Health Improvement Program for the Elderly
Tucson, Arizona
Contact:
Jane Singer
Principal Investigator
Jewish Family & Children’s Services of Southern Arizona, Inc.
4301 E. Fifth Street
Tucson, Arizona 85711
Phone: 520-795-0300, ext. 287
Email:
Janes@jfcstucson.org
Program Description:
The Health Improvement Program is a community-based collaboration of four provider agencies in Tucson, Arizona. This program provides office and home-based mental health services for individuals aged 65 and older. The collaborating agencies are Catholic Social Services, Family Counseling Agency, Marana Health Services, and the lead agency, Jewish Family and Children Services (JFCS).
The sole qualifying factor for services is age. This eliminates the sometimes lengthy application process and waiting period involved in qualifying for mental health services under the State of Arizona Medicaid system (the Arizona Health Care Cost Containment System [AHCCCS]) for individuals with low income. Finding mental health professionals can be equally difficult for people who qualify for Medicare and private health insurance. The project takes referrals from case managers serving individuals in need of long-term health care, also under AHCCCS, in the Arizona Long Term Care System (ALTCS); referrals from primary care physicians; outreach to assisted living facilities; and self-referrals.
Services are offered in the community provider agencies, at home, and through support groups. The project is reducing the high levels of anxiety, depression, and feelings of isolation experienced by many elder individuals as they face the loss of spouses, health, family members, and friends. Therapists provide counseling and social supports.
All intake is conducted through JFCS and clients are referred within 48 hours unless a crisis indicates that same-day service is needed. Clients are referred according to location, availability of therapists, and language (if a Spanish-speaking therapist is needed). A variety of instruments are used to develop a diagnosis and a treatment plan; these include the Geriatric Depression Scale, Beck Anxiety Inventory, and Stait and Trait Anxiety Scales. Clients usually are seen in the office unless their physical health condition indicates home visits. The office site is regarded as the most preferable place because clients must engage in daily life activities including short travel; communicate with others if using public transportation; and visit an agency.
Group therapy is provided, sometimes following, and sometimes in conjunction with individual therapy; this further reduces isolation and enables clients to have contact with peers on a weekly basis. Therapists in the Health Improvement Project have found that social support and social integration are major concerns in the assessment and treatment of the elderly in ways that may not seem as pertinent to younger clients with similar diagnoses. Cultural sensitivity to the age of seniors in the project (most of whom are over the age of seventy-five) and to the ethnic and socio-economic cultures represented is basic to the understanding of the constituent aspects of social support and social integration.
The provision of social supports by the therapists was not a planned project intervention initially. It evolved as the needs of the elderly were assessed during therapy, and it became an integral element of the holistic approach to service delivery. The relevance of social supports to the highly significant results of treatment is well documented in the literature.
Looking back to the Rand Health Insurance Experiment (Donald, Ware, Brooks, and Davies-Avery, 1978) a social well-being scale was developed. This scale consists of subscales labeled social contacts and social resources. The scales were reported to have internal consistency and to be stable over a one-year period. The summary index of social well-being was associated with better mental health regardless of stressful life events. As well, in longitudinal analyses, high levels of social well-being were found to predict subsequent improvements in mental health with social resources a better predictor than social contacts. Viewing the project therapists as social resources for the clients enables us to understand the outcomes of less anxiety and depression and the perception of greater well-being and life satisfaction. These outcomes have held rather firm over time despite ubiquitous stressful life events.
In 2000, Cohen, Underwood, and Gottleib published Social Support Measurement and Intervention. It summarizes much of the research in the areas of social support pertinent to behavioral health. The Health Improvement Project therapists believe that the relationship with the client is more important than any therapeutic technique or set of techniques. Their descriptors of the quality of the relationship correlate with the various aspects of social support through relationship processes that have been identified and defined by researchers. The quality of trust and intimacy characterized by supportive interaction, attentive listening, self-disclosure, and empathy has been extensively researched, primarily in terms of spouses and intimate friendships or best friends (Holmes & Rempel, 1989, and Miller & Lefcourt, 1983). The therapists see this quality as the primary feature of the therapeutic relationship without which no further treatment can take place. The quality of companionship as a social support--which is characterized by sharing of interests and beliefs, respectful interaction, and exchange of ideas--is described by the therapists as a form of social support missing in the lives of many clients who have become isolated through illness, disability, loss of mobility, loss of motivation, and poverty. The therapists facilitate the social re-engagement of clients through referral to social activities and support.
Sheldon Cohen, Lynn G. Underwood, and Benjamin H. Gottleib (eds.) (2000). Social Support Measurement and Intervention. New York, N.Y.: Oxford University Press.
Holmes, J.G. and Rempel J.K. (1989). Trust in close relationships, In C. Hendrick ed. Review of Personality and Social Psychology, vol 10: Close Relationships, pp 187-220. London: Sage.
Miller, R.S. and Lefcourt, H. (1983). Social intimacy: An important moderator of stressful life events. American Journal of Community Psychology, 11, 127-139.
