Psychosocial Interventions for Older Adults With Serious Mental Illness

What Research Tells Us

A review of the literature identified practices and programs used to provide care coordination and recovery supports for older adults experiencing serious mental illness (SMI). This chapter provides an overview of five practices, including a discussion of the typical settings, demographic groups, intensity and duration, and outcomes attributed to the intervention:

  1. Assertive Community Treatment (ACT)
  2. Cognitive Behavioral Social Skills Training (CBSST)
  3. Skills training practices, specifically Functional Adaptation Skills Training (FAST) and Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos (PEDAL)
  4. Integrated Illness Management and Recovery (I-IMR)
  5. Helping Older People Experience Success (HOPES)

Each program or practice description also provides a rating, based on its evidence of various outcomes among older adults experiencing SMI.

Practice Selection

To ensure inclusion of the most useful interventions, authors required practices to meet the following criteria:

  • Be clearly defined and replicable
  • Developed or adapted specifically for older adults, or studied in populations aged 50 and older
  • Be currently in use
  • Include evidence of impact on targeted outcomes
  • Have accessible implementation resources

Causal Evidence Levels

Strong Evidence

  • Causal impact demonstrated by at least two randomized controlled trials, quasi-experimental designs, or epidemiological students with a high or moderate rating.

Moderate Evidence

  • Causal impact demonstrated by at least one randomized controlled trial, quasi-experimental designs, or epidemiological students with a high or moderate rating.

Emerging Evidence

  • No study received a high or moderate rating. The practice may have been evaluated with less rigorous studies (e.g., pre-post designs) that demonstrate an association between the practice and positive outcomes, but additional studies are needed to establish causal impact.

Evidence Review and Rating

The authors conducted a comprehensive review of published research for each selected intervention to determine its strength as an evidence-based practice. Eligible studies had to:

  • Employ a randomized or quasi-experimental design, or
  • Be a single sample pre-post design or an epidemiological study with a strong counterfactual (i.e., a study that analyzes what would have happened in the absence of the intervention)

Descriptive studies, implementation studies, and meta-analyses were not included in the review but were documented to provide context and identify implementation strengths and challenges for the practices.

Authors reviewed each individual study in this chapter for evidence of outcomes, such as improved social functioning, medication adherence, symptoms of a mental health disorder or condition, service utilization, and ability to live independently.

Causal Impact: Evidence demonstrating that an intervention causes, or is responsible for, the outcome measured in the study’s sample population.

In addition, trained reviewers checked each study to ensure rigorous methodology, by asking questions such as:

  • Are experimental and comparison groups demographically similar, with the only difference being that participants in the experimental group received the intervention and those in the comparison group received treatment as usual or no or minimal intervention?
  • Was baseline equivalence established between the treatment and comparison groups on outcome measures?
  • Were missing data addressed appropriately?
  • Were outcome measures reliable, valid, and collected consistently from the participants?

Using these criteria, the authors used a two-step process to assess the strength of each study’s methodology, and the causal evidence associated with each practice. Each study was given a rating of low, moderate, or high, based on the research methods. Only randomized controlled trials (RCT), quasi-experimental designs (QEDs), and epidemiological studies with a strong comparison were eligible to receive a high or moderate rating.

After authors assessed and rated all studies for a practice, they placed it into one of three categories based on its causal evidence level:

  1. Strong evidence
  2. Moderate evidence
  3. Emerging evidence

This chapter includes a text box for each intervention that lists improved outcomes in older adults with SMI receiving that intervention. Authors also included additional findings that may be relevant for mental health professionals to consider when addressing the needs of individual clients, but these outcomes did not count towards grading either the study or the practice.

Research Opportunities

Providers face the challenge of limited evidence, particularly from RCTs, when selecting programs and practices designed specifically for older adults with SMI. The limitations in the current evidence base include:

  • Some of the findings have not been replicated beyond a single RCT.
  • More recent RCTs are currently in process, and results are yet to be published.
  • Although many RCTs have been conducted on psychosocial interventions for people with SMI across the lifespan, most do not include enough older adults to evaluate if they are effective for the subgroup (i.e., adults aged 50 and older).
  • Older Black, Indigenous, and other people of color are underrepresented in most of the current research on interventions for older adults with SMI, limiting the generalizability of findings to an ethnically diverse population.
  • Research has not been conducted to identify effective approaches to implementing and sustaining evidence-based interventions addressing the needs of older adults with SMI.

