PEARLS Details & FAQs

What is PEARLS?

PEARLS™ is an evidence-based program that helps older adults with depression create happier, healthier lives. The program educates older community members about what depression is (and is not) and helps them develop the skills they need for self-sufficiency and more active lives. PEARLS™ offers a home or community-based setting that is more accessible and comfortable for older adults who do not see clinical mental health programs as a good fit for them, while also allowing for coordination with their current health care providers.

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

PEARLS™ coaches (the name we give frontline staff at community-based organizations providing the program) meet one-on-one with older adults for six to eight one-hour sessions, typically over the course of four to five months. The program begins with weekly sessions that gradually taper to monthly. This is a common skill-building technique used to support people in learning to problem solve on their own.

The University of Washington PEARLS™ team provides long-standing and deeply rooted support, including establishing PEARLS™ as an evidence-based program. The UW Health Promotion Research Center (HPRC) supported PEARLS™ from its early development, and is committed to its success. We offer several training opportunities through the year. Those who complete training are eligible to participate in free, ongoing support – participation in monthly technical assistance calls with us and networking with other organizations that provide PEARLS™ around the country.

Information on our PEARLS™ Training

How is PEARLS different from other depression programs?

PEARLS is one of only a handful of programs that focuses on helping older adults develop the skills they need to maintain their health, happiness, and independence. The program is part of a cultural shift in how depression is managed by and for aging community members. Most programs address depression in older adults using only the clinical mental health toolkit (counseling and/or medication).

PEARLS™ teaches people skills to actively manage overwhelming problems that contribute to their depression, focusing on the here and now. The participant drives the program – selecting what problems they would like to address, defining reasonable goals, identifying possible solutions and weighing the pros and cons of each solution, and coming up with a feasible action plan. PEARLS™ was designed to be delivered at home, or in another place accessible for the participant. Some people do PEARLS™ and then engage in other traditional therapies, or do PEARLS™ in addition to other programs.

PEARLS™ was designed in collaboration with the organizations that deliver it, validated in partnership with the communities who use it, and adaptable to the people who need it. Support offered through the program is tailored to the individual needs of older adults.

Who can participate in PEARLS™?

PEARLS™ serves all older adults, especially those who have limited access to depression care because of systemic racism, trauma, language barriers, low income, and/or where they live. Older adults do not need be diagnosed with depression in order to participate in PEARLS™. Organizations screen potential participants for depressive symptoms using tools we provide. It is most important that the older adult is able to make decisions and be involved in the PEARLS™ process. Participants need to be able and willing to engage.

Because PEARLS™ was designed in collaboration with the organizations that deliver it and validated in partnership with the communities who use it, the program address various community needs and helps expands access to depression care in underserved communities, including rural ones.

Organizations have provided PEARLS™ to older adults who also receive other mental health or addiction services, and with participants who are on medication. Additional therapies and services should be provided outside PEARLS™ sessions and with a staff member or partnering organization that is not the participant’s PEARLS™ coach.

Which communities have had success with and been positively impacted by PEARLS™?

Through ongoing PEARLS™ research and ongoing assistance activities, we have learned PEARLS™ can positively impact unique populations and address health situations. Below are some of these communities. View a full list of communities or groups that have participated in PEARLS™.

