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Tailoring PEARLS During COVID-19 and Beyond

Facilitators

Nhat Ngo (she/her), Union of Pan Asian Communities (UPAC), Positive Solutions program
Mark Snowden (he/him), UW Health Promotion Research Center
Lesley Steinman (she/her), UW Health Promotion Research Center

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Zoom Housekeeping

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Use chat box, raise hand, or unmute for questions.

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What to Expect Today

Welcome & Introductions
Overview of Tailoring PEARLS During COVID
Discussion
What’s Next

Let’s learn together.

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What Is PEARLS?

Supports older adults who have depression.

No diagnosis needed.

Focuses on skill building and problem-solving.
Meets various community needs as a collaborative effort.

Requested by and developed with community organizations who use it.

Simple and easy to administer.

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Program to Encourage Active, Rewarding Lives

Mark

We want to make sure everyone has a general understanding of what PEARLS is and does before we discussion how it has been adapted to support older adults during the pandemic.

Mark provides PEARLS overview and ways PEARLS has been tailored during COVID. [RAS note: I would give the brief overview and then discuss adaptations.]

Messages to highlight:

No diagnosis needed.
PEARLS is an effective, home-based, skill-building program that helps older adults manage and reduce their feelings of depression and isolation. Some older adults might also describe those feelings as persistent sadness, loneliness, frustration, being overwhelmed, or losing interest in things they love.
PEARLS is adaptable to various community needs and helps expand access to depression care in underserved communities, including rural ones. The program is responsive to numerous cultural, racial, and ethnic communities, regardless of where they live.
PEARLS is simple and easy to administer by staff at community-based organizations who might not have previous counseling experience or a higher education. There is PEARLS training that prepares staff to provide the program to your community members.

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PEARLS & Depression Care Management

Screening with standardized questionnaires (PHQ-2 or PHQ-9).
Creating a line of referrals from inside and/or outside your organization.

Screening & Referrals

Measuring using standardized questionnaire (PHQ-9) for each session.

Measuring Outcomes

We offer training on how to provide PEARLS.

Problem-Solving Treatment and Behavioral Activation

Trained Care Manager

Coordination between older adults, PEARLS coaches, program supervisor, and primary care providers.

Team-Based Care

Offering services in a home or community-based setting, as well as through phone or video conferencing.

Accessible Settings

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PEARLS & Program Fidelity:�What Needs to Stay the Same

Screen potential participants for depression symptoms using a validated questionnaire (PHQ-2 or PHQ-9).

Screening & Referrals

Use the same validated questionnaire (PHQ-9) for each session.

Measuring Outcomes

Use Problem-Solving Treatment and Behavioral Activation.

Trained Care Manager

Clinical Supervision is required, but there are options for how organizations can work with a supervisor.

Team-Based Care

Offer the program in non-clinical settings.

Accessible Settings

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Tailoring PEARLS: What Has Changed

During a Pandemic

Accessible Settings
Program Eligibility
PEARLS Sessions & Follow-Up

Additional Tailoring

Staffing & PEARLS Coaches
Clinical Supervision
Behavioral Interventions
Cultural Flexibility

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Accessible Settings

Meeting people where they are.

TelePEARLS (phone or video-conferencing)
Community-based settings (community centers, community-based organizations, etc.)
Homes

Expanding where and how PEARLS is offered.

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Program Eligibility

Treats wide range of depression symptoms.

Less severe depression symptoms still have a significant negative health effect on older adults.
PEARLS can also help address social isolation and loneliness.

From major depression to social isolation and loneliness

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PEARLS Sessions & Follow-Up

Begins with weekly sessions that gradually taper to monthly.

A common skill-building technique

How it has changed over time:

Supplementing with case management before, during, after PEARLS
May extend or pause program sessions

Six to eight sessions over the course of four to five months.

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Staffing & PEARLS Coaches

No counseling experience or higher education needed.

Training from UW or community trainers (from train-the-trainers).

From PEARLS counselor to coach

Adapt the name to meet community needs.

Same support, regardless of the title.

Lesley

PEARLS is simple and easy to administer by staff at community-based organizations who might not have previous counseling experience or a higher education. There is PEARLS training that prepares staff to provide the program to community members.

While the PEARLS trial in 2000-2003 had master’s level social workers and case managers, research and practice since then has included:

Front-line providers with bachelor’s, some college, or no college
Student interns (bachelor’s or master’s in social work, counseling majors?)
Community health workers
Volunteers

We updated the name from PEARLS counselor to PEARLS coach to reflect the realities of providing PEARLS in real-world settings. We also encourage organization to adapt the name to meet community needs.

Nhat: Share about how they staff PEARLS (clinicians, interns, outreach) –

Engage Vietnamese and Latino outreach workers at local Buddhist temples and congregate meal sites to build trust and rapport.
Train and supervise bilingual/bicultural graduate interns in counseling and social work to build inclusive workforce to serve LEP communities 🡪 what is needed. Less about credentials but more about experience working with communities, having empathy, following the spirit of PEARLS. Interns or new employees shadow PEARLS clinicians and do role plays with the PEARLS team.
Networking with other organizations – eg referrals from other UPAC programs when cannot take on those clients. Mutually beneficial!

