Overcoming Common Barriers to Adequate Depression Care
The PEARLS Program approach to treating depression has several unique features that overcome common barriers to receiving adequate care for depression.
First, the PEARLS Program’s in-home delivery method overcomes limitations in ambulation or transportation that are common in the populations it serves. By providing “house calls” for depression, PEARLS counselors can ensure more regular contact with their clients than would often be possible in outpatient settings. This feature of PEARLS is based on evidence that home-based treatment can reduce depression among socially isolated, older or chronically ill adults. Current trends for care of other chronic illnesses such as diabetes, heart disease and arthritis are moving toward home-based care, as well.
Next, the PEARLS Program is designed to be part of existing community-based programs that already deliver care and provide resources to clients. The result of incorporating the PEARLS Program into existing programs increases the likelihood of providing safety net resources and comprehensive care to individuals, many of whom have few resources and who might otherwise “fall through the cracks” of the prevailing health care system.
The PEARLS Program is designed to be part of existing community-based programs that already deliver care and provide resources to clients.
Finally, the PEARLS Program incorporates current approaches to chronic illness care, including the Chronic Care Model and Collaborative Care:
- The Chronic Care Model advocates the use of educational materials, patient registries, tracking tools and system integration in order to empower individuals and ensure the most comprehensive care possible.
- Collaborative Care describes the clinical approach undertaken within the Chronic Care Model and includes: developing a collaborative or shared definition of an individual’s problems; targeting, goal-setting and planning a course of action; creating a continuum of self-management training and support; and ensuring active, sustained follow-up. All of these elements are major parts of the PEARLS approach to depression treatment.
The Three Key Components of PEARLS
- Problem solving treatment
Participants learn to recognize symptoms of depression, understand the link between unsolved problems and depression, and apply a highly effective 7‐step approach to solving their problems.
- Social and physical activation
Participants develop a plan to engage in activities that interest them, since involvement in social and physical activities improves quality of life and mood of people with depression.
- Pleasant activity scheduling
Very often, depressed individuals find it difficult to initiate activities that are enjoyable. PEARLS participants work with the PEARLS counselor to identify and participate in activities they find pleasurable, which helps them manage their depression.
Medical and Psychiatric Supervision
In order to address any medical problems that may arise during a client’s PEARLS Program treatment, each PEARLS case is reviewed regularly by a team that includes a psychiatrist. The supervising psychiatrist can also address other causes of depression and, when necessary, work with the client’s primary care provider or other health care provider to begin medication treatment for depression. For individuals with major depression in particular, the initiation of antidepressant medications can be an important treatment component of the PEARLS Program.