• Military Veterans & Their Partners: Aging and Disability Services in King County, Washington has had much success using PEARLS™ to support veterans and their partners. Recruitment and mental health stigma may be a barrier, but we encourage building a strong rapport with your local veteran community and its members.
• Racial & Ethnic Communities: PEARLS™ has been successfully served agencies that focus on specific racial and/or ethnic populations. Having a PEARLS™ coach from the same or similar cultural background as a participant is helpful but not required. If this is possible, having a community representative who can build a bridge between the coach and the participant is another option, as is providing cultural humility and cultural competency training for staff.
• LGBTQIA Community Members: The LGBTQIA community has benefited from PEARLS™, especially those who may be isolated and face stigma as a LGBTQIA community member. They may also be experiencing the loss of a partner and no adult children, which can add to their isolation, loneliness and/or depression.
• Rural Communities: These communities tend to have fewer transportation options and can be more isolated, including limited access to internet. Meeting older adults in their homes can be a huge advantage of PEARLS™. In rural areas, the coach provides connection to additional community services that might be difficult for isolated older adults to access. We recommend some sessions occur in the home or a community setting, especially the first two sessions. It is also possible to provide PEARLS™ sessions over-the-phone or online.
• Low-Literacy: A PEARLS™ coach can read worksheets aloud and may have a caregiver help an older adult fill out worksheets, as long as the caregivers or coach does not make decisions on behalf of the PEARLS™ participant.
• Mild Cognitive Impairment: If a participant is still able to focus during the session and complete goals, you may be able to include them in PEARLS™. Participants can engage caregivers to assist with activities; however, it is essential the caregiver not do the activity for the participant.
• Mental Illness: PEARLS™ has been benefited those with bipolar or other mental illnesses if they are managing their condition and/or on medication. Participants should be able to focus during sessions and complete goals.
• Substance Use: PEARLS™ has benefited those with substance use disorder if they are managing their condition so they are able to focus during the session and complete goals.

For what client age is PEARLS™ most effective? Are there age restrictions?

We have no age restrictions on PEARLS™ (early studies indicate that PEARLS™ can be effective for adults 18+, not just older adults). Consult your funder. We work with organizations who define older adult differently – 50+, 55+, 60+, 65+, etc., and all these older adults see success with PEARLS™.

The PEARLS™ program could be used for the 18–50-year-old age range. We’ve found that the program has been effective in a separate study on 18-year-olds with epilepsy and have anecdotal evidence from organizations currently doing PEARLS™ with different age ranges. We don’t have programs that cater to a younger demographic. A resource you may take a look at is the National Institutes of Health Database of evidence-based programs.

Can PEARLS™ serve participants who speak languages other than English?

Yes. There are organizations that offer PEARLS™ in languages other than English.

We have translated many of our PEARLS™ materials into other languages, including Chinese (Mandarin), Farsi, Korean, Russian, Somali, Spanish, and Vietnamese. We also recommend reviewing translated materials with native speakers from the community to ensure that the language is appropriate

The PHQ-9 – the questionnaire used to measure individual progress during PEARLS™ sessions) is  offered in more than 80 languages.

Contact us for copies and links to translated materials.

Which organizations have had success with PEARLS™?

Organizations with the most successful programs are ones where PEARLS™ aligns with their organization’s mission. Successful programs are those delivered by staff at community-based organizations who can visit older adults in their homes or in community settings that are outside of traditional mental health settings. PEARLS™ has also been implemented at community mental health agencies and has been successful at organizations that support underserved communities. For more info visit our website.

More than 9,400 older adults and 133 organizations across 26 states have participated in PEARLS™. See what some of our partners have to say about our work together.

To see some(not all) of the organizations that offer PEARLS™, check the Evidence-Based Leadership Collaborative (EBLC) Map of Programs. Filter by program and select PEARLS.

We also maintain a database of PEARLS™ programs across the country. For a specific list by state and/or city contact us.

How do I know if PEARLS is a good fit for my organization?

To answer, ask, “Does PEARLS align with my organization’s mission?”

If your organization’s mission includes these factors, PEARLS™ could support your efforts:

• Improving health (including behavioral health)
• Focusing on the most common issues that older people face
• Empowering participants to direct their own recovery by teaching them self-management skills

What are some benefits and challenges to seeing older adults in their homes (the PEARLS™ model)?

There are benefits and challenges to seeing older adults in their homes. Knowing both the benefits and challenges will help your organization decide if the program is a good fit. Knowing the potential challenges to visiting people in their homes will also allow you to brainstorm and consider solutions.

