A central part of the ALACRITY Center’s mission is to develop novel treatments for late- and mid-life mood disorders that can be tested and used in the community. For this reason, the Institute uses neurobiology models to identify core therapeutic components of psychotherapies. It uses these models to simplify its psychotherapies, while retaining their therapeutic properties, so that they can be used in busy community settings. To ensure that the novel psychotherapies are practical and fit in the routine of community settings, our investigators work closely with community partners both during the development and the testing of the new psychotherapies. Our ultimate goal is to develop treatments that can be used across the nation and be sustained without the support of research grants.
The Weill Cornell Institute of Geriatric Psychiatry has worked for more than 15 years with DFTA (http://www.nyc.gov/html/dfta/html/services/services.shtml). DFTA is an agency of NY City government and an Area Agency on Aging under the federal Administration on Aging. DFTA receives federal, state and city funds to provide essential services for seniors. It channels these funds to community-based organizations that contract with the DFTA to provide needed programs locally. Senior Centers, elder mistreatment services through its Elderly Crime Victims Resource Center, home-delivered meals, case management, home care, transportation and legal services are among the services DFTA supports. DFTA manages the contracts with these programs and ensures service quality. DFTA also provides services directly through its Senior Employment Services Unit, Alzheimer's and Caregiver Resource Center, Foster Grandparent Program, Grandparent Resource Center, Health Insurance Information Counseling and Assistance Program, and Health Promotion Unit.
The Institute’s relationship with DFTA has led to the development and delivery of many innovative mental health services in aging service settings. DFTA and the Institute’s investigators obtained joint funding from NY State to implement a service delivery model (SMART-MH) for identifying and serving older adults living in hurricane impacted areas in New York City. This joint project assessed over 2800 older adults speaking English, Chinese, Russian and Spanish and treated 200 of them with a 6-session, reward exposure therapy, based on the Institute’s “Engage” treatment model in their own language. The Institute has worked with DFTA to develop a sustainable “blended” funding model supported by ongoing NYC grants combined with billable services. This service delivery model has become the prototype for the NYC-wide older adult mental health initiative (ThriveNYC Geriatric Mental Health program) to deliver sustainable, evidence-based mental health services in senior centers. We are now setting up mental health services in 9 centers in NYC.
Recently, DFTA’s clinicians and the Institute’s investigators designed two developmental projects. The first Developmental Project, “EM/PROTECT: Improving Depression in Elder Mistreatment Victims”, is a therapy for victims of elder mistreatment with depression to be offered at two Elder Abuse agencies of DFTA along with elder mistreatment services. It is based on a neurobiology model and uses effective behavioral techniques and mobile technology to improve depression and quality of life. EM/PROTECT was developed with elder mistreatment experts to fit within community agencies. If EM/PROTECT is feasible, acceptable and effective in improving depression, we will conduct a larger study with the goal of creating a sustainable mental health program an elder mistreatment victims across the nation. The second Developmental Project “Reaching and Engaging Depressed Senior Center Clients (REDS): A Community Care Model” aims to address the needs of the large number of senior center clients with untreated depression. REDS integrates screening and recognition of depression and referral strategies; a neurobiology-based, streamlined group therapy called Engage-M; and mobile technology to augment treatment and treatment adherence. If effective, REDS may become a sustainable service supported across the country by billable services. REDS will be implemented in four senior centers of DFTA.
The community-based, primary care practices provide complete and affordable, family-oriented care in many locations of New York City. They treat a broad range of conditions and provide an array of primary care services, from annual physical exams to the management of more complex medical issues. Many of the physicians have additional expertise in preventative health, women's health, hypertension, geriatrics, pharmacology, osteoporosis and diabetes. Establishing long-term relationships with patients is an essential part of the primary care practices. The doctors encourage open communication and strive to connect with each person they treat. This approach helps us provide personalized care that addresses each patient's needs and concerns. Some of the practices also offer individual and group sessions covering topics like nutrition and diabetes management. The practices share electronic medical records make it easy for our internists and specialists to collaborate and coordinate their treatment plans.
