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In response to COVID-19, the Care Partners Depression in Late-Life project sites across California have rapidly re-tooled their responses and approaches to make sure that clients and patients are receiving the support they need.

Once shelter in place orders took effect in California, each of the seven Care Partners sites immediately began to provide telephone and other telemedicine outreach to currently enrolled patients. In addition, the technical assistance experts from the University of Washington quickly developed and launched the Stay Connected program, which involves outreach and support to older adults experiencing greater isolation due to the COVID-19 pandemic.

Stay Connected can be used with existing patients transitioning to telephone or telemedicine outreach and with new patients. The program was developed by Care Partners lead Jürgen Unützer, MD, MPH, MA, the Care Partners technical assistance coaches: Patrick Raue, PhD, John Kern, MD, Rita Haverkamp, MSN, PMHCNS-BC, CNS, Lesley Steinman, MSW, MPH, and Theresa Hoeft, PhD, and with support from Pat Areán, PhD, Brenna Renn, PhD, also at the University of Washington.

Participants for the Stay Connected program may be identified by their primary care team or through contact with a known housing or social service agency in their community. A diagnosable mental disorder or PHQ-9 score indicating moderate to severe depression is not required to engage with this supportive program. Individuals in Care Partners previously were enrolled if they had moderate to severe depression on the PHQ-9 depression symptom measure, but Stay Connected broadens the program reach to those experiencing anxiety, distress, and/or social isolation related to COVID-19.

Strategies to Stay Connected

The program begins with an engagement call. With existing patients, providers start by reintroducing themselves and referring to the work they have done with the patient. They let patients know that the purpose of the call is to see how they are doing. Then, they ask about any struggles related to the COVID-19 outbreak.

Providers are especially listening for: concerns about finances, food, medication, and/or supplies; increased isolation and loneliness; and emotional distress, depression, and/or anxiety. Providers then address urgent patient concerns, using local resource lists. Urgent concerns may include requests for help finding food (for example, grocery delivery for older adults who relied on the bus to get groceries), obtaining or taking medication, supplies, or housing.

After asking about immediate needs, the provider then turns the conversation to COVID-19 by saying:

“The current situation with coronavirus has been stressful for most people, and it is common to experience more distress and worry than usual. I’d like to ask you a few of our standard questions about what you might be experiencing. And we can track that over time to see how helpful our resources are to you.”

Providers will be using the PHQ-9 (a nine-item depression scale of the patient health questionnaire used to assist clinicians with diagnosing depression and monitoring treatment response), along with a select few other related questions, to check in on how patients are doing and about how well the program and resources are working to address these needs.

Next, patients will be guided to choose a “stay connected” strategy that best fits their individual needs and circumstances from a list of “behavioral activation strategies” (categorized as, pleasant, social, and physical activities) and/or a resources list that sites can adapt with their own resources. (A selection of items from the resources list can be found at the end of this post.)

Participants are encouraged to schedule at least one activity each day from the behavioral activation strategies they choose. Scheduling activities is an important way to deal with stress and depression, so the program provides an action plan form that allows participants to schedule and track the pleasant and rewarding activities they select for the week. For example, a pleasant activity might be reading a book or doing a hobby. A social activity might be calling or video-chatting with a friend. And a physical activity might be going for a walk. The sheet then lets participants rate how satisfied they felt after doing the activity.

Learning New Ways to Reach Isolated and Vulnerable Older Adults

The Stay Connected program builds on the important work that Care Partners sites had already done to provide services to patients during this pandemic. For example, Neighborhood Healthcare (NHcare), in partnership with Interfaith Community Services (Interfaith) located in North San Diego County, quickly implemented an outreach strategy to contact all of the more than 8,200 older adult patients served by the healthcare clinic to check in and assess social needs.

For nearly two years, NHcare and Interfaith have been working together to provide enhanced and partnered care for older adults with depression, and they continue to reach out regularly to these older adults by telephone. The new outreach work builds on a strong and longstanding partnership between these organizations.

Since the coronavirus pandemic began, they have been asking patients about needs for food, essential household items, medications, and other concerns. Interfaith has been delivering food and also connects patients to other resources for housing and transportation needs. High-risk patients without housing were placed in hotel rooms and provided regular telephone contact for additional support.

The Care Partners technical assistance team will continue to be in regular communication with each of the seven Care Partners sites to provide support and to add additional tools to the Stay Connected program as we learn more about patient and community needs. The evaluation team is also in the beginning stages of planning to follow up with the sites to systematically understand what we are learning and how to best share these lessons with other behavioral health providers.

During these unprecedented and uncertain times, it is more important than ever to support older adults who are experiencing depression, distress, and social isolation. And it is critical to keep the connection going. Although these are challenging times, they may also provide us with an opportunity to learn new ways to better reach and engage isolated and vulnerable older adults—including using telemedicine and delivering support outside of the clinic walls.

Archstone Foundation would like to thank the Care Partners project sites and technical assistance team for these important efforts to address depression, distress, and social isolation during the coronavirus pandemic. We would especially like to thank: Jürgen Unützer, Patrick Raue, John Kern, Rita Haverkamp, Pat Areán, Brenna Renn, and Theresa Hoeft from the UW AIMS Center and Lesley Steinman from the UW Health Promotion Research Center for developing and sharing this program.

For additional information about Stay Connected, please email Laura Rath.


Resources to Help Older Adults Stay Connected

The following are examples of some of the helpful resources used by the Stay Connected program to deal with increased isolation during the COVID-19 pandemic.

Tips for Managing Stress Associated with COVID-19

These information sheets from federal healthcare agencies offer practical tips for helping to manage the stress or anxiety of COVID-19:

Other Tips for Well-Being

The GeroCentral website offers a list of COVID-19 Resources that includes links for virtual activities like museum tours, videos, and other information. Scroll down for the section on "Older adult and family resources.”

Friendship Line

The Institute on Aging offers a 24-hour, toll-free Friendship Line that serves as both a crisis intervention hotline and a warmline for non-emergency emotional support calls for adults 60 years and older, and adults living with disabilities.

For more information or help, visit the Friendship Line webpage or call 1-800-971-0016 (toll-free).

National Suicide Prevention Lifeline

If you’re thinking about suicide or harming yourself, are worried about a friend or loved one, or would like emotional support, the National Suicide Prevention Lifeline network is available 24/7 across the United States.

Call 1-800-273-8255 (free and confidential), or visit Lifeline Chat to engage in a webchat with a Lifeline counselor.

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