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Clinical Supervision

Making supervision more accessible.

Originally: Psychiatrist offers in-person supervision

Now:

Psych NP, geriatrician, LCSW and more can serve supervision role and responsibilities
Group supervision via conference calls or Zoom

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Behavioral Interventions

Problem-Solving Treatment & Behavioral Activation

Originally: Both were required for each PEARLS Session.

Now:

Okay if only one happens during a PEARLS session.
Complement with other supports and services

Mark

Originally: Both were required for each PEARLS Session.

Now: Okay if only one happens during a PEARLS session.

Focus for a session might be Behavioral Activation (social, physical, and pleasant events scheduling) to introduce and practice Problem-Solving Treatment.
Focus could just be Problem-Solving Treatment if someone is not feeling well enough to be physical.

Nhat: Talk about UPAC starting with psychoeducation and/or case management for older adults

Provide case management, psychoeducation, and motivational interviewing with potential PEARLS clients to address stigma and address acute needs.
When start PEARLS with new client and new things come up during sessions (eg past trauma) that didn’t disclose during sessions, PEARLS becomes an avenue for opening the door to discussion.
People think they already do PEARLS on a daily basis, “talking dumb” 🡪 PEARLS slows down the process. May need to cover the PST steps more globally and less step by step (goal setting vs 7 steps)

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Cultural Flexibility

Original Study 2000-2003:

Mean Age: 73
Race & Ethnicity: 42% people of color (English speaking)

36% Black, 4% Asian, 1% Latino, 1% Indigenous

Living Alone: 72%
Low-Income*: 58%
Chronic Conditions: 4-5 conditions on average

* Less than $10,000 household income

Adaptable to various community needs.

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Cultural Flexibility

Racial, Ethnic, & Language Diversity

African Americans, Somali refugees and immigrants, Latino immigrants (from Mexico, Puerto-Rico, Dominican Republic), Asian American and Pacific Islander (AAPI) community members (Vietnamese, Chinese, Korean, Filipino, Cambodian)

Rural Communities

�You are the experts in how to best tailor PEARLS for your community. We are happy to connect you with organizations that have tailored PEARS for communities like yours.

Continuing to support underserved communities.

Mark

These are just some of the communities who use and may have adapted PEARLS. Underserved communities and community members also include

People with disabilities (e.g. vision and hearing impairments, wheelchair users)
Additional: caregivers, veterans, people experiencing homelessness

Nhat – share other ways Positive Solutions has tailored PEARLS to support underserved communities

-challenges doing PEARLS with Vietnamese clients bc not used to goal planning, this is our lot in life, accept things as way they are. Case management issue becomes concrete goal to work on + Allow space to vent + Discussing how to maintain health

NOTES

BIPOC

Black (African-American, Somali), Latino (1^st and 2^nd generation immigrants from Mexico, Puerto-Rico, Domincian-Republic, and other countries of origin), Asian (Vietnamese, Chinese, Korean, Filipino, Cambodian)

Native American / American Indian, and Native Hawaiian community members have participated in PEARLS, but no through a tribal government or tribal specific agency. We don’t have tribal information on those who have participated. We are always looking for new organization to collaborate and partner with to support the use and expansion of PEARLS to help older adults, regardless of their backgrounds.

Limited English Proficiency

PEARLS program materials have been translated into Spanish, Russian, Somali

PEARLS has been offered in Tagalog, Locano, and Vietnamese through translators and providers who speak the language. Materials have not been translated in these languages.

Rural Communities

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Breakout rooms

Ideas & questions for tailoring PEARLS

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Understanding Program Barriers

Brief survey (no more than 15 minutes) to help us better understand barriers or supporting factors your organization�experiences in adopting or funding programs like PEARLS.

This information will help us better support organizations like yours.
You may have already completed a survey about general org information.�

Entered into a drawing for $500 toward a conference or training.

A collaborative, proactive project.

Mark

James – do NOT share public T0 survey link

In addition to the every day PEARLS partnerships and work, we started a project to ensure all older adults can get the support they need, regardless of their race, ethnicity, language, income, or location. Previously, we have collaborated with organizations as they come to us to better understand who they are, why they are interested, and what they need to support their efforts. With this new project we are taking a more proactive approach to connect with organizations like yours. We realized that waiting for people to come to us was actually another barrier. A more proactive approach is more equitable.

Some of you have already completed a brief survey about your organization. Thank you to those who have! If you haven’t complete the survey about your organization, there is still time.

We will also be following up with organizations that have already completed a survey to learn more about the barriers or supporting factors your organization experiences when adopting or funding programs like PEARLS. Your responses will help us assist organizations like yours in adopting programs for older adult mental health.

These surveys should take no more than 15 minutes.

Organizations that complete a survey will be entered into a drawing for $500 toward a conference or training of their choice.

We will send you all a link to the appropriate survey in our email after this webinar with additional links to the recording and presentation from this event.

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Thank you!

Schedule a 1-1 Chat: Email us at equity-study@uw.edu

Keep in touch

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Great to see you today!