Seniors respond to depression treatment at home

A pilot program for delivering behavioral health services to seniors and their caregivers at home and in the patient’s primary language has been shown to reduce rates and severity of depression and anxiety, and improve overall quality of life, according to recently released preliminary results.

The initiative, known as Insights, is part of the Independence at Home (IAH) community service of SCAN, a not-for-profit Medicare health plan based in Long Beach, Calif.

Insights began providing services to address depression, anxiety and related behavioral health conditions in seniors and caregivers in early 2016. Program services are provided at no cost to health plan members. Participants in the program must be at least 55 years old and reside in Los Angeles or Orange County, Calif. As of this month, 273 seniors have been referred to Insights by community-based programs, local medical groups and other IAH programs, and 172 have enrolled.

Romilla Batra, MD, chief medical officer at SCAN, says the organization has looked for creative solutions to address the behavioral health needs of seniors and their caregivers in culturally and linguistically sensitive ways. Batra says there was initial concern over whether participants would welcome treatment providers into their homes. Preliminary results from evaluations by researchers at the University of Washington School of Nursing, however, have shown:

• Participants’ levels of depression feel from a moderate level at the start of the program to a mild level at its conclusion, as measured by the Patient Health Questionnaire (PHQ-9);
• Levels of anxiety were reduced from severe to mild, as measured by the Geriatric Anxiety Scale (GAS-10); and
• Participants posted higher scores on the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) at the end of the program.

“That, to me, is the most heartening thing,” Batra says of the quality of life score improvement. “It’s one thing to say, ‘Yes, I helped you improve one of your conditions,’ but to say, ‘I improved your overall quality of life’ is very powerful.”

Initially, the Insights program was deployed in English and Spanish. It recently was expanded to include service offerings in Korean and Vietnamese. Treatment, which is provided by licensed or license-eligible clinical social workers, and marriage and family therapists, runs for eight to 12 months with psychotherapy interventions that include:

• Program to Encourage Active Rewarding Lives in Seniors;
• Interpersonal psychotherapy; and
• Cognitive behavioral therapy for older adults for individuals and groups.

Additional work remains to further validate results of the program, but Batra hopes to “scale these programs and disseminate the best practices, not only locally or regionally, but nationally.”

She adds: “For us, the biggest thing is if we are able to provide seniors with access to some form of therapy in the place of their choice and the language they speak, I feel the adoption can be greater.”