Implementation of a Culturally Enhanced Depression Treatment Intervention for Latino Older Adults in Programs of All-Inclusive Care for the Elderly

BACKGROUND AND PURPOSE:  To address disparities in access to depression care such as those experienced by Latino older adults, a variety of integrated care models that incorporate psychiatric care in primary care settings have been developed. To an extent, the Programs of All-Inclusive Care for the Elderly (PACE) address depression care access barriers among older adults. However, in PACE settings, depression treatment has largely focused on medication management although Latinos have identified talk therapy as the preferred treatment for depression. The Programa Mano Amiga (PMA) is a NIMH-funded randomized controlled trial to determine if a culturally-adapted Problem Solving Treatment (PST) intervention is more effective in alleviating severe depression than the typical care received by Latino older adults who use PACE services. From the perspective of direct service providers, administrators, and PACE clients who participated in PMA, this qualitative study aims to evaluate the challenges, benefits, and opportunities for integrating a culturally enhanced Problem Solving Treatment intervention for geriatric depression among Latinos in PACE settings. 

METHODS:  Semi-structured interviews were conducted with 35 older Latinos (ages 60+) who participated in the PMA study and with 14 executive, administrative, and direct service employees of AltaMed Corporation which administrates the PACE programs in Los Angeles. A constant comparison approach rooted in grounded theory was applied to the qualitative analysis of data on their experience with receiving, planning, and/or providing depression care treatment in PACE. Three bicultural/bilingual researchers independently coded the transcripts; then discussed, matched, and integrated the codes into a single codebook through a consensus process.

RESULTS: Most participants reported perceived benefits of integrating PST into PACE settings. Benefits included increased depression literacy and access to culturally sensitive depression treatment. Specifically, older adults preferred the convenience of receiving depression information and psychosocial treatment within the PACE setting. Moreover, the endorsement and delivery of PST by their PACE primary care providers was reportedly important to engage in depression care. Direct service providers reportedly gained from tools and training on accurate depression screening received through the PMA. Executive-level employees anticipated benefits in mental health outcomes and quality of life as a result of attending current depression symptoms, yet withheld consideration of service planning until PMA outcomes could be thoroughly evaluated. Anticipated challenges to integrating PST into PACE settings included the current lack of trained personnel to deliver the intervention, the need for continued supervision and training on PST, and the current lack of resources available to fund specific programs. Imminent organizational initiatives and collaborative partnerships provide potential opportunities for integrating PST into PACE settings.

CONCLUSIONS AND IMPLICATIONS:  In an environment of limited funds, strained workforce, and growing Latino and older adult populations at risk for depression, the findings from this study provide a critical analysis of challenges, benefits, and opportunities to consider the feasibility of integrating a culturally adapted depression treatment intervention in PACE settings. Implications and recommendations for improving depression care with Latino older adults will be discussed.