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Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)
Date of Review: March 2007

The Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) is an intervention for people 60 years and older who have minor depression or dysthymia and are receiving home-based social services from community services agencies. The program is designed to reduce symptoms of depression and improve health-related quality of life. PEARLS provides eight 50-minute sessions with a trained social service worker in the client's home over 19 weeks. Counselors use three depression management techniques: (1) problem-solving treatment, in which clients are taught to recognize depressive symptoms, define problems that may contribute to depression, and devise steps to solve these problems; (2) social and physical activity planning; and (3) planning to participate in pleasant events. Counselors encourage participants to use existing community services and attend local events.

Descriptive Info Outcomes Ratings Study Populations Studies/Materials Contacts

Descriptive Information

Topics	Mental health promotion
Areas of Interest	Older adults/aging
Outcomes	Outcome 1: Symptoms of depression Outcome 2: Health-related quality of life
Study Populations	Age: 55+ (Older adult) Gender: Female, Male Race: American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, White (See Study Populations section below for percentages by study)
Settings	Home, Suburban, Urban
Implementation History	PEARLS has been implemented in the Seattle, Washington, area through two local agencies, Aging and Disability Services (ADS) and Senior Services of Seattle/King County (SSSKC). ADS and SSSKC each implemented the intervention as part of the first evaluation study of PEARLS conducted by the developers in 2000-2003. ADS has continued to offer PEARLS since then; SSSKC began offering it again in 2005. At the time of review, 160 older adults had participated in PEARLS (94 in the main evaluation study plus 41 ADS clients and 25 SSSKC clients); the developers continue to recruit new participants as implemention is ongoing.
Replications	No replications were identified by the applicant.
Adaptations	No population- or culture-specific adaptations were identified by the applicant.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the applicant.
Public or Proprietary Domain	Mix of public and proprietary
Costs	The cost to implement PEARLS is about $630 per patient. This estimate is based on mean costs in the 2000-2003 study, which included problem-solving treatment sessions ($422), follow-up and psychiatric telephone calls ($40), psychotherapy quality assurance ($87), and depression management team sessions ($81).
Institute of Medicine Category	Indicated

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Outcomes

Outcome 1: Symptoms of depression

Description of Measures	Symptoms of depression were measured using the Hopkins Symptoms Checklist 20 (HSCL-20), a self-report instrument used for the diagnosis of major depression in adult primary care patients.
Key Findings	At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to have at least a 50% reduction in symptoms of depression (43% vs. 15%; p < .001) and to achieve complete remission from depression (36% vs. 12%; p = .002).
Studies Measuring Outcome	Study 1 (Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs	Experimental
Quality of Research Rating	3.6 (0.0-4.0 scale)

Outcome 2: Health-related quality of life

Description of Measures	Health-related quality of life in functional, physical, social, and emotional well-being domains was assessed using the self-report Functional Assessment of Cancer Therapy Scale-General (FACT-G). The FACT-G is a generic core questionnaire with 27 items targeted to management of chronic illness. It has been used and validated with individuals diagnosed with cancer and other chronic conditions and with the general population.
Key Findings	At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to report greater health-related quality of life improvements in functional well-being (p = .001) and emotional well-being (p = .048).
Studies Measuring Outcome	Study 1 (Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs	Experimental
Quality of Research Rating	3.4 (0.0-4.0 scale)

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Ratings

Quality of Research Ratings by Criteria (0.0-4.0 scale)

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
Outcome 1: Symptoms of depression	4.0	4.0	3.0	4.0	3.0	3.5	3.6
Outcome 2: Health-related quality of life	3.0	4.0	3.0	4.0	3.0	3.5	3.4

Study Strengths: The investigators employed commonly used measures with sound psychometric properties. No differential attrition was evident across groups. Attrition and missing data were minimal and were handled appropriately with good statistical analyses. The intervention was implemented with the use of a manual, therapists underwent training consistent with the standard in the field, and weekly meetings were held to review cases. The investigators adequately attempt to account for variables found to differ significantly among groups. The use of a randomized controlled trial design minimized potential confounding variables.

Study Weaknesses: The articles did not mention any development or use of a fidelity instrument. The FACT-G (used to measure health-related quality of life in the study) appears to be used in research with cancer patients. However, consistent support for the use of this measure for a wider population (i.e., adults over the age of 60) is lacking. The study sample was small and drawn from a single geographic area.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

Implementation Materials	Training and Support	Quality Assurance	Overall Rating
2.0	1.5	1.8	1.8

Dissemination Strengths: The program materials offer detailed information on problem-solving treatment and some information on organizational implementation. In-person training is available on an as-needed basis, and limited guidance and suggestions for program adaptation are available for problem-solving treatment. Quality assurance forms are provided to assist supervisors in monitoring implementation fidelity.

Dissemination Weaknesses: A step-by-step program implementation manual is not yet available. Supervisory guidance is not provided. The manual appears complicated enough to require in-depth training and support, yet implementers are not required by the developer to undergo formal, in-person training. No procedures are specified for collecting and analyzing program data to support quality assurance.

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Contact Information

Web site(s):

http://depts.washington.edu/pearlspr/

For information about implementation:

Sheryl Schwartz, M.P.A.
Associate Director, Program Operations
Health Promotion Research Center
University of Washington
1107 NE 45th Street
Suite 200
Seattle, WA 98105
Phone: (206) 685-7258
Fax: (206) 543-8841
E-mail: sheryls@u.washington.edu

For information about studies:

Paul Ciechanowski, M.D., M.P.H.
Associate Professor, Psychiatry and Behavioral Sciences
University of Washington
Box 356560
Seattle, WA 98195-6560
Phone: (206) 543-8848
Fax: (206) 221-5414
E-mail: pavelcie@u.washington.edu

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The NREPP review of this intervention was funded by the Center for Mental Health Services (CMHS).