and Statistical Manual of Mental Disorders . During the course of this study, the Fourth Edition-Text Revision (DSM-IV-TR) was in use. A fifth edition is expected in 2013 (American Psychiatric Association, 2012). 5 The five states were California, Indiana, North Carolina, Texas, and Washington state. 6 Cost data were not available at the other study sites.

OCR for page 241
249 WORKFORCE IMPLICATIONS OF MODELS OF CARE upon review of the patient with the DCM or a course of “Problem Solving Treatment in Primary Care,” a brief structured psychotherapy delivered by the DCM in the primary care office setting (Hegel and Arean, 2003). The DCM follows up in person or by telephone approximately every 2 weeks during the intensive phase and approximately monthly for the remainder of the program. The duration of the intervention is 1 year. Staffing Training is required to become an IMPACT DCM. The Advanc- ing Integrated Mental Health Services Center at the University of Wash- ington offers two training options: a 2-day in-person course or free online training (IMPACT). While most trainees have been social workers, psychologists, counselors, marriage and family therapists, psychiatrists, PCPs, nurses, and nurse practitioners, others are eligible for training. An IMPACT certificate program is under development and planned for release in 2012 (IMPACT, 2011b). In primary care settings, IMPACT requires a partnership with a con- sulting psychiatrist (or other mental health specialist) who can provide regular consultation and supervision. If implemented in a mental health setting, a partnership is needed with the participant’s primary care pro - vider. The DCM works with the primary care provider and receives addi- tional support from the psychiatrist, who focuses on difficult cases and individuals not responding as expected. Kaiser Nurse Telehealth Model Older adults often have difficulty getting to providers’ offices because of cost, limited transportation options, or availability of services where they live (e.g., in rural areas). There is an emerging literature suggest - ing that telephone counseling and Internet-based programs may help overcome obstacles to accessing care and at substantially lower cost (Bee et al., 2008; Dieterich et al., 2004; Gellis et al., 2012; Hunkeler, 2011; Leach and Christensen, 2006; Pearson et al., 2003; Simon et al., 2004; Tutty et al., 2005). However, little related research specifically focuses on older adults. Patients receiving telecare must have affordable phone service with good connectivity and a private place to speak (Hunkeler, 2011). They must also hear well over the telephone, which could be a limitation for some older adults. Nurse telehealth care—including behavioral activation, supportive counseling, and monitoring of a patient’s response to pharmacotherapy— has been tested in a variety of settings (Meresman et al., 2003). The Kaiser Nurse Telehealth Care Model has been implemented and evaluated in 13 unaffiliated primary care clinics in Maine (Pearson et al., 2003) with similarly positive results, although with a younger, under-65 patient population.

OCR for page 241
250 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Intervention The Kaiser Nurse Telehealth Model was developed and evaluated in the northern California region of Kaiser Permanente as an adjunct to depression treatment (although not specifically for older adults). Hunkeler and colleagues (2000) compared usual physician care, telehealth care, and telehealth care plus peer support to evaluate two augmentations of antidepressant treatment in an unbalanced randomized trial7 in two large primary care clinics. Participants included adults, ages 19 to 90, who were beginning antidepressant treatment for major depres- sive disorder or dysthymia. The patients receiving the intervention (with or without peer support) were more likely to experience improvement in depression and mental functioning compared to patients using usual Kaiser services. Staffing Care was provided by a primary care physician and nurse and, in one arm of the trial, peer counselors (i.e., trained Kaiser members recovered from depression) as well. The nurses made 10 6-minute calls to the patients over a 4-month period. During the calls, the nurse answered patients’ questions about the medication, gave advice on dealing with side effects, and reinforced the importance of continuing the medication. The nurses also offered emotional support, encouraged patients to engage in pleasurable activities, reviewed the activities of the previous week, and helped the patient plan for future activities. Peer support was provided by volunteer health plan members who had been treated successfully for depression. They received approximately 20 hours of training and were matched with individuals of similar age and sex. Program to Encourage Active and Rewarding Lives for Seniors (PEARLS) Depression is particularly common among older adults who are socially isolated and have medical comorbidities or physical impair- ments. The PEARLS (Program to Encourage Active and Rewarding Lives for Seniors) program is a home-based intervention specifically designed for homebound, frail older adults with chronic medical conditions. The PEARLS trial, funded by the Centers for Disease Control and Prevention (CDC), was one of the first studies to demonstrate the feasibility of col - laborating with community service organizations to identify and effec- tively treat depressed, homebound older adults primarily with counseling rather than prescription drugs (Ciechanowski et al., 2004). Community service organizations in 14 states provide the PEARLS programs. 8 7 In an unbalanced randomized trial, more patients are put in the treatment group when there is a strong suggestion it will prove superior. 8 See http://www.pearlsprogram.org.