Given the rapid growth of the older adult population, there is a need for more large-scale studies to better understand how to improve quality of life, functioning, and clinical outcomes for older adults with SMI, including for those with comorbid physical illness. As underscored by the 2012 Institute of Medicine Report on the mental health workforce for older adults, the growing numbers of older adults with SMI will require a workforce specifically trained to address the special needs of this high-risk group. [3] In addition, research is needed on interventions that leverage the use of technology, peer support, community-based outreach, and integrated psychiatric and medical care for older adults with SMI to extend the reach of geriatric specialty providers.

The studies discussed in this chapter confirm that psychosocial interventions are effective in older adults with SMI. Despite existing research supporting the impact of these evidence-based practices on key functional outcomes, there is a lack of uptake and implementation in usual care settings. A critical priority for future research is identifying optimal strategies that successfully implement, scale, and sustain these interventions in diverse community settings.

Assertive Community Treatment (ACT)

Overview

Assertive Community Treatment (ACT) is a team-based model that consists of a multi-disciplinary team working together to support adults with SMI. ACT aims to reduce hospitalization rates and help clients adapt to community living through intensive case management via an integrated team. The ACT team addresses the comprehensive needs of clients, including psychiatric medication, outpatient psychotherapy, employment, and housing.[1] Teams consist of approximately 10 to 12 providers, representing various disciplines. Team members meet regularly and maintain a small caseload.[2]

This intervention differs from general case management programs in that the ACT team provides comprehensive services directly to clients, rather than coordinating services across multiple, disconnected providers and agencies.[3] Services are flexible and delivered in the settings that the clients are comfortable with and at a frequency that they need. Treatment and support services are individualized, and the team proactively reaches out to clients, rather than expecting them to initiate engagement with services.[4]

Typical Settings

The ACT team meets with clients in the community where they already spend time, such as their homes or community institutions like libraries or parks.

Target Population

ACT is intended for adults with SMI who live in the community and experience challenges in engaging with traditional outpatient services that may not provide a cohesive team approach.

Practitioner Types

Typical ACT teams include case managers, behavioral health clinicians, psychiatric specialist prescribers, registered nurses, community health workers, and peer specialists, among others.

For example, the ACT team could consist of a substance use specialist, rehabilitation worker, social worker, psychiatric nurse, nurse specializing in care of physical health conditions, community mental health nurse, and psychiatrist.

Intensity and Duration of Treatment

ACT offers 24/7 support to clients for as long as they need services.

Scope of Evidence Review

This review included two studies: one RCT for adults aged 60 and older, rated high for study design,4 and one QED study that enrolled adults with an average age of about 50 years, rated moderate for study design.5 Most outcomes in the studies were long-term (18 to 24 months).

Study Intervention Design

In the RCT reviewed, only minor modifications for older adults were made to the traditional ACT model, which has demonstrated effectiveness for adults with SMI. [6-11] These modifications included the use of ACT team members, such as a psychiatrist, who specialize in treating older adults.[5] Of note, however, another study— which did not meet inclusion criteria for review in this guide—found that older veterans receiving an ACT program not adapted specifically for the needs of older adults nonetheless benefited from it in terms of their ability to continue living in the community.[6] Similarly, the QED did not note any modifications made to the model to adapt for older adults.

Outcomes Associated With ACT

Studies included in this evidence review demonstrated that use of ACT for older adults experiencing SMI was associated with increased:

  • Treatment initiation within 3 months of contact with a mental health worker[7]
  • Treatment retention at 18 months of enrollment[8]
  • Medication adherence at 24 months of enrollment[9]

Study Demographic Groups

Both studies met inclusion criteria for age and a focus on providing services to older adults with SMI. To participate in the study, the RCT required difficulty with functioning, and the QED required high hospital use in the past year. Clients with severe cognitive impairment (inability to speak, recall distant or recent events, or learn new information[10]) were excluded from the RCT.

Participants in the QED, which took place in a U.S. Department of Veterans Affairs setting, were predominantly male (89 percent), majority White (57 percent), and a substantial proportion had experienced homelessness in the prior year (22 percent) or had a current substance use disorder (43 percent). In analyses, ACT participants were matched to non-ACT participants on all demographic factors and a number of clinical indicators of symptom severity.

