Evidence-based programs are programs that have been rigorously tested in controlled settings, proven effective in multiple settings, and translated into practical models that can be delivered in community and clinical settings outside of the research study. Since 2000, our academic-community partnerships have conducted:
- effectiveness research to develop and test PEARLS
- dissemination and implementation (D&I) research to understand and improve how the program is delivered
An Evidence-Based Treatment for Depression in Older Persons
PEARLS was created in partnership between the University of Washington Health Promotion Research Center and Aging and Disability Services, our local area agency on aging in Seattle-King County. PEARLS was evaluated using a community-based randomized controlled trial (RCT) between 2000 and 2003.
Study aim: To determine the effectiveness of PEARLS as a treatment approach for managing minor depression or dysthymia in older adults living with social isolation, multiple chronic medical problems and physical impairment.
Comparison: Usual care
Outcomes: depression, quality of life, and healthcare utilization.
- 138 clients aged 60 years or older who received community-based social services in metropolitan Seattle
- 4% had minor depression and 48.6% had dysthymia.
- mean of 4.6 (SD, 2.1) chronic medical conditions
- 42% identified as a racial/ethnic minority
- 72% lived alone
- 58% had an annual income of less than $10000
- 69% received a form of home assistance.
This study showed that over 12 months, individuals who received the PEARLS Program were more likely than those who did not receive PEARLS to:
- Have a 50% or greater reduction in depression symptoms
- Achieve complete remission from depression
- Have greater health-related quality-of-life improvements in both functional and emotional well-being
- Trend toward lower hospitalization rates
Moreover, the PEARLS Program study findings also support a model for community-based organizations to screen and effectively treat depressed, frail older adults using primarily non-pharmacological methods.
Study results have been published in JAMA.
Funding and Collaboration: The study was funded by the CDC and conducted as a collaboration between staff and faculty members from the University of Washington’s HPRC and managing, supervisory and clinical staff at Aging and Disability Services (ADS, the Seattle/King County Area Agency on Aging) and Senior Services of Seattle/King County.
Because this collaboration began at the outset, the PEARLS Program was designed to take into account the “real world” framework and challenges – such as staffing, data management and other program priorities – that may arise during implementation of the PEARLS Program in a community organization.
Expanding the Evidence Base: Treating Depression in Adults with Epilepsy
The success of the PEARLS Program in reducing depression and improving quality of life in older adults with minor depression and dysthymia led researchers at the University of Washington to seek to expand the evidence base by applying the PEARLS Program to adults with epilepsy. The epilepsy population may have similar functional limitations as the original PEARLS population of older adults, in part because of the transportation restrictions experienced by individuals who have seizures. People living with epilepsy and depression can also benefit from an in-home treatment such as PEARLS.
Researchers at the Health Promotion Research Center carried out another randomized controlled trial between 2006 and 2009, this time enrolling 80 adults with epilepsy and major depression, minor depression, or dysthymia. Just as in the first trial, half of participants were randomly assigned to receive the PEARLS Program and half were randomly assigned to continue with their usual medical care.
Individuals with epilepsy who participated in PEARLS were more likely to experience lower depression severity and suicidal ideation as well as better emotional well being, as compared to those receiving usual care. These findings persisted both 6 and 12 months following the PEARLS intervention period. One-year and 18-month study results have been published in Epilepsy and Behavior.
Dissemination and Implementation Research
Since PEARLS was first developed in the early 2000s, HPRC has partnered with local, state and national organizations to learn how to better deliver PEARLS and scale the program. This type of translational research is known as “Dissemination and Implementation” (or D&I) research. Our D&I projects have included:
- conducting focus groups with PEARLS participants, providers, managers and referrers to identify program benefits and unintended negative consequences, facilitators and barriers to program delivery, and strategies for addressing these barriers;
- piloting PEARLS using medically trained interpreters with Somali and Russian-speaking older adults;
- developing and evaluating a brief, self-report PEARLS fidelity instrument;
- interviewing PEARLS participants, providers and referrers from community-based organizations to better understand how to reach under-served populations;
- testing an implementation coaching model to facilitate PEARLS program delivery; and
- training recent PEARLS graduates who are veterans, or veterans’ spouses or widows, to provide outreach about PEARLS to their peers.
We are currently conducting the following PEARLS D&I activities:
- An evaluation of PEARLS effectiveness, adoption, and implementation with older Latinos, supported by a grant from the UW Latino Center for Health
- A retrospective economic evaluation of PEARLS and an evaluation of PEARLS on social isolation measures. This three-year project is supported by the AARP Foundation’s grant mechanism Scaling Evidence-Based Solutions for Vulnerable Older Adults.
- Consultation on Dr. Jun Ma’s five-year hybrid effectiveness-implementation trial to evaluate the clinical and cost effectiveness of PEARLS + nutrition and physical activity counseling for obese adults with depression. This work is supported by an NIH grant to the University of Illinois at Chicago and Palo Alto Medical Foundation Research Institute.
- Coaching on an Archstone Foundation-funded Care Partners initiative led by UW AIMS Center for Advancing Integrated Mental Health Solutions and UC Davis to develop and evaluate innovative approaches to recognizing and treating late-life depression through improved community-clinical linkages and engagement of family and peer supports.
- Clinical supervision, coaching and evaluation on the Edmond Senior Center’s implementation of PEARLS and expanding to other EBPs as part of the new Senior and Community Center on Edmonds’ waterfront. This work is supported by a grant from the Verdant Health Commission that supports EnhanceWellness implementation as well.
- Advising on the Administration on Community Living (ACL) Chronic Disease Self-Management Education (CDSME) grant to the Washington State Department of Social and Health Services, Aging and Long Term Support Administration. This two-year grant aims to improve the reach and sustainability of CDSME programs including diabetes, chronic pain, and chronic disease self-management workshops, as well as one-on-one models like PEARLS and EnhanceWellness. Learn more about the grant’s objectives here.