Benefits

• Participants are served in a place where they are comfortable and feel more in control
• Participants don’t have to go anywhere (minimized barriers to accessing services)
• No stigma of going to a therapist’s office
• Participants connect to the outside world via the PEARLS™ coach
• Allows you to see the participant in their home environment and get a more holistic picture (e.g. photos of their grandchildren, bare cupboards, fall risks, possible hoarding); this can also help you better understand what existing supports they have available

Challenges

• Travel time required by a coach, which can limit the number of people they see in a day
• Some participants might be reluctant to have someone enter their home (e.g., people with hoarding issues or family members who feel threatened by the older adult working on issues with someone like a PEARLS™ coach)
• Some home settings are unsafe or difficult to visit (e.g., homes with pest infestations, cigarette smoke, strong odors, etc.)

In challenging situations related to home visits, meeting in community settings where you can have privacy and the participant feels comfortable or meeting virtually or by phone can be other options.

Can PEARLS be done with current clients or do we need to recruit new ones?

You do not necessarily have to recruit new clients to provide PEARLS™. Your agency may already be reaching more isolated community members or those experiencing depression (a clinical diagnosis is not needed). PEARLS™ can help your organization expand or enhance current services you already provide.

With PEARLS™, communities have the tools to recognize and respond to depression as an illness that can be treated and managed. Many community-based organizations describe high levels of depression and social isolation among the older adults they serve. This should not be accepted as a normal part of aging.

If your organization is not already serving people who can benefit from PEARLS, you will need to partner with organizations that support underserved older adults, such as Meals on Wheels, senior service agencies, or visiting nurse associations.

We can provide more details and support for recruitment as needed. You can also find information about marketing materials in the FAQs section for “Spreading the Word About PEARLS.”

Where can I find information about the research behind PEARLS™?

We have conducted two RCTs with PEARLS™ to demonstrate significant improvement in depressive symptoms – the first was the original PEARLS™ efficacy trial with older adults, the second RCT was with all-age adults living with both depression and epilepsy (6-and-12-month findings and 18-month findings) one month after PEARLS™ participation ended.

We’ve also recently looked at other outcomes like social connectedness (multi-site single group mixed methods evaluation) and health services utilization (quasi-experimental study looking at inpatient hospitalization and nursing home stays); however, these did not use RCT study design.

There have been several studies conducted to date to better understand how PEARLS™ is being implemented. These studies include a study to examine implementation barriers, which resulted in a pilot study with medically trained interpreters with Russian- and Somali-speaking older adults and an examination of facilitators and barriers to reaching underserved communities, and a study to develop and assess a self-report fidelity instrument.

You can find information about the research studies behind PEARLS™, including research specific to isolation and depression, on our website. If you need additional resources or information, please feel free to contact us.

Within the context of PEARLS research studies, how do I know this program will work for the population we serve?

The two PEARLS™ randomized controlled trials included frail, homebound elders with 4 – 5 multiple chronic conditions and all-age adults with co-occurring epilepsy. For both studies, the majority of participants were low income. 25% in the epilepsy study and 42% in the study with older adults identified as a racial/ethnic minority. In a later study of underserved elder populations and through our work providing technical assistance to PEARLS™ providers, we learned that PEARLS™ has been successful with other populations, such as veterans and vet spouses/widows, immigrants and refugees, elders with limited mobility, and elders in rural settings. Read more about different populations.

To be clear, PEARLS™ did not work for everyone in the original RCTs and may not work for all of your participants. For example, in the first PEARLS™ RCT with older adults, only half of PEARLS™ participants experienced a significant response (50% of more reduction between their pre- and post PHQ-9).

How has PEARLS™ been recognized in national evidence-based registries?

See the agencies and organizations that have recognized PEARLS™ as an evidence-based program. The list includes but is not limited to:

• Administration for Community Living (ACL)
• Agency for Healthcare Research and Quality (AHRQ)
• Archstone Foundation
• Centers for Disease Control and Prevention (CDC)
• engAGED: The National Resource Center for Engaging Older Adults
• Evidence-Based Leadership Collaborative (EBLC)
• Guide to Community Preventative Services (The Community Guide)
• National Registry of Evidence-based Programs and Practices (NREPP)
• Osteoarthritis Action Alliance (OAAA)
• SANHSA’s National Registry for Effective Programs and Practices (NREPP)

In addition, PEARLS™ received the 2011 Archstone Award for Excellence in Program Innovation.