Cognitive Behavioral Social Skills Training (CBSST)

Overview

Cognitive Behavioral Social Skills Training (CBSST) is a treatment integrating cognitive behavioral therapy (CBT) and social skills training (SST) to address the needs of older adults with schizophrenia. CBSST aims to equip individuals with the skills to improve functioning and challenge defeatist beliefs through three modules:[11][12]

  1. Cognitive Skills Module—Based in CBT, individuals use thought challenging skills to examine their thinking and modify thoughts that interfere with healthy functioning behaviors. Targeted thoughts include beliefs about voices, events related to delusions, and defeatist beliefs that interfere with functioning behaviors, including self-efficacy beliefs and ageist beliefs (e.g., “I am too old to learn”).[13] The primary skill taught is the 3C’s:
    • Catch It (identify the thought)
    • Check It (examine evidence)
    • Change It (shift the thought)
  2. Social Skills Module—To improve communication skills, individuals engage in behavioral role plays focused on expressing feelings in an assertive and clear way while advocating for one’s needs with healthcare professionals; interacting with roommates, family, and friends; and engaging with service providers and support persons.
  3. Problem-Solving Skills Module—Problem-solving skills are taught using the acronym SCALE:
    • Specify
    • Consider possible solutions
    • Assess the best solution
    • Lay out a plan
    • Execute and evaluate the outcome

Participants develop plans to solve real-world problems specific to older adults, such as scheduling activities, taking medication, finding a volunteer opportunity, or obtaining eyeglasses or hearing aids.

Typical Settings

Practitioners can conduct traditional CBT in a variety of settings, including outpatient, inpatient, and partial hospitalization options.

Target Population

CBSST is designed for community-dwelling, middle-aged and older adults with an SMI diagnosis.

Practitioner Types

A wide range of practitioners trained to deliver CBSST, such as psychologists, clinical social workers, or psychiatric nurses, may lead sessions.

Intensity and Duration of Treatment

The treatment consists of 24 or 36 (see below) weekly 2-hour group therapy sessions, with a lunch or snack break (the pilot program consisted of 12 sessions, 90 minutes each).

Scope of Evidence Review

Three studies were included in this review; of which, one was rated high,[14][15] one moderate,[16] and one low for study design.[17] This gave the intervention an overall rating of strong support for causal evidence. Each study incorporated age-relevant modifications to CBSST. Modifications included repeating modules multiple times to compensate for age-related and SMI-related cognitive impairment, supporting increased skill acquisition, and encouraging engagement even with missed sessions. Content also identified and challenged ageist beliefs, included age-relevant role-playing situations, and focused on age-specific problems (e.g., finding transportation).[18]

Study Settings

These studies were conducted in outpatient settings, with one study providing transportation for participants to the intervention site. However, participants were recruited from both outpatient treatment centers and residential settings.

Outcomes Associated with CBSST

Studies included in this evidence review demonstrated that use of CBSST for older adults experiencing SMI was associated with statistically significant improvements in:

  • Independent functioning in the community
  • CBSST skills acquisition[19][20][21]

Study Demographic Groups

Participants ranged in age from 42 to 81, and the majority were unmarried White males with a high school education, living in assisted community housing (e.g., board and care homes). Participants were both veterans and non-veterans.[22][23][24]

Participants were excluded if they had:

  • Disabling medical problems that would interfere with testing
  • Prior exposure to CBT
  • A required level of care at baseline that would interfere with outpatient therapy (e.g., hospitalization)
  • An absence of medical records to inform diagnosis
  • A diagnosis of dependence on substances other than nicotine or caffeine within the past 6 months

Cognitive impairment was not an exclusion criterion, and one study demonstrated CBSST had comparable benefit to participants regardless of cognitive impairment.[25]

Mobile Adapted CBSST (MA-CBSST)

CBSST has been adapted to use a supplemental mobile device to reduce provider contact hours. CBSST sessions were reduced from 120 minutes to 60 minutes for the 24 weeks of treatment. Handheld personal devices prompted text-based, module-specific homework adherence, and participants completed brief self-monitoring ratings on moods, voices, current activities, and medication adherence three times per day. In older adults with schizophrenia or schizoaffective disorder, skill knowledge and self-reported functioning did not differ significantly between CBSST and MA-CBSST groups, and improvements among MA-CBSST participants were significant compared to the control group.

