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Intervention Summary

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Senior Reach

Senior Reach is a service-based intervention targeting older adults experiencing problematic mental and emotional states, personality and physical changes, poor health, social isolation, substance abuse, physical abuse or neglect, and risk factors for suicide. Training is provided to members of the community to identify, offer outreach services to, and refer at-risk independent-living older adults. These community partners serve as nontraditional (e.g., restaurant and retail staff, bus drivers, senior center staff) and traditional (e.g., primary care physicians, adult protective services) referral sources. When a trained community partner identifies an older adult who may be in need of help, he or she contacts a call center and provides information on the senior, including name, contact information, and concerns, all of which is kept confidential. The call center then contacts the senior to explain the program, engage the senior, establish possible needs (e.g., transportation, medication, health care, help with financial concerns, mental health care, recreation), and offer Senior Reach services. After an in-home assessment, the senior is referred to the best combination of Senior Reach services available for his or her needs, which may be mental health care, care management, information and referral, or any combination of the three. Treatment planning, which is done in partnership with the senior, is individualized, strengths based, and recovery oriented. When mental health treatment is needed, a solution-focused, brief therapy model is used, typically lasting an average of eight sessions, to address immediate mental health concerns. The trainings, in-home assessments, and therapy are led by licensed mental health professionals, and the call center is staffed by an experienced call center manager.

Descriptive Information

Areas of Interest Mental health promotion
Mental health treatment
Outcomes Review Date: September 2012
1: Isolation
2: Depression
3: Physical, social, and mental health functioning
Outcome Categories Family/relationships
Mental health
Social functioning
Ages 55+ (Older adult)
Genders Male
Female
Races/Ethnicities Data were not reported/available.
Settings Outpatient
Home
Other community settings
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Senior Reach, based on the Spokane Gatekeeper model, has been implemented in five counties in Colorado and one county in Kansas since 2006, serving more than 1,000 older adults with mental health and/or case management services. Senior Reach staff have trained over 26,000 individuals to become community partners who can refer at-risk older adults.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations Senior Reach trainings and clinical services are available in Spanish, and most program materials have been translated into Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Indicated

Quality of Research
Review Date: September 2012

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

Bartsch, D. A., & Rodgers, V. K. (2009). Senior Reach outcomes in comparison with the Spokane Gatekeeper program. Care Management Journals, 10(3), 82-88.  Pub Med icon

Supplementary Materials

Colorado Department of Human Services, Division of Mental Health, Data and Evaluation Section. (2006). Interrater Reliability Study, CCAR 2006.

Greenberg, S. A. (2012). The Geriatric Depression Scale (GDS). Try This: Best Practices in Nursing Care to Older Adults, Issue 4, Revised. New York, NY: Hartford Institute for Geriatric Nursing.

Kurlowicz, L. (1999). The Geriatric Depression Scale (GDS). Try This: Best Practices in Nursing Care to Older Adults, Issue 4. New York, NY: Hartford Institute for Geriatric Nursing.

National Guideline Clearinghouse. (n.d.). Guideline summary: Depression in older adults. In: Evidence-based geriatric nursing protocols for best practice. Available from the Agency for Healthcare Research and Quality's National Guideline Clearinghouse, http://www.guideline.gov/content.aspx?id=43922

Senior Reach. (n.d.). Keys to building fidelity manual. Lakewood, CO: Author.

Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., et al. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49.  Pub Med icon

Outcomes

Outcome 1: Isolation
Description of Measures Isolation was measured using the Care Manager Survey. Using a 5-point scale ranging from 0 (no impairment) to 4 (major, serious, or complete impairment or impact), research staff rated participants on the following factors that contribute to isolation among older adults: social isolation (e.g., lives alone, has no one to confide in), economic disadvantage (e.g., lacking necessary income from all sources to meet basic needs), emotional disturbance (e.g., anxious, depressed), physical impairment, and cognitive impairment (e.g., confusion; loss of judgment, memory, or concentration).
Key Findings Senior Reach clients served from 2006 to 2008 were compared with clients served by the Spokane Gatekeeper program in 1994 and 1995. The Spokane Gatekeeper program, upon which Senior Reach was modeled, educated the community on how to identify older adults who may benefit from care management but did not address the need for mental health treatment or information and referral assistance. Both groups were assessed at baseline (after being referred and agreeing to accept services) and at a second assessment, which was 12 months later for Spokane Gatekeeper participants and at discharge (after an average of 5.5 months) for Senior Reach participants. Findings from this study are as follows:

