A community-based psychogeriatric service

The elderly are most susceptible to mental illness, and they receive inadequate mental health services. The authors developed a community-based program to meet the needs of the psychiatrically impaired elderly by providing a multiplicity of indirect services to community caregivers. A psychiatrist and two clinical specialists in psychiatric nursing provide consultation, education, collaboration, and coordination to individuals and agencies dealing directly with elderly clients in the community. Evaluation of data show a high degree of consultee satisfaction, few recommendations for institutional care, satisfactory client outcomes, and a significant impact achieved by a formal educational program for community practitioners.     

Homebound Learning Opportunities: reaching out to older shut-ins and their caregivers.

Homebound Learning Opportunities (HLO) represents an innovative health promotion and educational outreach service for homebound older adults and their caregivers. It provides over 125 topics for individualized learning programs delivered to participants in their own places of residence, an audiovisual lending library, educational television programming, and a peer counseling service. Shut-ins are recruited as instructors and as participants in service projects that benefit the greater community. Preliminary assessments reveal high levels of participation and satisfaction with the program.     

Comprehensive community-based mental health outreach services for suburban seniors.

An outreach program to deliver mental health services to mentally ill older adults has been developed in Baltimore County, Maryland. Incorporating prevention and early intervention strategies, this program targets persons aged 60 and over with late-onset or previously undiagnosed psychiatric histories. Services are provided through a novel one-third/one-third/one-third delivery schedule in senior centers, in community mental health centers, and in seniors' homes.     

Mental health services for the rural elderly: the SAGE experience

The mental health services of the Senior Adult Growth and Enrichment (SAGE) Program, a demonstration project in North Carolina, are described. The SAGE staff used a differentiated model of day treatment that tracked clients according to disabilities and potentials. Staff provided outreach in a rural area to older people with mental illness and to their caregivers. The rationale and specialized methods of the project are described. Services were tailored to meet unique needs brought on by diverse mental disorders, functional disabilities, and varying life circumstances.     

Counseling the isolated elderly.

Increasing interest is manifest in the development of alternative models of counseling for older persons. Irrespective of the particular model used, the counseling of aged persons who have emotional and psychologic problems may require a treatment plan for health, mental health, and social services, to resolve the problems and to assess the functional limitations. Health and mental health centers employing both professional and nonprofessional counselors need to determine the value of adding outreach components to their services, and agencies which already have outreach programs may need to determine their relevance and effectiveness. Effective outreach requires a high level of gerontologic knowledge and clinical skills with aged patients. Agencies and clinics can design and implement mechanisms for supporting the elderly as they make use of multiple sources of service. Mobilization of the family and other informal helping networks in the community, the establishment of better coordination mechanisms within clinic and service programs, and multiple-service integration will improve the efficiency and effectiveness of long-term community care and follow-up programs.     

Responding to Mental Health Needs of the Elderly in Rural Areas:

In Iowa, the percentage of elderly persons in rural areas has increased dramatically in the past decade. Although delivery of mental health services to the rural elderly is a statewide and national priority, at present, too few health professionals are adequately prepared to meet this need. The rural elderly have limited access to psychiatrists and are underserved by Community Mental Health Centers. Therefore, general practitioners, public health nurses, social service workers and other core disciplines who participate in Iowa Geriatric Education Center (IGEC) educational and training programs must be able to understand the mental health needs of this population, provide basic care, and make referrals for needed services. From the inception of the Iowa Geriatric Education Center, an effort was made to incorporate clincial and service delivery into the IGEC curriculum. Through affiliation with the Rural Elderly Outreach Program, participants in IGEC programs have an opportunity to learn more about geriatric mental health and service delvery issues in rural settings.     

Assessing nursing assistants' knowledge of behavioral approaches to mental health problems

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.     