What can you share regarding Return on Investment (ROI) for PEARLS™?

Below are several PEARLS™-specific examples and recommended methods from the EBP field. Please contact us with any questions.

Potential cost savings through decreased health services utilization
Steinman, 2023. Can a Home-Based Collaborative Care Model Reduce Health Services Utilization for Older Medicaid Beneficiaries Living with Depression and Co-occurring Chronic Conditions? A Quasi-experimental Study.

This paper reports on a study we did where we found that PEARLS™ participants compared to similar Home and Community-Based Services (HCBS) participants had lower inpatient hospitalizations and nursing home stays. We used Medicaid claims data to evaluate these reductions in health service utilization. While we did not have costs of services available, these costly health service utilizations are often used as proxies for ROI. 

This Playbook 2024 blog Coaching Older Adults to Manage Depression: Program to Encourage Active, Rewarding Lives from the Center for Health Care Strategies describes this article + possible ROI from two PEARLS™ programs (Maintaining Active Citizens in Maryland and El Sol in California).

Zivin, 2013 The economic, public health, and caregiver burden of late-life depression. This paper describes the indirect and direct costs of late-life depression; we focused on health services utilization given this is such a large driver of the burden of depression.

Self-Reported Health Services Utilization: This 4-item self-report measure asks about Outpatient Visits to PCPs, Visits to Emergency Departments, Number of Hospitalizations, and Nights in Hospital as these utilizations are all associated with costs. This measure is built into Well Ware and is available to any PEARLS™ programs to measure pre/post PEARLS™ (and at follow-up after the program ends) if you would like to track costs. Ritter, 2001 article Self-reports of health care utilization compared to provider records provides evidence on this brief measure being comparable to patient records. 

Tracking costs of PEARLS™ delivery
We used the methods described in this article to track costs of PEARLS™ delivery for a case study we did in partnership with the AIMS Center and El Sol.

Any ROI study needs to measure costs of implementation so this method can help do this over an intensive one-month data collection period rather than the entire course of the program. 

Guidance on assessing potential ROI of EBPs

1. Triple Aim: Meeting the Triple Aim of Health Care Reform describes methods to evaluate quality, costs of the CDSMP program. Triple Aim–related outcome measures include:
   1. better health (eg, self-reported health, pain, fatigue, depression)
   2. better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms)
   3. better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo]
2. Practical Cost-Benefit Analysis: This paper describes how to conduct a practical cost-benefit analysis using falls prevention EBPs as an example.
3. Cost-Minimization Analyses: While this paper describes how to do an economic analysis from a health system perspective, it still provides useful methods for how to incorporate implementation costs, outpatient costs, and inpatient costs if you have access to this health care data.

What is a typical PEARLS caseload?

The average PEARLS caseload depends on how much full time equivalent (FTE) you have for PEARLS coaches and whether your coaches have other duties and responsibilities, such as providing case management services or other therapies.

Ballpark Caseload Estimate

• 15-20 participants for a half-time PEARLS coach
• 30-40 participants for a full-time PEARLS coach

Some PEARLS participants are seen for weekly sessions, while others have monthly sessions and/or follow-up calls, which allows coaches to have a bigger caseload. Other factors to consider include travel time (distance and traffic) needed to get to and from appointments with PEARLS participants.

Caseload sizes also vary between organizations. Some organizations span a large geographic area, which increases the travel time to see PEARLS participants. Not all the PEARLS coaches who have dispersed clients are able carry full caseloads. Some organizations have full time coaches who carry 25-to-50-person caseloads. However, another organization may have a few part-time coaches who work a total of 30 hours per week with an average of 10-12 active cases.