A recent collaboration with The Weill Cornell Institute of Geriatric Psychiatry and practice clinicians led to the development of “Relief”, a behavioral intervention for primary care patients suffering from chronic pain and depression. Relief” uses a neurobiological model to define the targets of its behavioral interventions, and is designed to be administered by non-medical clinicians of primary care practices eligible to provide billable services. If Relief is acceptable by patients and therapists and improves depression and disability, we will conduct a larger study with the goal to develop a sustainable mental health model for the large group of depressed-pain patients who have few viable treatment options.
The Weill Cornell Institute of Geriatric Psychiatry has been the founding partner of the Westchester County Mental Health Coalition (WMH-Coalition). The WMH-Coalition consists of over 30 agencies offering primary care, mental health, home health care, rehabilitation, social, and aging services providing services and/or advocacy to older adults in Westchester County. The objectives of the Institute and the Coalition are closed aligned and aim to: 1) Increase access to mental health care of older and middle-aged adults; 2) promote evidence-based practices; 3) rapidly incorporate scientific advances into service delivery; 4) address the medical, psychiatric, and social needs of middle-aged and older adults by creating linkages among agencies offering diverse services; and 5) advocate for better care and services.
The Coalition’s membership includes the Weill Cornell Institute of Geriatric Psychiatry, the Department of Senior Programs and Services (the designated Area Agency on Aging), the Department of Community Mental Health (DCMH), the National Alliance on Mental Illness (NAMI), Family Services of Westchester (social service agency), St. Vincent Catholic Medical Center Westchester (a major hospital provider), Visiting Nurse Services of Westchester, WestMed (a large group medical practice), the Burke Rehabilitation Hospital, the New Rochelle Adult Home, the Weill Cornell Institute and other community agencies. Since 2004, the Coalition has been meeting regularly on the premises of the Weill Cornell Institute of Geriatric Psychiatry. The Planning Committee, a subgroup of the Coalition responsible for initiating and designing activities and proposed service development projects, meets monthly. Jo Anne Sirey, Ph.D. of the Weill Cornell Institute has served as the Chair of the Planning Committee Coalition.
Participating agencies in the WMH-Coalition have built collaborative relationships and worked on several projects. The Coalition identified targeted mental health needs included in the Westchester County Pre White House Conference on Aging Recommendations. These recommendations were circulated nationwide and brought to the White House Conference on Aging in June 2005. In June of 2006, this group co-sponsored a conference examining approaches to integrate health and mental health services. A Center Grant by NIMH enabled the Weill Cornell Institute to develop a Community Network Unit that supported many of the WMH-Coalition activities. Most recently, the WMH-Coalition was competitively funded by the New York State Office of Mental Health. Through these funded initiatives, the Coalition has evolved into a unique entity that has the capacity and structure to design and implement programs integrating systems that coordinate and address the physical, mental health and social service needs of elders in Westchester County.
A number of studies have been jointly developed and conducted with members of the WMH Coalition. An ongoing, NIMH-supported, controlled study compares the effectiveness of Engage (a neurobiology based behavioral intervention) to that of Problem Solving Therapy (principal investigator: G. Alexopoulos, MD). Another ongoing, NIMH-supported, controlled study compares the effectiveness of a novel behavioral treatment for post-stroke depression with a psychoeducation approach (principal investigator: G. Alexopoulos, MD). We recently completed several NIMH-funded controlled effectiveness projects conducted jointly with members of the WMH Coalition. One study compared two behavioral interventions for depressed, disabled, low-income older adults funded by NIMH (principal investigator: G. Alexopoulos, MD). Another two studies compared behavioral interventions for older adults with major depression and severe chronic obstructive pulmonary disease (principal investigator: G. Alexopoulos, MD). We also studied the effectiveness of an intervention that improved acceptance of mental health referrals by depressed, homebound adults (principal investigator: JA Sirey, Ph.D.). The findings of these studies have already been published.
