Depression/ Screening/ Getting Started
What are the main differences between normal sadness/grief and depression (PDD, minor, or major)?
Normal sadness and grief have fewer symptoms and often improve over time. Depression is more than sadness, has multiple symptoms for more than two weeks for most of the days, and often requires treatment.
Where did PEARLS originate from?
The original PEARLS research came from community-based organizations looking for solutions that they could do in-house to improve access to depression care for the older adults that they serve.
Why is a suicide/self-harm protocol required for PEARLS?
Agency may already have a procedure in place; If not, need to develop one
Depressed people sometimes become suicidal
All staff, especially PEARLS coach and supervisor, need to know what to do
Identify resources within your agency and outside
What is required to be a PEARLS coach/counselor? Think about things like training, experience, skills, etc.
No mental health background or specific credentials required:
•Social Workers/Case Managers, Counselors, Graduate Students, Community Health Workers, Nurses, Volunteers
What types of instructional strategies would you use in an In-Person PEARLS Training workshop?
When can use of the PHQ-9 be challenging and what can a PEARLS coach do about it?
Problematic when:
-Secondary incentive for over/under reporting symptoms
-Coach feels client is minimizing/denying symptoms.
Solutions?
-Explore, clarify, broaden questionnaire but…
-Avoid coach subjective slippery slope of answering for the client.
What is the role of antidepressants in PEARLS care for people with minor depression and with major depression?
In the PEARLS Randomized Controlled Trial (RCT) studies, antidepressant treatment played no major role for older adults with minor depression, but did play a role for all age adults with epilepsy and major depression.
Why is clinical supervision required for PEARLS?
Regular clinical case review is important to ensure clients are improving, suggesting adjustments in treatment (medication or psychotherapeutic), they help brainstorm and problem solve, additional perspective. Particularly for cases that may be stagnant or complex; reduce liability concerns; can support ongoing training and professional development for coaches
What are some of the things to consider for organizations to assess whether PEARLS is a good fit for them?
>How PEARLS aligns with organizational mission
>Staffing (including coaches, clinical supervisors)
>Implementing other evidence-based programs
>Ability to see clients for 6-months
>Depression screening / referral mechanisms
Training and learning never end! What types of support/ongoing training are available after a coach is trained in PEARLS?
clinical supervision, self-evaluation, monthly conference calls
What does PEARLS teach as the connection between depression and problems?
Symptoms are due to depression Link btw depression and unresolved problems Increased activity reduces depression.
What are the four core components of PEARLS?
The three legs of the PEARLS stool: 1. PST: Problem-Solving Treatment 2. BA: Behavioral Activation (social & physical activities) 3. Pleasant Activities Planning
...and the floor upon which it stands: 4. Clinical Supervision
If a psychiatrist is not available for clinical supervision, how else can clinical supervision be done?
Must have clinical experience with older adults and their medications: Psychiatrist, Licensed Clinical Social Worker, Psychiatric Nurse Practitioner, Geriatrician
Explain when/why it might be appropriate to do PEARLS sessions remotely, and share some adaptations that would be needed to facilitate TelePEARLS
Describe the role a PEARLS Trainer plays when leading an Online Training "Practice Session".
>Role-play a Middle Session
–Case scenarios
–Trainer plays the PEARLS Participant
–Students take turns being the Coach (“round-robin”)
–Go through a PHQ-9 + PEARLS Worksheet
–OK to use the checklist & “say it messy”!
>Feedback from trainer & peers
>Q&A
Explain which conditions would exclude a person from participating in PEARLS, and which conditions might be appropriate (and when/under what circumstances).
Exclusions: Psychosis, Schizophrenia, Bipolar Disorder*, Substance Use Disorder*, Cognitive Impairment, Recent Loss/Grief**
*=might be eligible if not functionally impairing, taking meds, and Clin. Sup. approves
**=generally need to wait at least 6 months before starting PEARLS
Describe the 7 steps of Problem Solving Treatment and why they are important in PEARLS.
1. Clarify and define the problem
2. Set a realistic goal
3. Generate multiple solutions
4. Evaluate and compare solutions
5. Select a feasible solution
6. Implement the solution
7. Evaluate the outcome (at the following session)
What places someone at the highest risk for suicide?
Thoughts of suicide more definite (Intent)
Plan in place
Have the means to implement the plan
Preparatory/rehearsal behavior (Action)
What outcomes should be tracked to measure and demonstrate PEARLS effectiveness?
When preparing to lead an in-person PEARLS training, what materials would you need and where would you find them?
The Toolkit, PEARLS forms, training handouts, trainer notes, training outlines & agendas, flip charts
PHLearnLink + PEARLS Google Drive!!!
Briefly describe the overall flow of PEARLS (# and frequency of sessions) AND key features that coaches should remember about the first and final sessions.
8 visits over 5-6 months / tapered frequency
Generally, 1-hour sessions (Session #1 may be longer or divided into two meetings)
First session can be more “conversational” – getting to know each other, and includes Baseline Questionnaire
Balance interactional needs with getting to tasksUse clinical skills to “rein in” the big talkers or to “draw out” the quiet ones
Final session includes program review, final questionnaire and satisfaction survey
3 – 6 Monthly follow-up phone calls
Describe the “Do Less, Feel Worse” cycle and how this relates to Behavioral Activation.
Depression results in people feeling bad and then doing less
People become lethargic, less active, socially withdrawn
Another vicious cycle: feel bad > do less > feel bad
What are some of the FAQs that you will need to discuss when teaching how to do clinical supervision?
In person vs. teleconferencing?
As needed contacts, e-mail?
Frequency?
Documentation of supervision?
Payment?
Psychiatrist vs. Other clinical supervisor?
What are some of the ways that PEARLS has been adapted since the original research?
Think about things like populations, languages, settings, staff, health conditions, etc.
Briefly explain what the PEARLS Distance Training is, and how it bridges the gaps between the two-day in-person training and a fully remote/independent training.
Hopefully combines the best parts of each training!
>Self-paced modules (PH LearnLink) (on-demand)
>Live “Practice Sessions” via Zoom (opportunity to practice, ask qs, and get feedback)
>Evaluation