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Emergency department (ED) crowding poses a severe public health threat, and identifying acceptable means of treating medical conditions in alternative sites of care is imperative. We compared patients' experiences with in-home urgent care via mobile integrated health (MIH) vs urgent care provided in EDs.Survey, completed on paper, online, or by telephone. We surveyed all patients who received MIH care for an urgent health problem (n = 443) and consecutive patients who visited EDs for urgent care (n = 1436).Study participants were members of a managed care plan who were dually eligible for Medicare and Medicaid, 21 years or older, and treated either by MIH or in an ED for nonemergent conditions around Boston, Massachusetts, between February 2017 and June 2018. The survey assessed patients' perceptions of their urgent care experiences.A total of 206 patients treated by community paramedics and 718 patients treated in EDs completed surveys (estimated 66% and 62% response rates, respectively). Patients treated by MIH perceived higher-quality care, more frequently reporting "excellent" (54.7%) or "very good" (32.4%) care compared with ED patients (40.7% and 24.3%, respectively; P .0001), and were significantly more likely to report that decisions made about their care were "definitely right" compared with patients treated in the ED (66.1% vs 55.6%; P = .02).Patients appear satisfied with receiving paramedic-delivered urgent care in their homes rather than EDs, perceiving higher-quality care. This suggests that in-home urgent care via MIH may be acceptable for patients with nonemergent conditions.

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One in four older adults has Behavioral Health (BH) concerns, and over 63% are not receiving services. Older adults living in the community depend on the aging network for home- and community-based services and care managers are critical providers in this network. However, most care managers' current education and training are inadequate to care for older adults with BH needs. This study evaluated the effectiveness of training on the perceived self-efficacy of care managers working with older adults with BH needs. The study used a quasi-experimental design with a pre- and post-test approach and convenience sampling ( n = 90). We found a significant difference in mean self-efficacy scores, from pre-test (M = 62.31, SD = 10.11) to post-test (M = 65.88, SD = 7.40) related to working with clients with mental health problems. In addition, we found a significant difference between the mean pre-test (M = 59.81, SD = 10.68) and post-test score (M = 65.60, SD = 9.85) related to working with clients with substance use problems.

Background and Objectives The population of older adults (65 and over) continues to increase with projections of one in five by 2030. Furthermore, one in four older adults have a behavioral health problem, and over 63% are not receiving behavioral health (BH) services. Many older adults living in the community depend on aging networks for home- and community-based services. However, most care managers' current education and training do not cover the skills and competencies to provide adequate care for older adults with BH needs. This study aimed to evaluate the effectiveness of a training intervention on the perceived self-efficacy of care managers working with older adults with BH issues in the aging network. Research Design and Methods The study used a quasi-experimental design with a pre-and post-tests approach. The study used convenience sampling (n=90). Results We found a significant difference in the mean self-efficacy scores related to working with clients with mental health problems between pre-test (M=62.31, SD=10.11) and post-test (M=65.88, SD=7.40). In addition, results indicated a significant difference in the mean self-efficacy score between the pre-test (M=59.81, SD=10.68) and post-test (M=65.60, SD=9.85) related to working with clients with substance use problems. Discussion and Implications: The study found that self-efficacy was higher at post-test than pre-test. In addition, there was no difference in the self-efficacy scores of those participants who had previously completed a mental health course or certification and those who had not.

Increases in the numbers of older adults with mental health and substance use concerns compel us to identify best practices in training to address these issues. Senior Centers are an ideal location for behavioral health education programs as they are the go-to place for many older adults. This session will describe a program funded by The Retirement Research Foundation and offered in collaboration with Center for Aging and Disability Education and Research at Boston University and NCOA to increase senior center staff knowledge and skills. Approximately 250 senior center staff in Illinois, Florida, and Wisconsin completed an online certificate in Behavioral Health and Aging. Results show that 100% of respondents felt that the training was useful for their job; 93% felt that they will be a more effective worker as a result of the training; and 97% felt that the information they learned in the training will make a difference with the people they serve. We held key informant interviews to assess the impact of training and participants stated that their knowledge, skills, and behaviors were influenced by the program. At the organizational level, leaders reported new programming related to behavioral health and revised practices and protocols. This presentation will cover: (1) the extent to which training participants mastered the competencies needed for effective practice; (2) knowledge and skills gained from the training program; (3) Senior Centers’ capacity to identify and refer older adults to mental health services; and (4) organizational changes related to behavioral health programming with older adults.

The Acute Community Care Program (ACCP), otherwise known as mobile integrated health, which is based at Commonwealth Care Alliance (CCA) in Massachusetts uses specially trained paramedics to respond to urgent care calls to evaluate and treat patients, as appropriate, within their home or institutional residences (e.g., nursing homes) with the goal of avoiding unnecessary emergency department visits and potential hospital admissions. The population served by ACCP at CCA are clinically complex, socio-economically disadvantaged patients with heavy burdens of multimorbidity and physical and mental health disability. Funded by PCORI, we used in-depth, open-ended interviews to examine the training and skills, workplace experiences, and satisfaction of paramedics. We interviewed 23 people who are either ACCP paramedics or non-ACCP paramedics. Using a thematic analysis approach for qualitative analysis, we found important themes around Interpersonal skills and attributes of paramedics along with challenges of the profession. In particular, we found that paramedics: (1) report frequently working with patients with psychiatric needs; (2) report having inadequate behavioral health training; and (3) have many challenges in managing patients with psychiatric needs where they rely heavily on their experience and/or strong interpersonal skills, not training to address the needs of this population. This data indicates that there is a gap in paramedic training related to behavioral health. It is important to build the competencies of paramedics working in mobile integrated health so this workforce can appropriately respond to patients with psychiatric needs in order to better serve this population.