The Weill Cornell Institute of Geriatric Psychiatry has worked with the W-DSPS for longer than 20 years. The W-DSPS was established in 1974 in response to the Older Americans Act (OAA) and the New York State Community Services for the Elderly Act. The agency serves a fast growing population of nearly 160,000 older adults (1 in 5 Westchester residents is over age 60). The mission of the W-DSPS is to identify and prioritize the needs of the elderly; create comprehensive and coordinated plans for meeting those needs; and advocate for responsive policies, programs, actions, legislation, and resources on behalf of the elderly (http://seniorcitizens.westchestergov.com/senior-programs-and-services/contact-us). A central function of the W-DSPS is to support and oversee services for older adults, provide information, and serve as a referral point for local services. Commissioner Mae Carpenter, M.S. leads the W-DSPS and alongside her staff, provides oversight and financial support to a cohesive system of social service agencies, programs, and services.
The W-DSPS provides a comprehensive array of programs including access services, support services, in-home services, food and nutrition services, housing services, employment services, administrative assistance, and family caregiver support programs. Access services include information on services and benefits, referrals, case assistance, case management, and transportation for older adults with social and financial needs. Case management includes individual assessment by case managers during home visits, who develop a non-medical plan and link elders with community services. Case management services are free of charge. Support and in-home services for older adults with functional impairment help seniors to participate in family and community life and other activities of daily living. The family caregiver support program provides outreach to local family caregivers, usually middle-aged adults, and information on services and assistance in accessing services. W-DSPS has an active program (the Millennium Project) for needs assessment of older persons of Westchester County. Its goal is to survey the needs of older persons, their caregivers, and their family members and determine the most appropriate level of care. County, state, and federal agencies fund the W-DSPS programs. Its two primary granting agencies are the New York State Office for the Aging and the National Council on Aging, Department of Labor.
W-DSPS and Weill Cornell Institute of Geriatric Psychiatry have a long and productive collaboration. Together with County leaders, W-DSPS and the Institute have developed research projects in community settings, offered training to staff and traveled to community sites to identify middle-aged and older adults in need of mental health services. In response to requests from W-DSPS Commissioner M. Carpenter and her staff, the Institute convened meetings to identify needs of middle-aged and older adults, venues for outreach, and gaps in mental health services. Our meetings yielded collaborative projects (e.g., an educational activity, consultation to a senior housing facility, and staff intervention). Through the initiative of Commissioner Carpenter of W-DSPS, we have increased our role in training and expanded our outreach to older adults.
Two NIMH independently-funded studies have been conducted in collaboration with W-DSPS, i.e. an NIMH funded intervention study, which offered case management integrated with Problem Solving Therapy to depressed, home-bound, low-income patients receiving home-delivered meals (PI: G. Alexopoulos, M.D.), and an NIMH intervention study, which combined problem solving with environmental adaptations, with the goal of changing the “ecosystem” of depressed, cognitively impaired elders with major depression (PI: D. Kiosses, Ph.D.).
FSW is a non-profit, mental health and social service organization serving Westchester County for more than 50 years. It provides a broad range of social and mental health services to strengthen and support families, children and individuals across the life cycle (http://www.fsw.org). It operates seven Family Centers, which are outpatient mental health clinics licensed by New York State Office of Mental Health. FSW offers a comprehensive range of both community-based and residential Elder Services to help Westchester’s older residents maintain their highest possible level of independence in the community. A broad variety of services are provided to meet the needs of middle-aged and older adults, and enhance their quality of life at whatever level they are functioning. This spectrum ranges from employment services for Westchester’s most independent middle-aged and older adults, office-based and in-home clinical mental health services and supportive case management, adult day services for adults who live in the community but are unable to remain home alone, licensed home care services to help seniors remain in the community for as long as possible, and two residential programs. FSW’s Geriatric Outreach Program provides home-based mental health clinical and case management services to isolated elderly who cannot otherwise access office-based treatment. It also offers Elder Abuse Prevention to help vulnerable elders who are experiencing or are at risk of elder abuse, neglect or exploitation. The preliminary study of our NIMH funded Engage intervention was designed with input by our FSW partners and implemented by the FSW social workers.