Implementing evidence-based treatments in practice settings can be difficult, with interventions often needing adaptation to work in the real-world.1 One understudied strategy for implementation is engaging multiple stakeholders in bringing evidence-based intervention into practice settings. In the present article, Hasche and her colleagues present a case study to demonstrate how these stakeholder partnerships can aid in the successful implementation of evidence-based treatment into practice.
Community Long-Term Care
Community long-term care (CLTC) services are targeted toward low-income older adults to assist with chronic conditions while helping them continue living in the community.2 CLTC workers often serve as integral contact persons for biopsychosocial resource referrals.3 One potential need for service referral is depression with rates of depression to be disproportionately high in CLTC clients.4 Unfortunately, depression frequently goes undiagnosed in this population, possibly in part due to clients’ competing demands presented to the CLTC worker.5 In 2000, researchers partnered with a publicly-funded CLTC in a Midwestern state to identify challenges in implementing evidence-based practice with depression into CLTC.
Given evidence supporting collaborative care for older adult depression treatment,6 the research team drew from two existing treatment models to inform collaborative depression care in CLTC: the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) model7 and the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) model.8 Keeping in mind multi-level barriers to service implementation, researchers and practitioners were appointed to a team tasked with directing the adaptation of the existing models. The team’s overarching goal was to implement a sustainable and effective model in CLTC following adaptation.
Adaptations were based on four main factors: 1) eligibility and screening (i.e., for levels of depression); 2) treatment procedures (i.e., for clients with comorbid problems); 3) tracking methods for outcome evaluation (i.e., client-provider contact); and 4) communication protocols (i.e., with providers across service systems). The adapted model was pilot tested between May 2007 and September 2008, with initial findings indicating CLTC worker and client support for the adapted model.
Through this research-practice collaboration, the team made ongoing adaptations, the success of which the authors attribute to shared problem-solving goals and open communication among team members. Despite its successes, the collaboration did see challenges. For example, when NIH grant funding was exhausted, financial sustainability was threatened; the partnership was able to continue due to additional grant writing and policy advocacy. Despite its challenges, the authors assert that, given the unique demands of real-world service provision, future research-practice collaborations should be sought, both for gerontology as well as other social service areas.
For More Information
For a detailed overview of the adaptation of depression treatment for CLTC, read the full article, available in Administration and Policy in Mental Health and Mental Health Services Research. To learn more about Dr. Hasche and her work, visit her GSSW faculty page or DU portfolio.
Hasche, L. K., Lenze, S., Brown, T., Lawrence, L., Nickel, M., Morrow-Howell, N., & Proctor, E. K. (2013). Adapting collaborative depression care for public community long-term care: Using research-practice partnerships. Administration and Policy in Mental Health and Mental Health Services Research. Advanced online publication. doi: 10.1007/s10488-013-0519-z
1 World Health Organization. (2009). Practical guidance for scaling up health service innovations. Geneva: World Health Organization Press.
2 O’Shaughnessy, C. V. (2008). The Aging Services Network: Broad mandate and increasing responsibilities. Public Policy and Aging Report, 18(3), 1-18.
3 President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health in America—Final Report (DHHS Publication No. SMA-03-3832), Rockville, MD.
4 Morrow-Howell, N., Proctor, E K., Choi, S., Lawrence, L., Brooks, A., Hasche, L., et al. (2008). Depression in community long-term care: Implications for intervention development. Journal of Behavioral Health Services and Research, 35, 37-51. doi: 10.1007/s11414-07-9098-7
5 Proctor, E., Hasche, L., Morrow-Howell, N., Shumway, M., & Snell, G. (2008). Perceptions about competing psychosocial problems and treatment priorities among older adults with depression. Psychiatric Services, 59, 670-675. doi: 10.1176/appi.ps.59.6.670
6 Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314-2321. doi: 10.1001/archinte.166.21.2314
7 Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late life depression in the primary care setting: A randomized controlled trial. Journal of American Medical Association, 288, 2836-2845. doi: 10.1001/jama.288.22.2836
8 Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., et al. (2004). Community-integrated home-based depression treatment in older adults: A randomized controlled trial. Journal of American Medical Association, 291, 1569-1577. doi: 10.1001/jama.291.13.1569