A tip for maintaining your caseload is to build ample time for outreach, recruitment, screening, data entry, and supervision.

Funding source may dictate caseload size as well. Some grants or levy-funded programs aim to enroll a certain number of participants per month, quarter, or year.

How can my organization screen older adults for depression?

Some organizations currently screen for depression as part of their annual assessment or intake. If you do not already do this, you can add a brief, validated depression screening instrument (such as the PHQ-9) to your practices, which will be key to identifying older adults who may be eligible for PEARLS.

How can my organization measure individual progress or outcomes?

The University of Washington Health Promotion Research Center provides questionnaires to measure progress or outcomes for individual PEARLS participants. We will go over the questionnaires during training and provide the needed materials in the PEARLS Implementation Toolkit.

• Baseline & Final PEARLS Questionnaire: This questionnaire includes measures for self-rated health, physical activity, social activity, and pleasant activities. They help establish where the participant is when they begin the program and where they are at the end.

• Session Questionnaires: For each of the PEARLS session you will use what is known as the Patient Healthcare Questionnaire (PHQ-9). It is a brief, validated measure of depression severity used in primary care. It consists of nine questions that measure how much someone’s symptoms of depression (e.g., low energy, lack of appetite, depressed mood) are affecting them. Administering the PHQ-9 at each PEARLS session provides a way to monitor a participant’s progress throughout the program, as well as educate them about their depression symptoms.
  Depression Outcomes Include:
  • Remission (no longer meets criteria for clinically significant depressive symptoms)
  • Response ( ≥ 50% drop between baseline and final PHQ-9 score)
  • Significant Change (≥ 5-point drop between baseline and final total PHQ-9 score)

  These individual outcomes can be looked at collectively on a regular basis to show your organization’s impact, including the quarterly change in PHQ-9 scores for all PEARLS participants and/or the percent of participants that met remission each year.

• Participant Satisfaction Questionnaire: This allows you to see how participants felt about PEARLS, gather quotes and reactions, and evaluate where there are areas for improvement. In addition to this questionnaire, we encourage agencies to gather testimonials from participants to use for program evaluation and marketing.

How can my organization evaluate the overall program success?

In addition to individual outcomes, it is important to assess how well PEARLS is being implemented overall. This includes looking at the percentages of people that move through the program, such as referrals, people who enroll, people who complete the program, and people who enrolled but did not complete the program. You will also want to look at whether key program components are in place, such as regular clinical supervision meetings.

The PEARLS Implementation Toolkit offers one model for evaluating program implementation, including examining program reach, effectiveness, adoption, implementation, and maintenance.

Sticking to the PEARLS Protocol & Model
We have developed a tool to help organizations assess whether they are staying within the PEARLS protocol and model (referred to as program fidelity). PEARLS coaches or program supervisors can use this brief instrument. We published a research article about the development and testing of the fidelity instrument. A link to the instrument we tested can be found along the right-hand side of the research article webpage (Click “Open Supplemental Data”).

The PEARLS Implementation Toolkit also includes a coach self-assessment as well as a checklist to help coaches remember key components of sessions.
Please contact us with any questions about fidelity and balancing fidelity with program adaptations.

How can my organization collect and track data for PEARLS?

Regular data collection is important for monitoring individual PEARLS success and adjusting as needed. Tracking data also allows an organization to monitor and evaluate the program’s benefits and challenges. The PEARLS Implementation Toolkit provides forms needed for data collection as well as several spreadsheets to facilitate data management.

Data Tracking Options

• WellWare: We teamed up with Sound Generations to create this online data management system. Its features include tracking referrals and participants, process and outcome reports, and downloadable forms in Word and PDF format. The system is built on Salesforce’s secure cloud platform that is widely used in healthcare, financial industries, and government agencies.
  • Cost: $200 per year per single user license
  • Contact: Meghan Thompson, Sound Generation
    meghant@soundgenerations.org
    206-268-6701

• PEARLS Provided Resources: We provide a survey data excel sheet in the PEARLS Implementation Toolkit.

