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Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)

The Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) is an intervention for people 60 years and older who have minor depression or dysthymia and are receiving home-based social services from community services agencies. The program is designed to reduce symptoms of depression and improve health-related quality of life. PEARLS provides eight 50-minute sessions with a trained social service worker in the client's home over 19 weeks. Counselors use three depression management techniques: (1) problem-solving treatment, in which clients are taught to recognize depressive symptoms, define problems that may contribute to depression, and devise steps to solve these problems; (2) social and physical activity planning; and (3) planning to participate in pleasant events. Counselors encourage participants to use existing community services and attend local events.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: March 2007
1: Symptoms of depression
2: Health-related quality of life
Outcome Categories Mental health
Quality of life
Ages 55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Settings Home
Geographic Locations Urban
Suburban
Implementation History PEARLS has been implemented in the Seattle, Washington, area through two local agencies, Aging and Disability Services (ADS) and Senior Services of Seattle/King County (SSSKC). ADS and SSSKC each implemented the intervention as part of the first evaluation study of PEARLS conducted by the developers in 2000-2003. ADS has continued to offer PEARLS since then; SSSKC began offering it again in 2005. At the time of review, 160 older adults had participated in PEARLS (94 in the main evaluation study plus 41 ADS clients and 25 SSSKC clients); the developers continue to recruit new participants as implemention is ongoing.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Indicated

Quality of Research
Review Date: March 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

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 the American Medical Association, 291(13), 1569-1577.  Pub Med icon

Schwartz, S. J., Wagner, E. H., Ciechanowski, P. S., Schmaling, K., Collier, C., Kulzer, J., et al. (2002, February). Case-finding strategies in a community-based depression treatment program for older adults: PEARLS [Roundtable presentation]. 16th National Conference on Chronic Disease Prevention and Control, Atlanta, GA.

Supplementary Materials

Glass, R. M., Allan, A. T., Uhlenhuth, E. H., Kimball, C. P., & Borinstein, D. I. (1978). Psychiatric screening in a medical clinic. Archives of General Psychiatry, 35, 1189-1194.

Health Promotion Research Center. (n.d.). Progress report: June 2002-September 2003. Report submitted to the Centers for Disease Control and Prevention Research Center Program.

Lyness, J. M. (2004). Treatment of depressive conditions in later life: Real-world light for dark (or dim) tunnels. Journal of the American Medical Association, 291, 1626-1628.

Schwartz, S. J. (2000, November). The PEARLS study: Program to Encourage Active, Rewarding Lives for Seniors. Report presented at the 15th National Conference on Chronic Disease Prevention and Control, Washington, DC.

Williams, J. W., Jr., Stellato, C. P., Cornell, J., & Barrett, J. E. (2004). The 13- and 20-item Hopkins Symptom Checklist Depression Scale: Psychometric properties in primary care patients with minor depression or dysthymia. International Journal of Psychiatry in Medicine, 34(1), 37-50.  Pub Med icon

Outcomes

Outcome 1: Symptoms of depression
Description of Measures Symptoms of depression were measured using the Hopkins Symptoms Checklist 20 (HSCL-20), a self-report instrument used for the diagnosis of major depression in adult primary care patients.
Key Findings At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to have at least a 50% reduction in symptoms of depression (43% vs. 15%; p < .001) and to achieve complete remission from depression (36% vs. 12%; p = .002).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)
Outcome 2: Health-related quality of life
Description of Measures Health-related quality of life in functional, physical, social, and emotional well-being domains was assessed using the self-report Functional Assessment of Cancer Therapy Scale--General (FACT-G). The FACT-G is a generic core questionnaire with 27 items targeted to management of chronic illness. It has been used and validated with individuals diagnosed with cancer and other chronic conditions and with the general population.
Key Findings At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to report greater health-related quality of life improvements in functional well-being (p = .001) and emotional well-being (p = .048).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 55+ (Older adult) 79% Female
21% Male 		58% White
36% Black or African American
4% Asian
1% American Indian or Alaska Native
1% Hispanic or Latino

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Symptoms of depression 4.0 4.0 3.0 4.0 3.0 3.5 3.6
2: Health-related quality of life 3.0 4.0 3.0 4.0 3.0 3.5 3.4

Study Strengths

The investigators employed commonly used measures with sound psychometric properties. No differential attrition was evident across groups. Attrition and missing data were minimal and were handled appropriately with good statistical analyses. The intervention was implemented with the use of a manual, therapists underwent training consistent with the standard in the field, and weekly meetings were held to review cases. The investigators adequately attempt to account for variables found to differ significantly among groups. The use of a randomized controlled trial design minimized potential confounding variables.

Study Weaknesses

The articles did not mention any development or use of a fidelity instrument. The FACT-G (used to measure health-related quality of life in the study) appears to be used in research with cancer patients. However, consistent support for the use of this measure for a wider population (i.e., adults over the age of 60) is lacking. The study sample was small and drawn from a single geographic area.
Readiness for Dissemination
Review Date: March 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Ciechanowski, P. (n.d.). The PEARLS study: Community-integrated home-based depression treatment for the elderly [PowerPoint slides].

Ciechanowski, P., & Schwartz, S. (2004, February 19). PEARLS: Program to Encourage Active, Rewarding Lives for Seniors. Presented at the 18th National Conference on Chronic Disease Prevention and Control, Washington, DC.

Kaiser, C. (n.d.). PEARLS: A practitioner's perspective [PowerPoint slides].

Ludman, E. (2004, July). PEARLS dissemination training: Problem solving treatment [PowerPoint slides].

Schwartz, S. (n.d.). PEARLS: Background [PowerPoint slides].

Schwartz, S. (n.d.). PEARLS: Quality monitoring and program evaluation [PowerPoint slides].

University of Washington Health Promotion Research Center. (2005, September). PEARLS counselor training manual. Seattle, WA: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
2.0 1.5 1.8 1.8

Dissemination Strengths

The program materials offer detailed information on problem-solving treatment and some information on organizational implementation. In-person training is available on an as-needed basis, and limited guidance and suggestions for program adaptation are available for problem-solving treatment. Quality assurance forms are provided to assist supervisors in monitoring implementation fidelity.

Dissemination Weaknesses

A step-by-step program implementation manual is not yet available. Supervisory guidance is not provided. The manual appears complicated enough to require in-depth training and support, yet implementers are not required by the developer to undergo formal, in-person training. No procedures are specified for collecting and analyzing program data to support quality assurance.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
PEARLS Toolkit Free Yes
2-day training in Seattle, WA, offered in April and September $395 per person (plus $50 for late registration) Yes
Online support resources Free No
Counselor Self Assessment of PEARLS Procedure Adherence Free No
PEARLS Tracking Chart Free Yes
Introducing PEARLS to the Participant in Session 1: Checklist Free No
Data management spreadsheets (including program participation report and outcome report) Free Yes
PeerPlace Web-Based Case Management System Approximately $1,290 plus $95 per user, or $495 per use per year No

Additional Information

The cost to implement PEARLS is about $1,350 per client. This estimate is based on average costs from several PEARLS sites across the country.
Replications

No replications were identified by the developer.
Contact Information

To learn more about implementation, contact:
Lesley Steinman, M.S.W., M.P.H.
(206) 543-9837
lesles@uw.edu

To learn more about research, contact:
Mark Snowden, M.D., M.P.H.
(206) 744-9626
snowden@uw.edu

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