The Center for Aging and Disability Education and Research at Boston University in collaboration with the Age-Friendly New Bedford Coalition and New Bedford Council on Aging received funding from Tufts Health Plan Foundation to build an educational campaign focused on reducing the stigma of mental illness and increasing awareness of the effects of social isolation in the community. In order for older adults to be fully engaged in community life, behavioral health concerns need to be addressed with a focus on social isolation, depression, and substance use. Many Age Friendly efforts don’t address these issues even though significant numbers of older adults are impacted. Without a community-wide capacity building effort, behavioral health issues among older adults often fade into the background. The first phase of this program will develop a greater awareness of the impact of behavioral health concerns and stigma. This campaign will be developed in multiple languages reflecting the area’s diverse population. In the second year of the grant, training will be provided for key stakeholders, including aging service providers, clergy, first responders, and resident coordinators focusing on the need to effectively identify and respond to older adults with behavioral health concerns. Early results on the anti-stigma campaign are showing positive impacts. Using the Depression Stigma Scale, we measured perceived stigma among older adults pre and post workshop participation. We found statistically significant changes in how older adults perceive depression after participation in the workshop. A pilot training program is underway and results are forthcoming in May 2018.

Services for older adults and younger people with disabilities are increasingly merging, as reflected in the creation of Aging and Disability Resource Centers (ADRCs). Using ADRCs to coordinate services is challenging, primarily because these fields have different service delivery philosophies. Independent Living Centers, which serve people with disabilities, have a philosophy that emphasizes consumer control and peer mentoring. However, the aging service delivery philosophy is based in a case management or medical model in which the role of consumers directing their services is less pronounced. Using institutional logics theory and a qualitative research design, this study explored whether a unified service delivery philosophy for ADRCs was emerging. Based on focus groups and questionnaires with staff from ADRCs, findings revealed that competing service delivery models continue to operate in the aging and disability fields.

The Center for Aging and Disability Education and Research at Boston University in collaboration with the Age-Friendly New Bedford received funding from Tufts Health Plan Foundation to reduce the stigma of mental illness and increase awareness of the effects of social isolation in the community. In order for older adults to be fully engaged in community life, behavioral health concerns need to be addressed with a focus on social isolation, depression, and substance use. Many Age Friendly efforts don’t address these issues even though significant numbers of older adults are impacted. Without a community-wide capacity building effort, behavioral health issues among older adults often fade into the background. We developed and implemented a 3-tiered approach to incorporating behavioral health into an Age Friendly initiative. In the first tier, we focused on increasing awareness of the impact of behavioral health concerns and stigma by creating an anti-stigma campaign in multiple languages. The second tier focused on holding workshops for older adults on behavioral health related issues. The third tier provided training to key stakeholders, including aging service providers, clergy, first responders, and resident coordinators focusing on the need to effectively identify and respond to older adults with behavioral health concerns. Using the Depression Stigma Scale, we measured perceived stigma among older adults pre and post workshop participation. We found statistically significant changes in how older adults perceive depression after participation in the workshop. Training results were also statistically significant with gains pre-post training in key competency areas.

Older adults with behavioral health concerns are a vulnerable population. Studies show that during episodes of grief and depression, older adults are more likely to turn to clergy than to mental health professionals. Clergy report that while their ministries include heavy demands to provide mental health services to their congregants, many feel overwhelmed and ill equipped to help. Research indicates that clergy members often have had little or no training in gerontology while in the seminary or in continuing education. Funded by Massachusetts Department of Public Health, we conducted a pilot program with a group of clergy using an existing online Behavioral Health and Aging Certificate from BU. We also surveyed clergy around the country to better understand their needs in working with older adults who have behavioral health concerns. This served as a scan on the current environment for clergy working with older adults and provided insight into the scope of this challenge. Our findings show that 60% of older adults often come to clergy with issues about depression or anxiety, while fewer (16%) come to them with concerns about substance use. Just over 66% will often discuss issues related to dementia, while the majority (88%) would seldom discuss issues related to suicide. Participants showed significant improvements (p

The primary aim of this article is to identify, from the perspective of primary care physicians and nurses, the challenges encountered in provision of health care to older adults and to identify potential roles, challenges, and benefits of integrating social workers into primary care teams. As more older adults live longer with multiple chronic conditions, primary care has been confronted with complex psychosocial problems that interact with medical problems pointing to a potential role for a social worker. From a policy perspective, the lack of strong evidence documenting the benefits that will accrue to patients and providers is a key barrier preventing the wider use of social workers in primary care. This article presents findings from three focus groups with primary care physicians and nurses to examine the perspectives of these key providers about the benefits and challenges of integrating social workers into the primary care team.

This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified 568 problems, 59% of which were resolved. Most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. Using PST in primary care may facilitate patients in addressing key health and wellness issues.

This article describes a study to expand a proven evidence- based practice for depression to a population-based intervention for frail older adults. Problem-Solving Therapy (PST) has been proven effective in reducing depression and other mental health conditions in cognitively intact adults in many studies. The current study employs a randomized controlled trial to test the effectiveness of a social work intervention for frail older adults that uses PST to address depression and other psychosocial issues. The intervention employs Master's trained social workers integrated into a large primary care practice. The study population is comprised of home-dwelling older adults with multiple chronic conditions, a recent history of unnecessary hospitalizations, and no more than mild cognitive impairment.