• Develop Your Own Excel Sheet or Use Your Existing Data Systems: Some organizations have developed their own excel sheet(s) to track PEARLS data, while others use their existing data systems, such as ReferNET or PeerPlace databases.

Are there tips for administering the PHQ-9 (the nine questions done during PEARLS sessions)?

We recommend having the PEARLS coach read the nine questions in the PHQ-9 as stated on the form to ensure you are sticking to the PEARLS protocol and model (referred to as program fidelity).

The name PHQ-9 may not mean anything to PEARLS participants. Some PEARLS coaches refer to the PHQ-9 as the nine questions that they ask at the beginning of each PEARLS session to see how the participant is doing since they last met. As participants get more comfortable doing the PHQ-9 and talking about depression, the questions become a tool for teaching them about their symptoms of depression and how to monitor them (like with monitoring their blood pressure or sugar for people living with hypertension and diabetes).

Yes/No Framing & Using a Scale
It may be easiest to phrase PHQ-9 questions as a Yes/No and use visuals to help PEARLS participants answer, such as this visual scale or a calendar to display the past two weeks.
 
Timing
We recommend that coaches administer the PHQ-9 at the beginning of the session. However, participants may have a strong desire to talk about particular topics or events, so it is okay to cath up a bit and then administer the PHQ-9.

Additional Resources
More tips about administering the PHQ-9 can be found in the PEARLS Implementation Toolkit’s section on PEARLS sessions.

The Mental Health Training Network also offers a free, self-paced online training on the PHQ-9 that is geared towards working with older adults.

What if a participant’s PHQ-9 results become stagnant?

Consult your clinical supervisor about how the PEARLS participant is doing with their Problem-Solving Treatment and Behavioral Activation if a participant’s PHQ-9 score becomes stagnant. Work with the clinical supervisor to examine other things that could be affecting the participant’s depression.

Score Fluctuation
PHQ-9 scores may fluctuate both ways — e.g., some participants may start with a very high score and drop significantly after the first session, while others may increase after the first session. In some cases, the fluctuation in scores may be affected by how comfortable the participant is with answering the questions, whether they believe their score is tied their ability to continue to receive services, their increased awareness about depression, and/or how long it takes them to perceive a benefit from someone visiting their home.

It may be that the participant is working on problems and activities that are not central issues to their depression. Try to explore deeper problems that they may want to address.

At times the total PHQ-9 score stays the same but there may be improvements in some of the questions and decreases in other questions. A participant’s score could also stay the same even if they have made positive changes in their lives. Remember to point out the participant’s successes, even if they are small.

Can we repeat or pause PEARLS sessions?

Setbacks can create scheduling issues or disrupt the frequency of sessions. When a trauma happens in the middle of PEARLS sessions, work with your clinical supervisor to possibly meet the participant more frequently to get on top of the new problem or setback.

It is okay to pause PEARLS sessions for one to two months if a participant is away or in the hospital. When resuming sessions, you may need to meet more frequently at first to get the participant back on track. You are still aiming for a total of eight session.

After a setback, resume weekly sessions initially to reinforce skills even if the participant is further along in the program.

If a caseload permits, it is okay to repeat PEARLS a second time. If the participant is requesting to go through the program a third time, there may be other underlying issues that need to be addressed outside of PEARLS, including that some participants enjoy having a visitor. Many communities offer free services for friendly visits.

Do PEARLS coaches have to do both Problem-Solving Treatment and Behavioral Activation during each PEARLS session?

While we encourage and teach Problem-Solving Treatment and Behavioral Activation (social, physical, and pleasant events scheduling) at each PEARLS session, it is okay if only one happens during a PEARLS session given other circumstances.