Initiation of services in the Boston HAPPENS Program: human immunodeficiency virus-positive,homeless, and at-risk youth can access services

This study evaluates the factors associated with initiation of services in the Boston HAPPENS Program, which is a collaborative network of care consisting of multiservice outreach agencies, community health centers and hospitals, for human immunodeficiency virus (HIV)-positive and hard to reach youth who are 12-24 years old. The program served 2116 youth who were 19.8 +/- 2.9 years old; 64% female; 45% youth of color; 16% gay/lesbian, bisexual, or undecided; and 10% homeless or runaway. At first contact with the program, 56% received outreach services; and 91% received a health intervention. Among those receiving a health intervention, 55% had HIV counseling and testing services, 49% medical care, 24% case management, and 9% mental health services. HIV-positive youth needed more contacts before a first medical visit than those who were HIV-negative or untested (p < 0.001). Different kinds of service sites reached different populations of at-risk youth. Logistic regression modeling showed that for young women, older age, lesbian-bisexual orientation, substance use, high-risk sexual behaviours, and receiving outreach services at first contact were independent predictors of initiation of services at outreach agencies; however, unprotected sex with males, and pregnancy were associated with a greater likelihood of care at hospitals or community health centers. For young men, older age, Asian/other ethnicity, and substance abuse were associated with care at outreach agencies; however, positive HIV status and unprotected sex with females were associated with care at hospitals or community health centers. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect underserved youth to health care.     

SRx: a regional approach to geriatric medication education

Medication use is becoming increasingly recognized as an important factor in the total health care needs of older persons. Combining clinical and educational interventions that reinforce one another can prove an effective means of educating the consumer and provider about geriatric medication misuse and strategies for its prevention. This paper discusses one such program, the SRx Regional Program of the San Francisco Bay area.     

Doctoral Clinical Geropsychology Training in a Primary Care Setting

Abstract

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.     

Doctoral clinical geropsychology training in a primary care setting

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.     

Compliance with recommendations in a geriatric outreach assessment service

OBJECTIVES: to measure the extent to which the recommendations of a geriatric outreach assessment service were being followed, and to determine what patient-related factors were associated with compliance with assessment recommendations. METHODS: eighty-one eligible patients or caregivers who had an assessment in a geriatric outreach service participated in a telephone interview. The interview focused on the use of health services and compliance with assessment recommendations. Patient-related variables obtained from charts included demographics, caregiver support and stability, health status and assessment recommendations. RESULTS: overall compliance with recommendations from the geriatric outreach assessment service was 65%. Patients were less likely comply fully with recommendations if they had a high number of recommendations [odds ratio (OR) = 0.23; 95% confidence interval (CI) = 0.12-0.46; P = 0.0001], inadequate caregiver support (OR = 0.212; 95% CI = 0.04 to 1.02; P = 0.0523), or the ability to transfer themselves independently (OR = 0.12; 95% CI = 0.02-0.63; P = 0.0124). They were more likely to have full compliance if they had normal vision (OR = 6.67; 95% CI = 1.22-36.46; P = 0.0284). CONCLUSION: it is important to focus on key issues when developing service recommendations and on the role of the informal caregiver in facilitating compliance with them. Good communication between the patient or caregiver and the family physician and geriatric services can help to identify strategies which might improve acceptance of recommendations.     

Mental health services of the rural elderly outreach program

This paper describes an elderly outreach program (EOP) designed to identify and provide mental health services to the rural elderly. The project integrates a variety of health, mental health, and human service agencies in the planning and delivery of services. Five referral sources are identified and described as well as the assessment, treatment, and referral process. Outcomes are discussed in terms of: characteristics of persons served, ability of the project to identify and deliver mental health services, treatment effectiveness, and cost effectiveness of the project. The EOP seems to have prevented an increase in need for mental health care among Iowans that might have occurred in the program's absence.     