OCR for page 241
251 WORKFORCE IMPLICATIONS OF MODELS OF CARE The original PEARLS trial included 138 adults with minor depres- sion or dysthymia who were recruited from community senior service agencies in Seattle, WA. The participants had an average of five chronic medical conditions. Racial and ethnic minorities made up 42 percent of the study population. More than half of the study population (58 percent) had annual incomes of less than $10,000. Patients with minor depression or dysthymia were randomized to the intervention or usual care. Inter- vention patients had significantly greater improvement in depression symptoms and quality of life compared to usual care patients and they showed a trend of fewer (self-reported) hospitalizations. PEARLS has also been tested and found effective in reducing depres- sion and suicidal ideation in adults of all ages with epilepsy (Ciechanowski et al., 2010a). Intervention A DCM supervised by a psychiatrist provides six to eight depression management sessions in the patient’s home over a 5-month period and follows up with up to six brief monthly telephone contacts. The sessions include problem-solving treatment, in which participants are taught to recognize depressive symptoms, to define problems that may contribute to their depression, and to devise steps to solve those problems; and behavioral activation such as social and physical activity planning and pleasant event scheduling. Staffing The DCMs in the original PEARLS trial were two trained master’s-level social workers and a registered nurse. In posttrial imple- mentation, a wide selection of bachelor’s-level workers, typically drawn from the staff of the community organization implementing the program, have been trained. PEARLS training includes 2 days of in-person instruc- tion in how to deliver the problem-solving treatment, as well as tech- niques that encourage physical and social activation. Training is available in sites around the country (http://www.pearlsprogram.org/Training. aspx). A PEARLS toolkit is available online and an online toolkit is being developed (Ciechanowski et al., 2010b).9 Substance Use Models Substance use10 is often unappreciated as relevant to geriatric care even though, as the previous chapter reports, many older adults misuse 9 Go to: http://www.pearlsprogram.org/LinkClick.aspx?fileticket=X-rXfpFDF0Q%3d& tabid=69. 10 This report uses the term “substance use” to refer to misuse of alcohol and drugs (pre - scription, over the counter, and illicit).

OCR for page 241
272 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Patients The models reviewed often have as a core component the education and activation of the patient (and/or caregiver) as a more engaged par- ticipant. The most promising MH/SU models include patient education and activation, with the goal of having the patient more actively partici- pate in care choices and learn to self-manage his or her own condition. While viewed as an advantage by many of the baby boomer generation who are not as likely to simply accept the judgment of their health care provider, this may not be an attitude of some current older adults who feel it is appropriate to seek the advice and defer to the opinions of their primary care provider. Equally important, especially given the diversity of the population, is how engagement is achieved within the context of the participant’s culture and language. CONCLUSIONS A persuasive body of evidence, drawn from two decades of research, shows that two common MH/SU disorders among older adults— depression and at-risk drinking—are most effectively addressed when care is organized to include these essential ingredients: (1) systematic outreach and diagnosis, (2) patient and family education and self-man- agement support, (3) provider accountability for outcomes, and (4) close follow-up and monitoring to prevent relapse. Moreover, these elements are best obtained when care is patient centered (integrating patient pref- erences, needs, and strengths), in a location easily accessed by patients (e.g., in primary care, senior centers, or patients’ homes), and coordi - nated by trained personnel with access to specialty consultation. There is also evidence suggesting great promise in telehealth and Web-based interventions for older adults with MH/SU conditions. Progress in these areas is not likely to be achieved, however, without practice redesign and change in Medicare payment rules. There is a fundamental mismatch between older adults’ need for coordinated care and Medicare fee-for- service reimbursement that precludes payment of trained care managers and psychiatry consultation. The committee concluded, as have many other studies, that the deliv- ery of and payment for health care services to older adults must be reor- ganized to reflect the chronic nature of MH/SU and other health condi - tions prevalent in the 21st-century geriatric population (IOM, 2008). The workforce implications are daunting. Registered nurses are particularly well suited to coordinate MH/SU and physical health care, but they need additional training to serve in this capacity. Primary care providers, such as physicians, advanced practice registered nurses, and physician assis- tants are an integral component of these models, yet, many of them have

OCR for page 241
273 WORKFORCE IMPLICATIONS OF MODELS OF CARE not been trained in collaborative care and do not work in a practice or system supportive of comanagement, colocation, screening, and outcome monitoring. Frontline workers within the aging provider network agencies may be a potential source of care managers. However, they will require intensive training in evidence-based program treatment as they are likely to have limited knowledge of MH/SU. Finally, research on effective delivery of MH/SU care for certain older populations is urgently needed, especially for individuals residing in nursing homes and other residential settings, prisoners, rurally isolated elders, and older adults with severe mental illnesses. REFERENCES ACTA (Assertive Community Treatment Association). 2007. ACT history and origins. http:// www.actassociation.org/origins/ (accessed February 13, 2012). AHCA (American Health Care Association). 2010. LTC stats: Nursing facilities patient character- istics report. June and December 2010 updates. http://www.ahcancal.org/research_data/ oscar_data/NursingFacilityPatientCharacteristics/Forms/AllItems.aspx (accessed February 21, 2012). Alecxih, L., S. Shen, I. Chan, D. Taylor, and J. Drabek. 2010. Individuals living in the community with chronic conditions and functional limitations: A closer look. http://www.lewin.com/ content/publications/ChartBookChronicConditions.pdf (accessed January 19, 2012). American Psychiatric Association. 2012. DSM-IV-TR. http://www.dsm5.org/Pages/Default. aspx (accessed June 1, 2012). Arean, P. A., L. Ayalon, E. Hunkeler, E. H. Lin, L. Tang, L. Harpole, H. Hendrie, J. W. Williams, Jr., and J. Unützer. 2005a. Improving depression care for older, minority patients in primary care. Medical Care 43(4):381-390. Arean, P. A., A. Gum, C. E. McCulloch, A. Bostrom, D. Gallagher-Thompson, and L. Thompson. 2005b. Treatment of depression in low-income older adults. Psychology & Aging 20(4):601-609. Arean, P. A., L. Ayalon, C. Jin, C. E. McCulloch, K. Linkins, H. Chen, B. McDonnell-Herr, S. Levkoff, and C. Estes. 2008. Integrated specialty mental health care among older mi - norities improves access but not outcomes: Results of the PRISMe study. International Journal of Geriatric Psychiatry 23(10):1086-1092. Austrom, M. G., T. M. Damush, C. West Hartwell, T. Perkins, F. Unverzagt, M. Boustani, H. C. Hendrie, and C. M. Callahan. 2004. Development and implementation of non - pharmacologic protocols for the management of patients with Alzheimer’s disease and their families in a multiracial primary care setting. Gerontologist 44(4):548-553. Babor, T. F., B. G. McRee, P. A. Kassebaum, P. L. Grimaldi, K. Ahmed, and J. Bray. 2007. Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the management of substance abuse. Focus 9(1):130. Barber, J. A., R. A. Rosenheck, M. Armstrong, and S. G. Resnick. 2008. Monitoring the dis - semination of peer support in the VA Health Care System. Community Mental Health Journal 44(6):433-441. Barker, J. C., L. S. Mitteness, and S. J. Wood. 1988. Gate-keeping: Residential managers and elderly tenants. Gerontologist 28(5):610-619.

