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Depression Management


HPRC's work on depression focuses primarily on disseminating the depression management program PEARLS (Program to Encourage Active, Rewarding Lives), an evidence-based program developed at HPRC. PEARLS is now included in SAMHSA's National Registry of Evidence-based Programs and Practices.

PEARLS is an in-home, brief counseling program that empowers adults to manage depression and improve their quality of life. It teaches three depression management techniques: problem solving, planning social and physical activities, and scheduling pleasant events. In the original PEARLS randomized controlled trial (1999-2003), participants were three times more likely to significantly reduce depressive symptoms or completely eliminate their depression. Participants also improved their functional and emotional well-being. Study results also showed a strong trend toward reduced hospitalization.

PEARLS has also been studied in adults with epilepsy. Participants reduced depression and thoughts of suicide and increased emotional well-being. These effects persisted at one year after the study. Read more about PEARLS

Through the Healthy Aging Research Network, HPRC investigators also work on healthy brain and cognition topics.

Selected Activities

PEARLS evaluation and dissemination efforts

  • PEARLS received the 2011 Archstone Foundation Award for Excellence in Program Innovation.
  • PEARLS is included in the national registry of evidence-based programs and practices of the Substance Abuse and Mental Health Services Agency (SAMSHA) and on the Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange.
  • HPRC investigators are working with the Washington State Aging and Disability Services Administration, the National Council on Aging, and other organizations on broader state and national program dissemination strategies.
  • Several organizations around the country offer the PEARLS program — including our original partner in the research study Seattle-King County Aging and Disability Services (ADS) — and other aging services organizations, senior centers, and social service agencies that serve specific ethnic groups and veterans. To date, 24 organizations are offering PEARLS in 9 states.
  • In collaboration with ADS and and other PEARLS program providers, HPRC investigators conducted the PEARLS Dissemination Study to 1) test the use of an implementation management team to improve program reach to depressed older adults; 2) pilot the delivery of PEARLS with an expanded client population, including younger older adults (aged 50-59), Russian and Somali-speaking older (using interpreters), and those with more severe clinical depression; and 3) develop and test a brief instrument to assess providers' fidelity to the PEARLS treatment model.
  • HPRC partnered with the African-American Elders Program, Senior Services, and the International Drop-In Center to conduct focus groups and interviews with PEARLS counselors, referral staff, and former clients to explore how to better connect PEARLS to hard-to-reach clients.
  • HPRC investigators partnered with the Washington State Aging and Disability Administration to explore the use of the PHQ-9 depression screening instrument in their annual assessments of clients receiving home and community-based services.
  • A CDC-supported expert panel guided a systematic literature review of screening instruments and interventions for community-based older adults with late-life depression. The panel recommended depression care management programs, such as PEARLS, to public health and aging services networks. These recommendations were also included in the Community Guide after consideration of the findings from the literature review.

PEARLS technical assistance and training

  • The PEARLS web site provides information to get started implementing PEARLS, including a free implementation manual, stories from PEARLS clients and information on in-person trainings.
  • Biannual PEARLS training sessions for providers are available through HPRC's partner CHAMMP (Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations). By 2010, more than 300 participants from 17 states had been trained since training was first offered in 2004. Register for training at www.pearlsprogram.org.
  • HPRC provides technical assistance to adopters of the program and facilitates access to clinical supervision services that are integral to the PEARLS model. We are currently offering monthly technical assistance conference calls for agencies that attend the PEARLS trainings. Contact Lesley Steinman at lesles@uw.edu to sign up.
  • A national research-to-practice symposium in 2008 on depression care management, sponsored by the CDC Healthy Aging Research Network (CDC HAN), included extensive presentations on PEARLS. See archived presentations.
  • CDC HAN sponsored a webinar and related action brief on PEARLS (hosted by the National Council on Aging).