Exploring the Aging Services Potential to Implement Depression Care

Background and Purpose: Depression is a prevalent, debilitating yet treatable psychiatric disorder affecting older adults. Simply knowing about empirically-supported depression practices is insufficient because older adults underutilize specialty mental health care, persistently receive poor quality care in primary care settings, and have high rates of non-adherence to pharmacotherapy. Aging network services, such as adult day services, homecare services, senior centers, and supportive housing may be able to improve the quality of depression care for older adults. Thus, this study, based on an Organizational Social Context perspective, described the organizational factors, staff factors, and current agency practices regarding depression among aging network services. The goal was to examine their potential to adopt new depression practices.

Methods: Using mixed methods, data was gathered on the organizational culture, climate, and structure, current depression practices, and provider attitudes through in-depth interviews with program managers (n =20) and surveys with staff (n = 142) from 17 agencies. The surveys utilized standardized scales for organizational social context, and attitudes towards evidence-based practices. The judgment sample consisted of agencies that have ongoing contact with community-based older adults and was stratified by service type (i.e., adult day services, homecare services, senior centers, supportive housing). Multilevel modeling and constant comparative analysis was completed. Agencies were primarily private and not-for-profit, with funding sources including private pay, the Older American's Act, and Medicaid. One third of staff had a college degree and most nurses/social workers were program managers. Adult day services typically had 20 clients or less; whereas, the other agencies reported serving over 100 clients.

Results: Although agencies did significantly vary according to service type by organizational context (i.e., funding; the proficiency, rigidity, and resistance of organizational culture; and the engagement, functionality, and stress of organizational climate), these factors were not related to provision of empirically-supported depression practices or staff attitudes about depression care. Most barriers to implementing new depression practices were universal across agency type. These findings applied to organizational factors (i.e., lack of resources, limited funding) and staff factors (i.e., limited knowledge and interest). As facilitators, agencies frequently offered psychoeducation, collaborated with health providers, and provided holistic services to promote socialization, independence and health. The distinctions between service types involved their provision of current depression practices (i.e., supportive housing staff rarely screened for depression due to privacy mandates for housing facilities, competition among homecare agencies prompted delivery of in-home psychotherapy and case management). Out of the 17 agencies sampled, the agencies reported the following evidence-based depression practices: conducted systematic depression screening (n=5), established suicide risk protocols (n=4), offered case management (n=11), and had mental health consultation (n=5).

Conclusions and Implications: When exploring an agency's potential to implement new practices, organizational factors and the divergence from existing empirically-supported practices is informative. These findings can guide multilevel implementation strategies for translating research into acceptable and sustainable practices for aging network services, and they highlight the broader needs for increased funding, training, and awareness to improve the quality of depression care across agencies.