Author's School

Brown School of Social Work

Author's Department/Program

Social Work

Language

English (en)

Date of Award

January 2009

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Nancy Morrow-Howell

Abstract

Depression is a prevalent, debilitating yet treatable psychiatric disorder affecting older adults. Older adults underutilize specialty mental health care, persistently receive poor quality care in primary care settings, and have high rates of non-adherence to pharmacotherapy. Aging network services, such as adult day services, homecare services, senior centers, and supportive housing may be able to improve the quality of depression care. However, it is unknown how current models of empirically supported depression care are used within or could be adopted by aging network services. Thus, this study described the organizational factors, staff factors, and current agency practices regarding depression among aging network services to examine their potential to adopt new depression practices. Using mixed methods, data were gathered on the organizational culture, climate, and structure, current depression practices, and staff attitudes through interviews with program managers: n =20) and surveys with staff: n = 142) for 17 agencies. The judgment sample consisted of agencies that have ongoing contact with community-based older adults and was stratified by agency type: i.e., adult day services, homecare services, senior centers, supportive housing). Multilevel modeling and constant comparative analysis was completed. Although agencies did significantly vary according to agency type by organizational context: i.e., funding; the proficiency, rigidity, and resistance of organizational culture; and the engagement, functionality, and stress of organizational climate), these factors were not related to empirically supported depression practices or staff attitudes about depression care. Most barriers to implementing new depression practices were universal. These findings applied to organizational factors: i.e., lack of resources, limited funding) and staff factors: i.e., limited knowledge and interest, concern for client acceptance of depression care). As facilitators, agencies frequently offered psychoeducation, collaborated with health providers, and provided holistic services to promote socialization, independence and health. The distinctions between agency types involved their current depression practices: i.e., supportive housing staff rarely screened for depression due to privacy mandates for housing facilities, competition among homecare agencies prompted delivery of in-home psychotherapy and case management). Findings inform multilevel implementation strategies for translating research into acceptable and sustainable practices for aging network services, and they highlight the broader needs for increased funding, training, and awareness to improve the quality of depression care across agencies.

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Permanent URL: http://dx.doi.org/K7B27SF1

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