  • Social isolation: From baseline to the second assessment, social isolation decreased among Senior Reach participants (p < .05) and increased among comparison group participants (p < .05). Relative to comparison group participants, Senior Reach participants were more socially isolated at baseline (p < .05) and less socially isolated at the second assessment (p < .05).
  • Economic disadvantage: From baseline to the second assessment, economic disadvantage decreased among Senior Reach participants (p < .05) and stayed the same among comparison group participants. Senior Reach participants were more economically disadvantaged than comparison group participants at both baseline (p < .05) and the second assessment (p < .05).
  • Emotional disturbance: From baseline to the second assessment, emotional disturbance decreased among Senior Reach participants (p < .05) and stayed the same among comparison group participants. Senior Reach participants were less emotionally disturbed than comparison group participants at both baseline (p < .05) and the second assessment (p < .05).
  • Physical impairment: Neither group had a significant change in physical impairment from baseline to the second assessment, although Senior Reach participants were less physically impaired at the second assessment than comparison group participants (p < .05).
  • Cognitive impairment: From baseline to the second assessment, cognitive impairment decreased among Senior Reach participants (p < .05) and increased among comparison group participants (p < .05). Senior Reach participants were less cognitively impaired than comparison group participants at both baseline (p < .05) and follow-up (p < .05).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.3 (0.0-4.0 scale)
Outcome 2: Depression
Description of Measures Depression was measured using the Geriatric Depression Scale (Short Form), a 15-item scale designed to screen older adults for depression. Participants respond either "yes" or "no" to each question (e.g., "Are you basically satisfied with your life?" "Do you often get bored?" "Are you afraid that something bad is going to happen to you?"). Scores range from 0 to 15, with higher scores indicating greater depression.
Key Findings Senior Reach participants were assessed at baseline (after being referred and agreeing to accept services) and at discharge, which occurred after an average of 5.5 months. From baseline to discharge, Senior Reach participants had a decrease in depression (p < .05).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 3: Physical, social, and mental health functioning
Description of Measures Physical, social, and mental health functioning were measured using the Colorado Client Assessment Record Excerpt. Using a 9-point scale ranging from 1 (no concern) to 9 (most severe), research staff rated participants on the following 12 functioning dimensions: physical health, self-care/basic needs, attention issues, anxiety issues, interpersonal relationships, social support relationships, empowerment, hopefulness, activity involvement, overall mental health symptom severity, overall level of functioning, and overall recovery.
Key Findings Senior Reach participants were assessed at baseline (after being referred and agreeing to accept services) and at discharge, which occurred after an average of 5.5 months. From baseline to discharge, Senior Reach participants had improvement in all 12 dimensions of physical, social, and mental health functioning (all p values < .05).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.8 (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) 72.6% Female
27.4% Male
Data not reported/available

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:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

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: Isolation 1.5 2.0 2.8 2.5 2.5 2.8 2.3
2: Depression 3.3 3.3 2.8 2.5 2.5 2.8 2.8
3: Physical, social, and mental health functioning 3.0 3.0 2.8 2.5 2.5 2.8 2.8

Study Strengths

For two of the measures used in the study, internal consistency is acceptable. All measures have face validity, with two of the measures having some evidence of content and construct validity. Efforts to maximize intervention fidelity are well described and included the use of protocols (e.g., implementation manual, self-evaluation tool) sufficient to support fidelity to the model and goal attainment. There was a small amount of missing data for two of the measures, and there was an indication that missing data were random. Although the length of time between data collection for the Senior Reach and Spokane Gatekeeper programs was approximately 10 years, the researchers demonstrated that the population demographics remained constant during that time period. The analyses employed were appropriate, and sample size was adequate, based on power calculations.

Study Weaknesses

One measure has not been previously investigated for reliability and validity, and internal consistency for this measure in the present study was low. Attrition and missing data were not sufficiently addressed. Potential confounding variables were not sufficiently addressed; for example, for the isolation outcome, statistically significant findings could be related to differences between the populations served (e.g., demographic characteristics, baseline ratings on four of the five factors contributing to isolation).

Readiness for Dissemination
Review Date: September 2012

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.

Legault, T., Smith, L., & Rodgers, V. (n.d.). Senior Reach materials for marketing and community training [Packet]. Lakewood, CO: Senior Reach.

Program Web site, http://www.seniorreach.org

Rodgers, V. (2011). Senior Reach implementation and training manual. Lakewood, CO: Senior Reach.

Rodgers, V. (n.d.). Senior Reach training manual. Lakewood, CO: Senior Reach.

Senior Reach. (n.d.). Keys to building fidelity manual. Lakewood, CO: 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
4.0 3.8 4.0 3.9

Dissemination Strengths

The implementation manual is comprehensive, detailed, and clearly written in a step-by-step format to guide developers throughout the process of building community support, developing a local adoption plan, and implementing the program. Training materials include high-quality, colorful, and informative marketing materials in a variety of media and extensive resources for further knowledge and skill development. Training materials are designed for implementers with varied skill levels and roles, and materials are easily accessible in a variety of formats. The fidelity manual includes protocols for fidelity assessment, specific benchmarks for the fidelity measurement process, and examples of data and reports to illustrate how new implementers should use the provided tools. The developer emphasizes the importance of ongoing data collection for quality improvement and outcome monitoring.

Dissemination Weaknesses

Additional guidance is needed on issues of culture, race, ethnicity, and language that may be relevant for Senior Reach community partners.

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
Program toolkit (includes all materials) $75 each Yes
2-day, on-site training for administrative and clinical staff $2,400 per site, plus travel expenses No
1-day, on-site program overview training $1,200 per site, plus travel expenses No
4-hour, on-site community planning training $800 per site, plus travel expenses No
Ongoing administrative consultation Contact the developer No
On-site consultation $1,200 per day, plus travel expenses No
Off-site consultation $100 per hour No
Contact Information

To learn more about implementation, contact:
Vicki K. Rodgers, M.S., LPC
(303) 432-5093
vickir@jcmh.org

To learn more about research, contact:
David Bartsch, Ph.D.
(720) 210-1977
dbartsch@triwestgroup.net

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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