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Project FOCUS

El Paso, Texas

Contact:

Gabriela Martinez, Project Manager
City of El Paso
2 Civic Center Plaza, 8th floor
El Paso, TX 79901
Tel: (915) 541-4278
Email: martinezgz@elpasotexas.gov

Program Description:

The mission of the City of El Paso’s Project For the Optimal Care of Underserved Seniors (FOCUS) is to expand the availability and quality of mental health services to mostly lower income Hispanic seniors at high risk for depression and dementia due to multiple chronic health problems and social isolation. The project’s goal is to develop a strong network of agencies that provide mental health services to older adults regardless of where they enter the care system.

A senior caseworker at the City-County Nutrition Program screens older adults for mental health symptoms.  Older adults who answer “yes” to either one of two depression screening questions from the Composite International Diagnostic Interview (CIDI) are referred for assessment and diagnosis by one of the caseworkers at El Paso Mental Health & Mental Retardation (MHMR). The two screening questions are: Have you experienced a depressed mood for a period of two weeks or more in the past year?  Have you experienced a loss of interest for two weeks or more in the past year?  Participants are referred for services based on their DSM-IV diagnosis.

Seniors who are diagnosed with a mental health problem, namely major depressive disorder, schizophrenia, or bipolar disorder, meet “priority population“ status. They are then assigned a case manager and given financial assistance to help them access, pay for, and adhere to psychiatric treatment from El Paso MHMR that is based on the Texas MHMR-mandated model, the Texas Implementation of Medication Algorithms (TIMA).  The TIMA establishes a model for psychiatric services based on the latest scientific research, expert consensus, and DSM-IV criteria.

Older adults who are not part of the priority population, but who are experiencing mild to moderate mental health symptoms, are offered services at Centro San Vicente (CSV), a federally qualified health center (FQHC). CSV offers a combination of case management services and treatment with a clinical psychologist. The clinical psychologist uses a variety of instruments (e.g., Beck Anxiety Inventory, Beck Depression Scale, and geriatric depression scale) to make a diagnosis and develop an appropriate intervention to treat mild to moderate depression, anxiety, and other mental health problems.  The psychologist has found that cognitive behavioral therapy helps to reduce participants’ symptoms significantly in 4 to 6 sessions.  A social worker works with the psychologist to provide case management services, referrals, and follow-up.

Seniors who do not want to enroll in typical psychiatric/psychological treatment at El Paso MHMR or CSV are referred to the Senior Peer Counseling Services Program.  This program, which is offered at both El Paso MHMR and CSV, offers an alternative to typical psychiatric/ psychological treatment and is based on the peer counseling for seniors model developed by the Center for Healthy Aging. Specially trained volunteers who are supervised by a licensed mental health professional provide peer counseling in both individual and group settings. Project FOCUS is in the process of securing funding from the Hogg Foundation for Mental Health and is training staff and recruiting volunteers to provide these services.

Seniors who screen negative for mental health symptoms are referred for wellness services.  Wellness services are offered both at LULAC Project Amistad and CSV. Case managers, or wellness coaches, develop and provide individualized preventive education and training, as well as traditional case management. Wellness services are based on a combination of Rowe & Kahn’s “successful aging” concepts and Rapp’s strengths model (Rowe & Kahn, 1998; Rapp, 1998).  Wellness services are designed to prevent or delay the onset of depression and/or dementia and to address the client’s other needs.

Moreover, Project FOCUS caseworkers help older adults by strengthening their formal and familial support systems through referrals, as appropriate, to El Paso Human Services, Inc. (EPHSI) for family group conferencing services. This family decision making model, which was developed in New Zealand, has been used successfully worldwide to address the care and protection needs of children (Walker, 1996).  EPHSI is collaborating with Project FOCUS on adapting the model to work with older adults.

As of March 31, 2005, Project FOCUS has screened 727 older adults aged 65 and older for mental health symptoms.  A total of 137 individuals have been diagnosed with a major mental illness and 133 are receiving mental health treatment at El Paso MHMR or CSV.  Although 323 older adults were not experiencing mental health symptoms, their socioeconomic and health status and their homebound situations place them at risk for mental illness.  These individuals thus receive wellness services.

Last, Project FOCUS is developing a network among aging and mental health systems to increase outreach, integration, and prevention efforts. Training is provided to staff in the area of mental health, long-term care, cultural competency, and other aging services to increase their capacity and ability to provide high-quality services. The City of El Paso also coordinates an executive committee of service providers and consumer representatives.  This committee identifies and develops strategies to overcome barriers and gaps encountered by seniors served by the project.