Academic journal article Generations

Implementation of Evidence-Based Practices: SAMHSA's Older Adults Targeted Capacity Expansion Grant Program

Academic journal article Generations

Implementation of Evidence-Based Practices: SAMHSA's Older Adults Targeted Capacity Expansion Grant Program

Article excerpt

Implementation of EBPs has been promoted as a means to decrease problems with the quality of and access to mental health service.

Since 2002, the Substance Abuse and Mental iealth Services Administration (SAMHSA) has awarded 30 grants through its Older Adults Mental Health Targeted Capacity Expansion (OA TCE) program. These grants are designed to increase, develop, and implement mental health services for individuals older than age 60 and to build infrastructure to support the service system using Evidence-Based Practices (EBPs). The most recent funding cycle awarded ten grants in 2008. These grants will fund projects for up to 3 years at approximately $400,000 per year. This article describes the OA TCE program and reviews SAMHSA's support of EBP through various other initiatives.

By the year 2030, it is estimated that there will be 71 million adults older than age 60 in the United States. They will represent about 20% of the population (U.S. Department of Health and Human Services, 2008). The vast majority of these individuals will have at least one chronic health condition, with mental illnesses accounting for a significant number of these conditions (USDHHS, 1999). As an example, while older adults represent about 12% of the U.S. population, they account for nearly 16% of all suicides (Centers for Disease Control and Prevention, 2005).

Depression, anxiety, and substance misuse are not part of "normal" aging, although they may be associated with chronic physical health conditions, loss of spouse, loss of sensory and physical abilities, loss of independent living skills, and the re-emergence of response to earlier life trauma. As with other Americans, the mental health of older adults is as essential to overall health and well-being as physical health. The Healthy People 2010 objectives (USDHHS, 2000), the 2005 White House conference on Aging (USDHHS, 2006), and the Surgeon General's Report on Mental Health all identify the mental health of older Americans as a priority (USDHHS, 1999).

Older adults with mental disorders are more likely to receive inappropriate or inadequate treatment compared with younger adults who have mental disorders (Unützer et al., 1997) and compared with other older adults who do not have mental disorders (Luber et al., 2001; Cornwell, 1994). There are a variety of potential reasons for poorer quality of geriatric mental health services such as more limited economic resources, physical barriers to care, fragmented services, and a workforce inadequately trained in geriatric mental health interventions (USDHHS, 1999; Cook et al., 1991).

Almost half of older adults with a recognized mental disorder do not seek or receive mental health services (Bartels et al., 2002). Barriers to care include a lack of economic resources; stigma associated with mental health services; poor recognition of mental disorders; and a lack of accessible, affordable, and age-appropriate services (Thomas and Rockwood, 2001; Mark et al., 2005).

Implementation of EBPs has been promoted as a means to decrease problems with the quality of and access to mental health service. Evidence-based practices are interventions that have strong scientific proof that they produce positive outcomes for certain types of disorders. However, implementing these practices in real-world settings is often difficult. Although many EBPs exist for older adults with mental health problems, the extent of their availability varies.

There have been broad-based calls to disseminate and implement evidence-based practices as a means to improve the quality of health and social services for older adults (Institute of Medicine, 2001; Hogan, 2003; Bartels, 2003). Recommendations from the President's New Freedom Commission on Mental Health (NFC) highlight the implementation of EBPs as the foundation for improving the quality of mental health services in America (Bartels, 2003). While the use of EBPs is a focus of substance abuse and mental health research and policy, implementing these practices in real-world settings has been slow. …

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