Serious mental illness and tobacco addiction: a model program to address this common but neglected issue

Tobacco addiction among persons with serious mental illness (SMI) has been largely ignored. About 75 to 85% of persons with schizophrenia, bipolar disorder, and other SMI use tobacco; most will either die and/or have reduced quality of life because of tobacco-caused medical diseases. Tobacco addiction is the most common co-occurring disorder for the SMI population. A dramatic reduction in tobacco use in the general population has occurred during the past 40 years; however, there has been almost no reduction for smokers with SMI. The University of Medicine and Dentistry of New Jersey program targets smokers with SMI and provides outreach services, clinical treatment and research, and consultation to other community-based mental health treatment agencies in New Jersey. Clinical and research evidence supports motivation-based treatment, blending mental health and addiction treatment approaches, and integrating tobacco dependence treatment within mental health settings. The unique barriers and clinical issues for this population are described.     

Residential treatment for dually diagnosed homeless veterans: a comparison of program types

This study compared two types of residential programs that treat dually diagnosed homeless veterans. Programs specializing in the treatment of substance abuse disorders (SA) and those programs addressing both psychiatric disorders and substance abuse problems within the same setting (DDX) were compared on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge reports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by program administrators, perceived environment surveys were completed by veterans in treatment, and discharge reports were completed by VA case managers. DDX programs were characterized by lower expectations for functioning, more acceptance of problem behavior, and more accommodation for choice and privacy, relative to SA programs after adjusting for baseline differences. Dually diagnosed veterans in DDX programs perceived these programs as less controlling than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of veterans from DDX than SA programs left without staff consultation. A higher percentage of veterans from DDX than SA programs were discharged to community housing rather than to further institutional treatment. Program effects were not different for psychotic and non-psychotic veterans. Although differences were modest, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homeless veterans. Such integration did not differentially benefit dually diagnosed veterans whose psychiatric problems included a psychotic disorder.     

Geriatric medicine curriculum consultations for family practice residency programs: american academy of family physicians residency assistance program/hartford geriatrics initiative

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. These programs have an average of only seven full-time equivalent physician faculty. This report summarizes results of the Residency Assistance Program/Hartford Geriatric Initiative (RAP/HGI) geriatric medicine curriculum consultations for family practice (FP) residency programs conducted from 1996 to 2001. This project was developed as part of the RAP in family practice. Ten experienced FP educators were selected and trained as special consultants. Between 1996 and 2001, 39 FP residency programs participated in the 1- to 4-day RAP/HGI consultations. The programs were diverse in size and location. The consultations reached 308 family practice residency faculty members involved in training 807 residents. Program evaluations of the consultants were uniformly in the very good to excellent range, with a mean rating of 4.6 (5-point scale, with 5 indicating excellent). At the end of the initial consultation visit, the residency program faculty and the consultant developed short-term goals for geriatrics program development. Eighty-five percent (33/39) of the programs submitted their curriculum goals in writing. The mean number of goals per program was 4.8 (range = 3-11). Of the 33 programs with written goals, follow-up was documented for 29 programs. Seventy-nine percent of the programs' self-defined educational goals were met during the 6 to 12 months of follow-up (range 50-100%). Ten of the programs implemented all of their educational goals. The RAP/HGI project demonstrated that achievable geriatric medicine curriculum improvements could occur as part of an onsite consultation process.     

Implementing a university-community-retail partnership model to facilitate community education on universal design

PURPOSE: A collaborative partnership model was used to develop and implement a state-wide community education program on universal design. DESIGN AND METHODS: University faculty, extension professionals, older adult service agencies, service learning students, and a community retail chain made up the original partnership. RESULTS: This collaboration resulted in a five-stage partnership model. The model was used to develop and disseminate a consumer education program to promote aging in place. The five stages include (a) identifying partner strengths and shared learning, (b) program development, (c) implementing the universal design program, (d) facilitating collaborative outreach, and (e) shifting toward sustainable outreach. IMPLICATIONS: A lack of knowledge exists among consumers, builders, and health care professionals regarding strategies for aging in place. Collaborations between educators, outreach professionals, students, and a retail partner resulted in increased interest and awareness about universal design changes that enable seniors to age in place.