Some participants are resistant to doing Problem-Solving Treatment because this type of approach is not something that they are familiar with or does not resonate with their worldview. One way to address this is to teach problem-solving skills using barriers that come up when doing Behavioral Activation. For example, if the participant is unable to walk around their neighborhood because of safety concerns, the PEARLS coach and participant can work through seven problem-solving steps to identify other ways to be physically active such as walking during the day with a neighbor or doing seated exercises in their living room.

Other participants might prefer to just work on only Problem-Solving Treatment, skipping a physical activity for that week, for reasons such as feeling ill.

Can my organization provide other therapies during PEARLS sessions?

The original PEARLS research focused on two evidence-based treatments — Problem-Solving Treatment (PST) and Behavioral Activation (BA). We encourage PEARLS coaches to stay focused on delivering those two treatments during PEARLS sessions to teach older adults skills to manage their depression.

Why just those two?
If you do other treatments during PEARLS sessions, you can never be sure that you are giving someone an adequate dose of any psychotherapy, and the evidence-base requires a certain amount of Problem-Solving Treatment and Behavioral Activation.

When are other psychotherapies okay?
It is okay to do other psychotherapies:

• After the PEARLS sessions have ended; OR
• While PEARLS is in progress if the other psychotherapies are with a separate staff member or PEARLS coach AND not during the same time as the PEARLS session.

How do I handle inappropriate behavior or issues from a participant?

If a participant is being inappropriate toward a PEARLS coach, have the coach set firm boundaries around the type of language or behavior that is not okay. It may be appropriate for other staff to accompany the coach on initial visits if they are uncomfortable.

Look into participant history and assess potential safety and other issues. Participants may need to be referred to other therapy resources such as mental health or addiction services.

Some older adults may have bedbug or insect issues. Coaches should bring minimal things such as their own chair and disinfect their items with alcohol after the sessions (not in front of the participant). You could also try to meet in a community setting that is convenient for the participant and private.

Are there suggestions on how to recruit PEARLS participants?

PEARLS participants can come from referrals within your organization or from outside your organization. Your organization will need to create an internal pipeline for current or inquiring clients, as well as potentially cultivating community relationships for outside referrals.

Many times, the PEARLS coach is the person doing the recruitment, although this can vary from organization to organization.

Whoever is in charge of recruitment should be prepared with materials about PEARLS. We recommend the PEARLS coach send a possible participant an introductory letter once they are referred to the program. We discuss more about marketing materials in the other questions in this section.

General Recruitment Tips
Things to keep in mind with your recruitment activities.

• Build in Recruitment Time
  You’ll need time to create and nurture relationships around the community. Some organizations will have their PEARLS coach hold monthly meetings with local agencies to talk about the program and referrals.
• Communicate Eligibility & Consider Your Capacity
  It is important to communicate eligibility criteria for PEARLS and have sufficient capacity for processing referrals and enrolling new participants to ensure that referrals are appropriate and you do not discourage future referrals from your contacts.
• Make sure referral partners know that older adults do not have to have a clinical diagnosis of depression to participate.
• Multiple Types & Points of Contact With Potential Participants
  When contacting a potential PEARLS participant, it may take mailing information three times, making multiple phone calls, and/or visiting a them in-person to help them engage.

Finding Referrals
Building relationships with community-based organizations and other agencies that serve older adults and isolated populations is key to successful recruitment outside your organization. Begin networking by attending local health and aging events in your community. Connect with people from the following organizations:

• Senior Centers
• Religious Institutions
• Clinics
• Assisted Living Facilities
• Senior Housing
• Meal Delivery Programs: Meals on Wheels, etc.
• Media Sources: newspapers, TV, and radio
• Housing Authorities
• Adult Protective Agencies
• Veterans Health Administration (VA)
• Rehabilitative Units
• Addiction Treatment and Support Programs
• Emergency Responders: firefighters, 911, and/or emergency medical technicians (EMTs)
• Healthcare Providers: neurologists, primary care physicians, geriatric physicians, nurses, social workers
• Transportation Assistance Programs and Services
• Hair Stylists
• PEARLS Participants (they can refer friends and family based on their experience)

Promotional & Relationship Building Activities
Putting on events can bring awareness to the issue of depression and isolation for older adults and PEARLS as a solution.