OCR for page 241
274 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Bartels, S. J. 2004. Caring for the whole person: Integrated health care for older adults with severe mental illness and medical comorbidity. Journal of the American Geriatrics Society 52:S249-S257. Bartels, S., and S. I. Pratt. 2009. Psychosocial rehabilitation and quality of life for older adults with serious mental illness: Recent findings and future research directions. Current Opinion in Psychiatry 22(4):381-385. Bartels, S. J., G. S. Moak, and A. R. Dums. 2002. Models of mental health services in nursing homes: A review of the literature. Psychiatric Services 53(11):1390-1396. Bartels, S. J., E. H. Coakley, C. Zubritsky, J. H. Ware, K. M. Miles, P. A. Arean, H. Chen, D. W. Oslin, M. D. Llorente, G. Costantino, L. Quijano, J. S. McIntyre, K. W. Linkins, T. E. Oxman, J. Maxwell, and S. E. Levkoff. 2004. Improving access to geriatric mental health services: A randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. American Journal of Psychiatry 161(8):1455-1462. Bee, P. E., P. Bower, K. Lovell, S. Gilbody, D. Richards, L. Gask, and P. Roach. 2008. Psycho - therapy mediated by remote communication technologies: A meta-analytic review. BMC Psychiatry 8:60. Berenson, R. A., and J. Horvath. 2003. Confronting the barriers to chronic care management in Medicare. Health Affairs 22(1):37-53. Bernstein, J. 1982. Who leaves—who stays—residency policy in housing for the elderly. The Gerontologist 22(3):305-313. Blazer, D. G. 2003. Depression in late life: Review and commentary. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences 58(3):M249-M265. ———. 2009. Depression in late life: Review and commentary. Focus 7(1):118-136. Blow, F. C. 1998. Substance abuse among older adults. Treatment Improvement Protocol (TIP) Series 26, Report No. (SMA) 98-3179. http://www.ncbi.nlm.nih.gov/books/NBK64419/ (ac- cessed February 1, 2012). Blow, F., and K. Barry. 1999. Advances in alcohol screening and brief intervention with older adults. In Advances in medical psychotherapy, Vol. 10, edited by P. A. Lichtenberg. Dubuque, IA: Kendall Hunt. Bluebird, G. 2008. Paving new ground: Peers working in in-patient settings. http://www. nasmhpd.org/general_files/publications/ntac_pubs/Bluebird%20Guidebook%20 FINAL%202-08.pdf (accessed March 9, 2012). Bodenheimer, T., E. H. Wagner, and K. Grumbach. 2002a. Improving primary care for pa - tients with chronic illness. JAMA 288(14):1775-1779. ———. 2002b. Improving primary care for patients with chronic illness: The chronic care model, Part 2. JAMA 288(15):1909-1914. Borson, S., J. P. Loebel, M. Kitchell, S. Domoto, and T. Hyde. 1997. Psychiatric assessments of nursing home residents under OBRA-87: Should PASRR be reformed? Pre-Admission Screening and Annual Review. Journal of the American Geriatrics Society 45(10):1173-1181. Borson, S., S. J. Bartels, C. C. Colenda, G. L. Gottlieb, and B. Meyers. 2001. Geriatric mental health services research: Strategic plan for an aging population: Report of the Health Services Work Group of the American Association for Geriatric Psychiatry. American Journal of Geriatric Psychiatry 9(3):191-204. Boult, C., S. R. Counsell, R. M. Leipzig, and R. A. Berenson. 2010. The urgency of preparing primary care physicians to care for older people with chronic illnesses. Health Affairs 29(5):811-818. Boustani, M. A., G. A. Sachs, C. A. Alder, S. Munger, C. C. Schubert, M. Austrom, A. M. Hake, F. W. Unverzagt, M. Farlow, B. R. Matthews, A. J. Perkins, R. A. Beck, and C. M. Callahan. 2011. Implementing innovative models of dementia care: The Healthy Aging Brain Center. Aging & Mental Health 15(1):13-22.

