Yes, Healthy IDEAS has been designated as an evidence-based program that meets the Administration for Community Living’s criteria for highest-level evidence-based programs under Title IIID of the Older Americans Act and is recommended for national replication. Evidence of effectiveness to decrease functional disability associated with depression was demonstrated by the program evaluation conducted by the academic partners, Baylor College of Medicine and the Health Services Research Center at the Michael E. DeBakey Veterans Affairs Medical Center. Healthy IDEAS participants experienced a reduction in depression severity and pain. Their knowledge increased about how to get help for depression and how to reduce depression symptoms through increasing activities. Participation in the behavioral activation component of the intervention positively predicted reduction in depression severity scores at 6 months. The outcome results are published in The Journal of Applied Gerontology, 26(2), 139-156 (Quijano et al., 2007).

 

The program is delivered as part of routine case management services over a 3-6 month period through face-to-face visits in the client’s home and telephone contacts. Typically the program involves at least three face-to-face visits and at least three telephone contacts, although clients with more severe depression symptoms may require more contacts or attention beyond an initial intervention period. Agencies with only short-term relationships (less than 3-6 months) with their older adult clients are not able to implement the program.

 

To implement the core components of Healthy IDEAS, agencies need to undertake an organizational change process that requires some planning time and involves partnering with organizations that can add expertise from behavioral/mental health to the strengths of aging services. Some new policies may need to be put in place, and the tools and forms for Healthy IDEAS will need to be customized for each agency setting. Additional time needs to be allocated for staff to: a) participate in formal training, b) develop confidence and mastery of new skills, and c) spend additional time with clients.

 

Agencies need some dedicated administrative/program leadership time to implement the program, typically over a 2-3 month period. There is a one-time Technical Assistance and Training Package fee plus travel expenses for the HICRT, to provide technical assistance, onsite consultation, and the Healthy IDEAS Toolkit, including an agency program manual, an intervention manual for staff, tools and resources for staff and clients, and a training DVD. HICRTs conduct the onsite skills-based “intervention” training for staff and supervisors.

 

Agency staff and supervisors need “introductory training” about depression in older adults and the Healthy IDEAS program, and skills-based “intervention training” on how to deliver the core components of the program, and “follow-up/coaching training” to address challenges they encounter in the real world of working with older adults with depression. This three-phase approach to training occurs over 3-6 months and typically involves 14-20 hours. Agencies can choose from a full 2-day onsite skills training or having their staff take and pass an online Healthy IDEAS foundation course, followed by a 1-day “hands-on” practice and return demonstration of the skills and knowledge acquired from participating in the online Healthy IDEAS course. “Follow-up/coaching training” builds confidence in staff, addresses questions or barriers that staff are encountering, and prevents “drift” in staff skills.

 

The Healthy IDEAS program does not rely on mental health professionals to perform the intervention. Bachelor’s- and master’s-level social workers with differing levels of experience have been effectively trained, as have nurses and case managers with less traditional backgrounds. Workers with prior mental health experience are more accustomed to addressing some barriers presented by clients; however, all staff that are open to learning new skills can generally succeed with adequate training and coaching support.

 

The Healthy IDEAS program is designed so that all five steps (core components) of the intervention are embedded into the ongoing assessment and care plan routine of community case management programs or other settings where staff members are helping clients with other problems or needs through in-person and telephone contact. Routine screening of all clients is part of the initial assessment or reassessment of all current and new agency clients, using a two-question screen and then administering a standardized assessment to identify and assess severity of depressive symptoms.

 

The demonstration establishing the effectiveness of Healthy IDEAS excluded clients who could not communicate verbally or who were significantly cognitively impaired. Clients who had other mental illnesses such as schizophrenia/psychotic disorders were assisted in obtaining further medical or mental health attention.

 

Healthy IDEAS is currently being implemented in 10 different states through a variety of funding sources, including:

 

• Older American’s Act case management programs through Area Agencies on Aging
• Older American’s Act Family Caregiver Support Programs through state and local agencies
• Medicaid home and community based services case management programs
• State-funded case management
• United Way-funded non-profit case management program
• Grant funding from private foundations