Study Practitioner Types

In the studies included in this review, psychotherapists, including doctoral-level and master’s-level practitioners with at least 2 years of CBT experience delivered sessions. Two practitioners led all group sessions. Two clinical psychologists provided training and supervision, including review of session videotapes.

Study Intensity and Duration of Treatment

Researchers taught each of the three modules weekly for four sessions. Each module was completed twice over 24 weeks. Subsequently, they increased the time for each module to 6 weekly sessions, increasing the duration of treatment to 36 weeks.[26] Overall, treatment adherence was high, with participants attending an average of 22 of the 24 group therapy sessions[27] or 30 of the 36 group therapy sessions.[28]

Social Skills Training: Functional Adaptation Skills Training (FAST) and Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos (PEDAL)

Overview

Functional Adaptation Skills Training (FAST) is a manualized behavioral intervention for older adults with schizophrenia or schizoaffective disorder. It is based on Social Cognitive Theory and the Social and Independent Living Skills Program.[29] The practice aims to improve patients’ independence and quality of life by targeting six areas of everyday functioning:

  1. Medication management
  2. Social skills
  3. Communication skills
  4. Organization and planning
  5. Transportation
  6. Financial management

Practitioners teach the 6 areas over four 120-minute long sessions, with content repeated and reviewed to maximize benefit to those with age-related cognitive impairment.[30][31] Group sessions consist of homework assignment and review, discussion around applying exercises to real world settings, and in-session practice of skills.

Each class is structured as follows:[32]

  • Establish the class agenda
  • Review the materials and skills learned in the previous session
  • Review homework assignments (generalization)
  • Hear a psychoeducational lecture teaching a new concept and/or skills
  • Have group or self-practice (e.g., behavioral modeling, role-playing, hands-on practice with props)
  • Develop individual homework

FAST was adapted to be culturally relevant for Latino older adults—specifically of Mexican descent—with schizophrenia or schizoaffective disorder. Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos (PEDAL) is based on the structure and content of FAST and shares the same aim to improve patients’ independence and quality of life.[33]

PEDAL was adapted in three stages from the FAST protocol:

  1. Measures, intervention materials, and manuals were directly translated into Spanish, back translated into English, and then compared by bilingual intervention group leaders. Modules were reviewed for cultural relevance and refinement by mental health professionals of Mexican descent.
  2. Materials were modified to include culturally appropriate scenarios, roles, and icons. For example, they incorporated foods, songs, telenovelas/soap operas, and proverbs common in the Mexican tradition.
  3. Format, content, and treatment goals were adapted to be based on Mexican values and cultural scripts. For example, materials incorporated concepts such as simpatía (the use of polite social relations) and personalismo (emphasizing warm relationships). In all modules, scenarios and examples were modified to reflect culturally normative gender roles among older adults of Mexican descent. The language of respect and hierarchical expectations in Latino culture were observed (i.e., use of formal style usted rather than the informal tú). Medication management sessions emphasized a sense of orgullo (i.e., pride) at contributing to the family by alleviating symptoms.

Typical Settings

Practitioners deliver FAST in board and care facilities, which house a sizable proportion of older adults with SMI. PEDAL participants live in the community with their families, and the intervention is delivered in outpatient psychiatric clinics, such as community mental health centers. Since the treatments are similar in structure, FAST and PEDAL have the potential to be delivered in both settings.

Target Population

FAST and PEDAL are designed to treat community-dwelling adults over age 40 with longstanding psychotic disorders (a diagnosis of schizophrenia, schizoaffective disorder, or psychotic mood disorder).

Practitioner Types

Trained research assistants (both FAST and PEDAL) and management or nursing para-professionals based in board-and-care facilities (FAST) lead group sessions. A wider range of mental healthcare professionals who are trained in the delivery of FAST or PEDAL and have experience conducting interventions in a group format could also lead sessions.

Intensity and Duration of Treatment

Group sessions for both FAST and PEDAL last 120 minutes and are held once weekly for 24 weeks. The pilot study for FAST was conducted semi-weekly for 12 weeks; the results indicated a need for a longer intervention duration. Following the weekly group sessions, participants receive monthly group sessions for 6 months to review and reinforce concepts learned during the intensive intervention.