OCR for page 241
275 WORKFORCE IMPLICATIONS OF MODELS OF CARE Bruce, M. L., T. R. Ten Have, C. F. Reynolds, I. I. Katz, H. C. Schulberg, B. H. Mulsant, G. K. Brown, G. J. McAvay, J. L. Pearson, and G. S. Alexopoulos. 2004. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A ran - domized controlled trial. JAMA 291(9):1081-1091. Bruce, M. L., A. D. Van Citters, and S. J. Bartels. 2005. Evidence-based mental health services for home and community. Psychiatric Clinics of North America 28(4):1039-1060. Callahan, C. M., H. C. Hendrie, R. S. Dittus, D. C. Brater, S. L. Hui, and W. M. Tierney. 1994. Improving treatment of late life depression in primary care: A randomized clinical trial. Journal of the American Geriatrics Society 42(8):839-846. Callahan, C. M., F. W. Unverzagt, S. L. Hui, A. J. Perkins, and H. C. Hendrie. 2002. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care 40(9):771-781. Callahan, C. M., M. A. Boustani, F. W. Unverzagt, M. G. Austrom, T. M. Damush, A. J. Perkins, B. A. Fultz, S. L. Hui, S. R. Counsell, and H. C. Hendrie. 2006. Effectiveness of collaborative care for older adults with Alzheimer’s disease in primary care: A random- ized controlled trial. JAMA 295(18):2148-2157. Callahan, C. M., M. A. Boustani, M. Weiner, R. A. Beck, L. R. Livin, J. J. Kellams, D. R. Willis, and H. C. Hendrie. 2011. Implementing dementia care models in primary care settings: The Aging Brain Care Medical Home. Aging & Mental Health 15(1):5-12. Casado, B. L., L. M. Quijano, M. A. Stanley, J. A. Cully, E. H. Steinberg, and N. L. Wilson. 2008. Healthy IDEAS: Implementation of a depression program through community- based case management. Gerontologist 48(6):828-838. Castelein, S., R. Bruggeman, J. T. van Busschbach, M. van der Gaag, A. D. Stant, H. Knegtering, and D. Wiersma. 2008. The effectiveness of peer support groups in psy - chosis: A randomized controlled trial. Acta Psychiatrica Scandinavica 118(1):64-72. Cavanagh, K., D. A. Shapiro, S. Van Den Berg, S. Swain, M. Barkham, and J. Proudfoot. 2006. The effectiveness of computerized cognitive behavioural therapy in routine care. British Journal of Clinical Psychology/British Psychological Society 45(Pt 4):499-514. Chan, D. C., J. D. Kasper, B. S. Black, and P. V. Rabins. 2003. Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: The Memory and Medical Care Study. International Journal of Geriatric Psychiatry 18(2):174-182. Chang-Quan, H., D. Bi-Rong, L. Zhen-Chan, Z. Yuan, P. Yu-Sheng, and L. Qing-Xiu. 2009. Collaborative care interventions for depression in the elderly: A systematic review of randomized controlled trials. Journal of Investigative Medicine 57(2):446-455. Chinman, M., A. Hamilton, B. Butler, E. Knight, S. Murray, and A. Young. 2008. Mental health consumer providers, a guide for clinical staff. http://www.rand.org/pubs/technical_reports /2008/RAND_TR584.pdf (accessed March 9, 2012). Ciechanowski, P., E. Wagner, K. Schmaling, S. Schwartz, B. Williams, P. Diehr, J. Kulzer, S. Gray, C. Collier, and J. LoGerfo. 2004. Community-integrated home-based depression treatment in older adults: A randomized controlled trial. JAMA 291(13):1569-1577. Ciechanowski, P., N. Chaytor, J. Miller, R. Fraser, J. Russo, J. Unützer, and F. Gilliam. 2010a. PEARLS depression treatment for individuals with epilepsy: A randomized controlled trial. Epilepsy & Behavior 19(3):225-231. Ciechanowski, P. S., S. Schwartz, M. Snowden, L. Steinman, C. Kaiser, P. Piering, D. Sugiyama, M. P. O’Leary, A. Yip, S. Favaro, and J. Huchital. 2010b. Program to encour- age active, rewarding lives. http://www.pearlsprogram.org/LinkClick.aspx?fileticket=X- rXfpFDF0Q%3d&tabid=69 (accessed January 24, 2012). CMS (Centers for Medicare & Medicaid Services). 2011. Fact sheet: Substance (other than tobacco) abuse structured assessment and brief intervention (SBIRT) services. https://www. cms.gov/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf (accessed Janu- ary 31, 2012).

OCR for page 241
276 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS ———. 2012. MDS 3.0 RAI Manual. https://www.cms.gov/Medicare/Quality-Initiatives- Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html (accessed March 12, 2012). Coleman, K., B. T. Austin, C. Brach, and E. H. Wagner. 2009. Evidence on the chronic care model in the new millennium. Health Affairs 28(1):75-85. Conn, D., and I. Silver. 1998. The psychiatrist’s role in long-term care. Canadian Nursing Home 9:22-24. Cook, J. A., M. E. Copeland, M. M. Hamilton, J. A. Jonikas, L. A. Razzano, C. B. Floyd, W. B. Hudson, R. T. Macfarlane, and D. D. Grey. 2009. Initial outcomes of a mental illness self-management program based on wellness recovery action planning. Psychiatric Services 60(2):246-249. Cook, J. A., M. E. Copeland, J. A. Jonikas, M. M. Hamilton, L. A. Razzano, D. D. Grey, C. B. Floyd, W. B. Hudson, R. T. Macfarlane, T. M. Carter, and S. Boyd. 2012. Results of a randomized controlled trial of mental illness self-management using wellness recovery action planning. Schizophrenia Bulletin 38(4):881-891. Davidson, L., M. Chinman, B. Kloos, R. Weingarten, D. Stayner, and J. K. Tebes. 1999. Peer support among individuals with severe mental illness: A review of the evidence. Clini- cal Psychology: Science and Practice 6(2):165-187. Dieterich, M., C. Irving, B. Park, and M. Marshall. 2011. Intensive case management for severe mental illness. Evidence-Based Mental Health 14(1):29. Druss, B. G., R. M. Rohrbaugh, C. M. Levinson, and R. A. Rosenheck. 2001. Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry 58(9):861-868. Eklund, K., and K. Wilhelmson. 