• Hold a presentation for agencies and community partners about depression, aging, isolation, and PEARLS. Provide food (if possible).
• Hold a presentation for potential participants on wellness education, feeling better, and/or becoming more self-sufficient or social where they could enter to win a gift if they complete a two-question survey (the PHQ-2) and provide their contact information.
• Hold a training on how to screen for depression (using the PHQ-2 or PHQ-9) and make referrals to your organization for PEARLS.
• Consider topical or timely promotion times, such as May. It is both Mental Health Month and Older Adults Month.

Connecting With a Possible PEARLS Participant
When you do contact and connect with a potential PEARLS participant for the first time, it is important to be delicate in the way you discuss and describe the program. About 75% of PEARLS participants do not know that they are depressed or experiencing mental health issues. Approach the initial call as if they do not know. It’s more important for them to get their foot in the door instead of convincing them that they are depressed.

After you have a referral, contact the potential participant on the phone or in-person as soon as possible (24-48 hours). Calls may take 5-20 minutes. Initial one-on-one contact could include discussing:

• The program focuses on developing skills and problem-solving to address issues that may be making them feel unpleasant or sad so they can improve their health, happiness, and quality of life.
• PEARLS takes place in their home or a community setting that works for them.
• The program is for older adults who might be experiencing multiple health issues, have difficult family dynamics, or want to be more self-sufficient.
• It’s a collaborative effort with a coach, and they will decide which issues in their life they want to tackle. They are in the driver’s seat.
• They will work with the PEARLS coach on establishing goals they want to achieve and collaboratively brainstorm ways to achieve those goals.
• While there is a fair amount of paperwork during the first PEARLS session, the coach will help them complete it.

Some organizations encourage the referral source to be present at the first three sessions to help build rapport and trust between the coach and participant if the participant is from a community that has had negative experiences with services or health systems.

Are there tips for recruiting underserved populations?

Here are a few suggestions on how you can improve your recruiting efforts with underserved communities.

• Consider renaming PEARLS to something that better suits your organization or the community you are trying to reach.
• Connect with community representatives to learn how to best reach potential participants. This could include representatives from religious centers, veteran organizations, cultural centers, and/or neighborhood resources, etc.
• It is okay to use forms that have been translated and reviewed by members of the community. If you translate forms, please share them with us so we can make them available to other organizations as needed.
• Be aware that some cultures may be apprehensive about paperwork and signing documents if they have had negative historical experiences (this could include immigrants and/or Native American communities).
• Consider using words that will make sense to the greatest number of people in a community. Also think about how to best reach and connect with people who have limited-English skills.
• Make sure materials are appropriate in terms of literacy, culture, images, and spiritual backgrounds.

Are there samples or templates for PEARLS flyers or brochures?

Yes, we have sample and template materials for organizations to use. They can be found here on our Google Drive. Please feel free to adapt the branding to meet your organization and community needs. You can even rename PEARLS.

Are there tips for creating informational materials about PEARLS?

Yes, we have some tips and ideas for your PEARLS materials.

Avoid Stigmatizing Words
You might want to avoid using the terms like depression, mental health, or counseling (or other terms you know would not resonant well with your community). You can use terms and phrases like wellness, well-being, mood, emotion, feel better, quality of life, problem-solve, skills for more independence, etc. Use terms and phrases that will resonate with the communities you are trying to reach.

Success Stories
Include success stories in your PEARLS materials. You can use stories from our website to help get you started.

Can we use the PEARLS logo in the promotion of and within our PEARLS program materials?

The Program to Encourage Active, Rewarding Lives (PEARLS) logo is owned by the University of Washington and the PEARLS program. To use the logo, organizations must request and have approved its use, as well as acknowledge and accept our Logo Use Guidelines. Should PEARLS approve the request, PEARLS staff will send trademarked logos to the contact identified on the request form.

REQUEST LOGO USE