Outcomes Associated With FAST and PEDAL

Studies included in this evidence review demonstrated that use of FAST and PEDAL for older adults experiencing SMI was associated with statistically significant improvements or reductions in:

  • Functional capacity in the community[34][35]
  • Psychiatric symptoms[36]
  • Social and communication skills[37]
  • Emergency service use[38]
  • Emergency service use for psychiatric reasons[39]
  • Medication management[40]

Scope of Evidence Review

This review included two FAST RCTs[41][42][43] and one PEDAL RCT of older adults with schizophrenia, schizoaffective disorder, or psychotic mood disorder.[44] All three studies were rated high for study design.

Study Demographic Groups

The FAST participants were racially and ethnically diverse, living in board and care facilities, and mainly high school educated males.[45][46]

The PEDAL participants were Latino, specifically of Mexican descent, and community-dwelling monolingual Spanish speakers or individuals who preferred to communicate in Spanish.[47]

Patients were excluded if they had a diagnosis of dementia or were a serious suicide risk, could not complete the assessment, or were participating in other psychosocial interventions or drug research at intake.

Study Practitioner Types

In the PEDAL RCT, therapists were bicultural and bilingual. The therapists in FAST were paired with a para-professional from the board and care facility management or nursing staff.

Integrated Illness Management and Recovery (I-IMR)

Overview

Integrated Illness Management and Recovery (I-IMR) is designed to assist older adults living with SMI and chronic medical conditions. The I-IMR program was developed by modifying the Illness Management and Recovery (IMR) program, which teaches physical illness self-management.[48] I-IMR aims to improve functioning and symptom outcomes for people with SMI and chronic medical conditions through the training of self-management for both psychiatric and general medical conditions by an I-IMR specialist, complemented by healthcare management provided by an onsite nurse or case manager.

The psychiatric focus of the intervention includes psychoeducation about illness and treatment, cognitive-behavioral approaches to increase medication adherence, training in relapse prevention, instruction about coping skills to manage persistent symptoms, and social skills training.[49]

The general medical illness component consists of an individually tailored curriculum that applies the same skills and strategies used for self-management of psychiatric illness. The psychiatric and medical components are fully integrated and administered concurrently with the perspective that “whole health” consists of common elements of mental health and physical health self-management. In addition, a nurse manager facilitates coordination and navigation of necessary preventive and ongoing health care.[50]

Typical Settings

I-IMR is administered in community mental health centers.

Target Population

I-IMR is intended for community-dwelling individuals aged 50 and older with SMI and co-occurring chronic health conditions.

Practitioner Types

An I-IMR specialist provides skills training. A nurse or health outreach worker provides complementary healthcare management.

Intensity and Duration of Treatment

I-IMR is delivered individually or in groups, through weekly sessions, over a period of eight months. Twice weekly sessions may also be offered. The program requires about 40 sessions to complete.

Scope of the Evidence Review

This review included an RCT, rated high for study design,[51] and a pre-post study, rated low for study design,[52] of older adults with SMI and co-occurring chronic health conditions. Two additional RCTs of I-IMR are currently underway.

Study Demographic Groups

The studies included participants with:

  • Diagnosis of schizophrenia spectrum, bipolar disorder, or major depression associated with pervasive impairment lasting at least one year across multiple areas of psychosocial functioning; and
  • Diagnosis of diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, ischemic heart disease, hypertension, hyperlipidemia, or osteoarthritis, with treatment received at a community mental health center for at least three months.

Outcomes Associated With I-IMR

Studies included in this evidence review demonstrated that use of I-IMR for older adults experiencing SMI was associated with statistically significant improvements in:

  • Psychiatric illness self-management
  • Diabetes self-management
  • Use of hospitalization
  • COPD self-management
  • Community functioning[53]

Participants were majority White (97 percent), and 55 percent were female.[54]

Participants were excluded for previous participation in the IMR program, residence in a nursing home or psychiatric hospital, diagnosis of dementia, terminal illness with life expectancy of one year or less, or moderate to severe cognitive impairment.

Study Practitioner Type

An I-IMR specialist with a master’s degree in social work conducted the intervention weekly for 8 months. The I-IMR specialist received 1.5 days of training in administering I-IMR. The training for the I-IMR specialist was based on the standardized program toolkit and manual.