2009. Outcomes of coordinated and integrated interventions targeting frail elderly people: A systematic review of randomised controlled trials. Health & Social Care in the Community 17(5):447-458. Ell, K., B. Xie, B. Quon, D. I. Quinn, M. Dwight-Johnson, and P. J. Lee. 2008. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. Journal of Clinical Oncology 26(27):4488-4496. Ell, K., M. P. Aranda, B. Xie, P. J. Lee, and C. P. Chou. 2010. Collaborative depression treat - ment in older and younger adults with physical illness: Pooled comparative analysis of three randomized clinical trials. American Journal of Geriatric Psychiatry 18(6):520-530. Epping-Jordan, J. E., S. D. Pruitt, R. Bengoa, and E. H. Wagner. 2004. Improving the quality of health care for chronic conditions. Quality and Safety in Health Care 13(4):299-305. Fleming, M. F., L. B. Manwell, K. L. Barry, W. Adams, and E. A. Stauffacher. 1999. Brief physi- cian advice for alcohol problems in older adults: A randomized community-based trial. Journal of Family Practice 48(5):378-384. Florida BRITE Project. 2009. Brief intervention and treatment for elders. http://brite.fmhi.usf. edu/BRITE.htm (accessed February 2, 2012). Frederick, J. T., L. E. Steinman, T. Prohaska, W. A. Satariano, M. Bruce, L. Bryant, P. Ciechanowski, B. DeVellis, K. Leith, K. M. Leyden, J. Sharkey, G. E. Simon, N. Wilson, J. Unützer, and M. Snowden. 2007. Community-based treatment of late life depression: An expert panel-informed literature review. American Journal of Preventive Medicine 33(3):222-249. Gallo, J. J., C. Zubritsky, J. Maxwell, M. Nazar, H. R. Bogner, L. M. Quijano, H. J. Syropoulos, K. L. Cheal, H. Chen, H. Sanchez, J. Dodson, S. E. Levkoff, and the PRISM-E Investiga - tors. 2004. Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: Results from a multisite effectiveness trial (PRISM-E). An- nals of Family Medicine 2(4):305-309. Garrido, M. M., R. L. Kane, M. Kaas, and R. A. Kane. 2011. Use of mental health care by community-dwelling older adults. Journal of the American Geriatrics Society 59(1):50-56.

OCR for page 241
277 WORKFORCE IMPLICATIONS OF MODELS OF CARE Gellis, Z. D., B. Kenaley, J. McGinty, E. Bardelli, J. Davitt, and T. Ten Have. 2012. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: A randomized controlled trial. Gerontologist 52(4):541-552. Gilmer, T. P., C. Walker, E. D. Johnson, A. Philis-Tsimikas, and J. Unützer. 2008. Improving treatment of depression among Latinos with diabetes using Project Dulce and IMPACT. Diabetes Care 31(7):1324-1326. Goldstrom, I. D., J. Campbell, J. A. Rogers, D. B. Lambert, B. Blacklow, M. J. Henderson, and R. W. Manderscheid. 2006. National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services. Administration and Policy in Mental Health 33(1):92-103. Grumbach, K., and T. Bodenheimer. 2002. A primary care home for Americans: Putting the house in order. Journal of the American Medical Association 288(7):889-893. Grypma, L., R. Haverkamp, S. Little, and J. Unützer. 2006. Taking an evidence-based model of depression care from research to practice; making lemonade out of depression. Gen- eral Hospital Psychiatry 28:101-107. Gum, A. M., P. A. Areán, E. Hunkeler, L. Tang, W. Katon, P. Hitchcock, D. C. Steffens, J. Dickens, J. Unützer, for the IMPACT Investigators. 2006. Depression treatment prefer- ences in older primary care patients. Gerontologist 46(1):14-22. Havard, A., A. Shakeshaft, and R. Sanson-Fisher. 2008. Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments: Interventions re - duce alcohol-related injuries. Addiction 103(3):368-378. Hegel, M., and P. A. Arean. 2003. Problem solving treatment in primary care (PST-PC): A treat- ment manual for depression. Hanover, NH: Dartmouth College. Hunkeler, E. 2011. Workforce implications of telephonic and Internet-based mental health inter - ventions (eCare for moods) for geriatric populations. Paper presented at the June 1, 2011 Meeting of the Committee on the Geriatric Mental Health Workforce, Washington, DC. Hunkeler, E. M., J. F. Meresman, W. A. Hargreaves, B. Fireman, W. H. Berman, A. J. Kirsch, J. Groebe, S. W. Hurt, P. Braden, M. Getzell, P. A. Feigenbaum, T. Peng, and M. Salzer. 2000. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Archives of Family Medicine 9(8):700-708. Hunkeler, E. M., W. Katon, L. Tang, J. W. Williams, Jr., K. Kroenke, E. H. B. Lin, L. H. Harpole, P. Arean, S. Levine, L. M. Grypma, W. A. Hargreaves, and J. Unützer. 2006. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. British Medical Journal 332(7536):259-262. Hybels, C. F., D. G. Blazer, C. F. Pieper, L. R. Landerman, and D. C. Steffens. 2009. Profiles of depressive symptoms in older adults diagnosed with major depression: Latent cluster analysis. American Journal of Geriatric Psychiatry 17(5):387-396. IMPACT. 2011a. IMPACT: Improving Mood—Promoting Access to Collaborative Treatment for Late-Life Depression. http://impact-uw.org/files/IMPACTwebslides.pdf (accessed Janu- ary 23, 2012). ———. 2011b. Training. http://impact-uw.org/training/ (accessed January 23, 2012). IOM (Institute of Medicine). 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. ———. 2008. Retooling for an aging America: Building the health care workforce. Washington, DC: The National Academies Press. IRETA (Institute for Research, Education, and Training in Addictions). 2010. SBIRT coding, billing and reimbursement manual. Prepared for Wisconsin Initiative to Promote Healthy Lifestyles. sbirt.ireta.org/sbirt/pdf/SBIRTBillingManual20100217.doc (accessed Febru- ary 4, 2012). Jensen, J. 2011. Gatekeeper model (1978): Case finding & response system. Paper presented at Meeting of the Committee on the Geriatric Mental Health Workforce, Washington, DC, June 1.

