Psychosocial Interventions for Older Adults With Serious Mental Illness
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:
- Assertive Community Treatment (ACT)
- Cognitive Behavioral Social Skills Training (CBSST)
- Skills training practices, specifically Functional Adaptation Skills Training (FAST) and Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos (PEDAL)
- Integrated Illness Management and Recovery (I-IMR)
- 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.
In addition, trained reviewers checked each study to ensure rigorous methodolog