Additionally, throughout the study, each specialist received a weekly call with a clinical psychologist with expertise in behavior change, motivational interviewing, and illness self-management.[55]

A primary care nurse was embedded 1 day per week at each mental health center to coordinate healthcare appointments, medication adjustments, transfer of medical records, and counseling on self-management and lifestyle changes for management of chronic health conditions. Participants met with the nurse healthcare manager twice per month to discuss progress and barriers to meeting health goals.[56]

Helping Older People Experience Success (HOPES)

Overview

The Helping Older People Experience Success (HOPES) program is designed to improve independent functioning of older adults with SMI living in the community and help them continue living in the community by teaching them social, community living, and healthy living skills. A nurse provides coordination of preventive care to individuals in the program.

Skills training is a main component in the HOPES curriculum, which includes the following skills modules:[57]

  1. Communicating effectively
  2. Making and keeping friends
  3. Making the most of leisure time
  4. Healthy living
  5. Using medications effectively
  6. Making the most of a healthcare visit
  7. Living independently in the community

Each standalone module consists of six to eight component skills, with one skill taught each week. Programs offer the modules on a rotating basis, so clients can join throughout the year. Clients receive a workbook to reinforce skills and are encouraged to identify a support person, such as a family member, friend, or individual clinician, to help them practice skills learned in the training group.[58] Clients also set goals for preventive health care and managing chronic medical conditions through monthly meetings with a nurse.

Typical Settings

The skills training session can be held in a variety of settings, such as a mental health clinic, rehabilitation center, or senior center.

Target Population

HOPES was developed for community-dwelling older adults with SMI and enrolled in mental health treatment.

Practitioner Types

Rehabilitation specialists co-lead the skills training (e.g., one bachelor’s-level clinician and one master’s-level clinician or nurse manager). A registered nurse provides the monthly health management.

Intensity and Duration of Treatment

HOPES participants complete 2 years of skills training: the first year consists of intensive hour-long weekly sessions, and the second year consists of monthly maintenance sessions. Participants also receive individual meetings with a nurse and participate in trips into the community to practice social skills in a variety of settings.[59]

Scope of the Evidence Review

This review included four studies, three of which were associated with the same RCT, which followed HOPES participants for three years following enrollment and was rated high for study design.[60][61][62] The fourth study was a pre-post pilot trial of an individually tailored HOPES model, rated low for study design.[63] The studies focused on community-dwelling older adults with SMI enrolled in mental health treatment for at least 3 months.

Study Intervention Design

One of the goals of the HOPES program is to teach the participants effective social skills for day-to-day living and interactions with the general community. To accomplish this objective, periodic trips to the outside community were scheduled. enabling the patients to practice skills (e.g., conversational) they learned in the group sessions in real world settings. These trips, which were planned jointly by the coaches and patients, occurred biweekly during the intensive phase and monthly during the maintenance phase. During the latter phase, patients were also encouraged to plan their own group outings.

Study Demographic Groups

The participants in the four studies were aged 50 and older, experienced impairment in multiple areas of life, and had a diagnosis of major depression, bipolar disorder, schizoaffective disorder, or schizophrenia. The participants were overwhelmingly White (86 percent) and non-Latino (93 percent) and were majority female (58 percent). Men consistently benefited more from HOPES than women, for reasons that are unclear.

Outcomes Associated With HOPES

Studies included in this evidence review demonstrated that use of HOPES for older adults experiencing SMI was associated with statistically significant improvements in:

Improved functioning and symptoms were maintained at 3-year follow-up. In addition, a secondary analysis of HOPES found that improved self-efficacy associated with HOPES was also associated with improved independent living skills.[76]

Exclusion criteria included residence in a nursing home, diagnosis of dementia, terminal illness with life expectancy of one year or less, or moderate to severe cognitive impairment. An additional RCT of HOPES is currently underway.

Study Practitioner Type

In the RCTs reviewed, one master’s-level clinician and one bachelor’s-level clinician co-led skills training sessions. A registered nurse provided the monthly health management, starting with a medical history and evaluation of healthcare needs, including preventive health care. In the pre-post trial, the coaches were trained to provide the intervention. They had varied professional backgrounds and included interns, case managers, and master’s-level therapists.

Citation

Substance Abuse and Mental Health Services Administration (SAMHSA). Psychosocial Interventions for Older Adults With Serious Mental Illness. SAMHSA Publication No. PEP21-06-05-001. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.

This work resides in the public domain, unless otherwise indicated.

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