OCR for page 241
278 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Johns Hopkins Office of Community Services. 2011. Community engagement inventory. Patch (psychogeriatric assessment and treatment in city housing). https://cds.johnshopkins.edu/ cei/index.cfm?fuseaction=display_program&id=173 (accessed February 10, 2012). Kaskie, B. P., and K. C. Buckwalter. 2010. The collaborative model of mental health care for older Iowans. Research in Gerontological Nursing 3(3):200-208. Katon, W. J., and M. Seelig. 2008. Population-based care of depression: Team care ap- proaches to improving outcomes. Journal of Occupational and Environmental Medicine 50(4):459-467. Katon, W. J., M. Von Korff, E. H. B. Lin, G. Simon, E. Ludman, J. Russo, P. Ciechanowski, W. Walker, and T. Bush. 2004. The Pathways Study—a randomized trial of collab- orative care in patients with diabetes and depression. Archives of General Psychiatry 61(10):1042-1049. Katon, W. J., M. Schoenbaum, M.-Y. Fan, C. M. Callahan, J. Williams, Jr., E. Hunkeler, L. Harpole, X.-H. A. Zhou, C. Langston, and J. Unützer. 2005. Cost-effectiveness of im - proving primary care treatment of late-life depression. Archives of General Psychiatry 62(12):1313-1320. Katon, W., J. Unützer, M. Y. Fan, J. W. Williams, Jr., M. Schoenbaum, E. H. B. Lin, and E. M. Hunkeler. 2006. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care 29(2):265-270. Krahn, D. D., S. J. Bartels, E. Coakley, D. W. Oslin, H. Chen, J. McIntyre, H. Chung, J. Maxwell, J. Ware, and S. E. Levkoff. 2006. PRISM-E: Comparison of integrated care and enhanced specialty referral models in depression outcomes. Psychiatric Services 57(7):946-953. Leach, L. S., and H. Christensen. 2006. A systematic review of telephone-based interventions for mental disorders. Journal of Telemedicine & Telecare 12(3):122-129. Legal Action Center and Abt Associates. 2010. Partners for recovery. Financing recovery support services: Review and analysis of funding recovery support services and policy recommendations. http://www.friendsofrecoveryvt.org/wp-content/uploads/Partners-for-Recovery- RSS_financing_report.pdf (accessed March 9, 2012). Levkoff, S. E., H. Chen, E. Coakley, E. C. Herr, D. W. Oslin, I. Katz, S. J. Bartels, J. Maxwell, E. Olsen, K. M. Miles, G. Constantino, and J. H. Ware. 2004. Design and sample char- acteristics of the PRISM-E multisite randomized trial to improve behavioral health care for the elderly. Journal of Aging and Health 16(1):3-27. Lin, J. C., M. P. Karno, K. L. Barry, F. C. Blow, J. W. Davis, L. Tang, and A. A. Moore. 2010. Determinants of early reductions in drinking in older at-risk drinkers participating in the intervention arm of a trial to reduce at-risk drinking in primary care. Journal of the American Geriatrics Society 58(2):227-233. Lin, W.-C., J. Zhang, G. Y. Leung, and R. E. Clark. 2011. Chronic physical conditions in older adults with mental illness and/or substance use disorders. Journal of the American Ge- riatrics Society 59(10):1913-1921. Lindley, S., H. Cacciapaglia, D. Noronha, E. Carlson, and A. Schatzberg. 2010. Monitoring mental health treatment acceptance and initial treatment adherence in veterans: Veter- ans of Operations Enduring Freedom and Iraqi Freedom versus other veterans of other eras. Annals of the New York Academy of Sciences 1208:104-113. Linkins, K. W., A. M. Lucca, M. Housman, and S. A. Smith. 2006. Use of PASRR programs to assess serious mental illness and service access in nursing homes. Psychiatric Services 57(3):325-332. Loebel, J. P., S. Borson, T. Hyde, D. Donaldson, C. Vantuinen, T. M. Rabbitt, and E. J. Boyko. 1991. Relationships between requests for psychiatric consultations and psychiatric diagnoses in long-term-care facilities. American Journal of Psychiatry 148(7):898-903.

OCR for page 241
279 WORKFORCE IMPLICATIONS OF MODELS OF CARE McDonald, K., V. Sundaram, D. Bravata, R. Lewis, N. Lin, S. Kraft, M. McKinnon, H. Paguntalan, and D. Owens. 2007. Care coordination, Vol 7. Closing the quality gap: A criti- cal analysis of quality improvement strategies. Technical review 9. AHRQ Pub. No. 04(07)- 0051-7. http://www.ahrq.gov/downloads/pub/evidence/pdf/caregap/caregap.pdf (accessed October 12, 2011). Meeks, S., L. L. Carstensen, P. B. Stafford, L. L. Brenner, F. Weathers, R. Welch, and T. F. Oltmanns. 1990. Mental health needs of the chronically mentally ill elderly. Psychology and Aging 5(2):163-171. Meresman, J. F., E. M. Hunkeler, W. A. Hargreaves, A. J. Kirsch, P. Robinson, A. Green, E. Z. Mann, M. Getzell, and P. Feigenbaum. 2003. A case report: Implementing a nurse telec - are program for treating depression in primary care. Psychiatric Quarterly 74(1):61-73. Molinari, V. A., D. A. Chiriboga, L. G. Branch, J. Schinka, L. Schonfeld, L. Kos, W. L. Mills, J. Krok, and K. Hyer. 2011. Reasons for psychiatric medication prescription for new nursing home residents. Aging & Mental Health 15(7):904-912. Money, N., M. Moore, D. Brown, K. Kasper, J. Roeder, P. Bartone, and M. Bates. 2011. Best practices identified for peer support programs. http://www.dcoe.health.mil/Content/ N avigation/Documents/Best_Practices_Identified_for_Peer_Support_Programs_ Jan_2011.pdf (accessed March 9, 2012). Moore, A. A., F. C. Blow, M. Hoffing, S. Welgreen, J. W. Davis, J. C. Lin, K. D. Ramirez, D. H. Liao, L. Tang, R. Gould, M. Gill, O. Chen, and K. L. Barry. 2011. Primary care-based intervention to reduce at-risk drinking in older adults: A randomized controlled trial. Addiction 106(1):111-120. Mueser, K. T., P. W. Corrigan, D. W. Hilton, B. Tanzman, A. Schaub, S. Gingerich, S. M. Essock, N. Tarrier, B. Morey, S. Vogel-Scibilia, and M. I. Herz. 2002. Illness management and recovery: A review of the research. Psychiatric Services 53(10):1272-1284. Mueser, K. T., S. I. Pratt, S. J. Bartels, K. Swain, B. Forester, C. Cather, and J. Feldman. 2010. Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness. Journal of Consulting & Clinical Psychology 78(4):561-573. NIAAA (National Institute on Alcohol Abuse and Alcoholism). 2005. Helping patients who drink too much. A clinician’s guide, updated 2005 edition. NIH Pub. No. 07-3769 (accessed October 24, 2011). Okura, T., B. L. Plassman, D. C. Steffens, D. J. Llewellyn, G. G. Potter, and K. M. Langa. 2010. Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: The Aging, Demographics, and Memory Study. Journal of the American Geriatrics Society 58(20374406):330-337. Oslin, D. W., S. Grantham, E. Coakley, J. Maxwell, K. Miles, J. Ware, F. C. Blow, D. D. Krahn, S. J. Bartels, C. Zubritsky, and Prism-E Group. 2006. PRISM-E: Comparison of inte - grated care and enhanced specialty referral in managing at-risk alcohol use. Psychiatric Services 57(7):954-958. Ostrow, L., and R. Manderscheid. 2010. Medicare and mental health parity: A high potential change that is long overdue. Journal of Behavioral Health Services & Research 37(3):285-290. Pearson, B., S. E. Katz, V. Soucie, E. Hunkeler, J. Meresman, T. Rooney, and B. C. Amick. 2003. Evidence-based care for depression in Maine: Dissemination of the Kaiser Permanente Nurse Telecare Program. Psychiatric Quarterly 74(1):91-102. Peikes, D., A. Chen, J. Schore, and R. Brown. 2009. Effects of care coordination on hospital - ization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA 301(6):603-618. Pfeiffer, P. N., M. Heisler, J. D. Piette, M. A. Rogers, and M. Valenstein. 2011. Efficacy of peer support interventions for depression: A meta-analysis. General Hospital Psychiatry 33(1):29-36.

OCR for page 241
280 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Pratt, S. I., S. J. Bartels, K. T. Mueser, and B. Forester. 2008. Helping older people experience success: An integrated model of psychosocial rehabilitation and health care manage - ment for older adults with serious mental illness. American Journal of Psychiatric Reha- bilitation 11(1):41-60. Proudfoot, J., D. Goldberg, A. Mann, B. Everitt, I. Marks, and J. A. Gray. 2003. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychological Medicine 33(2):217-227. Quijano, L. M., M. A. Stanley, N. J. Petersen, B. L. Casado, E. H. Steinberg, J. A. Cully, and N. L. Wilson. 2007. Healthy IDEAS: A depression intervention delivered by community- based case managers serving older adults. Journal of Applied Gerontology 26(2):139-156. Rabins, P. V., B. S. Black, R. Roca, P. German, M. McGuire, B. Robbins, R. Rye, and L. Brant. 2000. Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly. JAMA 283(21):2802-2809. Rahman, A. N., and R. A. Applebaum. 2009. The nursing home Minimum Data Set assess - ment instrument: Manifest functions and unintended consequences—past, present, and future. The Gerontologist 49(6):727-735. Raschko, R. 1990. The gatekeeper model for the isolated, at-risk elderly. In Psychiatry takes to the street, edited by N. L. Cohen. New York: Guilford. Pp. 195-209. Resnick, S. G., and R. A. Rosenheck. 2008. Integrating peer-provided services: A quasi- experimental study of recovery orientation, confidence, and empowerment. Psychiatric Services 59(11):1307-1314. ———. 2010. Who attends Vet-to-Vet? Predictors of attendance in mental health mutual support. Psychiatric Rehabilitation Journal 33(4):262-268. Resnick, S. G., M. Armstrong, M. Sperrazza, L. Harkness, and R. A. Rosenheck. 2004. A model of consumer-provider partnership: Vet-to-Vet. Psychiatric Rehabilitation Journal 28(2):185-187. Robbins, B., R. Rye, P. S. German, M. Tlasek-Wolfson, J. Penrod, P. V. Rabins, and B. S. Black. 2000. The Psychogeriatric Assessment and Treatment in City Housing (PATCH) pro- gram for elders with mental illness in public housing: Getting through the crack in the door. Archives of Psychiatric Nursing 14(4):163-172. Rodriguez, C. A., L. Schonfeld, B. King-Kallimanis, and A. M. Gum. 2010. Depressive symp - toms and alcohol abuse/misuse in older adults: Results from the Florida BRITE Project. Best Practice in Mental Health 6(1):90-102. Rogers, E. S., M. Farkas, W. Anthony, M. Kash, M. Maru, and Center for Psychiatric Rehabili- tation. 2012. Systematic review of peer delivered services literature 1989-2009. http://www. bu.edu/drrk/research-syntheses/psychiatric-disabilities/peer-delivered-services/ (ac- cessed March 9, 2012). SAMHSA (Substance Abuse and Mental Health Services Administration). 1998. Quick guide for clinicians: Based on TIP 26. Substance abuse among older adults. Rockville, MD: SAMHSA. Schonfeld, L., B. L. King-Kallimanis, D. M. Duchene, R. L. Etheridge, J. R. Herrera, K. L. Barry, and N. Lynn. 2010. Screening and brief intervention for substance misuse among older adults: The Florida BRITE project. American Journal of Public Health 100(1):108-114. Semke, J., W. H. Fisher, H. H. Goldman, and A. Hirad. 1996. The evolving role of the state hospital in the care and treatment of older adults: State trends, 1984 to 1993. Psychiatric Services 47(10):1082-1087. Simon, G. E., E. J. Ludman, S. Tutty, B. Operskalski, and M. Von Korff. 2004. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial. JAMA 292(8):935-942. Skultety, K. M., and R. L. Rodriguez. 2008. Treating geriatric depression in primary care. Current Psychiatry Reports 10(1):44-50.

OCR for page 241
281 WORKFORCE IMPLICATIONS OF MODELS OF CARE Skultety, K. M., and A. Zeiss. 2006. The treatment of depression in older adults in the pri - mary care setting: An evidence-based review. Health Psychology 25(6):665-674. Snowden, M., J. Piacitelli, and T. Koepsell. 1998. Compliance with PASRR recommendations for Medicaid recipients in nursing homes. Preadmission Screening and Annual Resi - dent Review. Journal of the American Geriatrics Society 46(9):1132-1136. Snowden, M., L. Steinman, and J. Frederick. 2008. Treating depression in older adults: Chal - lenges to implementing the recommendations of an expert panel. Preventing Chronic Disease 5(1):1-7. Speer, D. C., and M. G. Schneider. 2003. Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. Clinical Psychology: Sci- ence and Practice 10(1):85-101. Stein, L. I., and M. A. Test. 1980. Alternative to mental-hospital treatment. Conceptual-model, treatment program, and clinical-evaluation. Archives of General Psychiatry 37(4):392-397. Steinman, L. E., J. T. Frederick, T. Prohaska, W. A. Satariano, S. Dornberg-Lee, R. Fisher, P. B. Graub, K. Leith, K. Presby, J. Sharkey, S. Snyder, D. Turner, N. Wilson, L. Yagoda, J. Unützer, M. Snowden, and Late Life Depression Special Interest Project Panelists. 2007. Recommendations for treating depression in community-based older adults. American Journal of Preventive Medicine 33(3):175-181. Test, M. A., and L. I. Stein. 2000. Practical guidelines for the community treatment of mark - edly impaired patients. Community Mental Health Journal 36(1):47-60. Tutty, S., E. J. Ludman, and G. Simon. 2005. Feasibility and acceptability of a telephone psychotherapy program for depressed adults treated in primary care. General Hospital Psychiatry 27(6):400-410. Unützer, J., W. Katon, C. M. Callahan, J. W. Williams, Jr., E. Hunkeler, L. Harpole, M. Hoffing, R. D. Della Penna, P. H. Noel, E. H. Lin, P. A. Arean, M. T. Hegel, L. Tang, T. R. Belin, S. Oishi, and C. Langston. 2002. Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA 288(22):2836-2845. Unützer, J., W. Katon, C. Callaban, J. Williams Jr., E. Hunkeler, L. Harpole, M. Hoffing, R. Della Penna, P. Noel, E. Lin, L. Tang, and S. Oishi. 2003. Depression treatment in a sample of 1,801 depressed older adults in primary care. Journal of the American Geriatrics Society 51(4):505-514. Unützer, J., W. J. Katon, M.-Y. Fan, M. C. Schoenbaum, E. H. B. Lin, R. D. DellaPenna, and D. Powers. 2008. Long-term cost effects of collaborative care for late-life depression. American Journal of Managed Care 14(2):95-100. USPSTF (U.S. Preventive Services Task Force). 2011. Recommendations. http://www.us preventiveservicestaskforce.org/recommendations.htm (accessed October 12, 2011). Wagner, E. H. 1998. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice 1(1):2-4. Wagner, E. H., B. T. Austin, and M. Von Korff. 1996. Organizing care for patients with chronic illness. Milbank Quarterly 74(4):511-543. Wagner, E. H., B. T. Austin, C. Davis, M. Hindmarsh, J. Schaefer, and A. Bonomi. 2001. Im - proving chronic illness care: Translating evidence into action. Health Affairs 20(6):64-78. Whitlock, E. P., M. R. Polen, C. A. Green, T. Orleans, J. Klein, and U. S. Preventive Services Task Force. 2004. Behavioral counseling interventions in primary care to reduce risky/ harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine 140(7):557-568. WHO (World Health Organization). 2003. Investing in mental health. http://www.who.int/ mental_health/en/investing_in_mnh_final.pdf (accessed January 19, 2012). Williams, J. W., Jr., W. Katon, E. H. B. Lin, P. H. Nöel, J. Worchel, J. Cornell, L. Harpole, B. A. Fultz, E. Hunkeler, V. S. Mika, and J. Unützer. 2004. The effectiveness of depression care management on diabetes-related outcomes in older patients. Annals of Internal Medicine 140(12):1015-1024.

OCR for page 241
282 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Young, A. S., M. Chinman, S. L. Forquer, E. L. Knight, H. Vogel, A. Miller, M. Rowe, and J. Mintz. 2005. Use of a consumer-led intervention to improve provider competencies. Psychiatric Services 56(8):967-975. Zimmerman, S., R. Connolly, J. L. Zlotnik, M. Bern-Klug, and L. W. Cohen. 2012. Psycho- social care in nursing homes in the era of the MDS 3.0: Perspectives of the experts. Journal of Gerontological Social Work 55(5):444-461.