The Omnibus Budget Reconciliation Act of 1987 (OBRA), and the inclusion of psychologists as independent practitioners in Medicare has led to increased interest in, and clinical activity with older adult nursing home residents. The aim of OBRA was to improve the quality of nursing home care. While its major effects have been to decrease use of psychotropic drugs, and physical restraint, OBRA has also highlighted the need to focus on nursing home residents' quality of life. The inclusion of psychologists into Medicare, with its emphasis on medical necessity, and without (up until 1995) any strong managed care influences, has opened the doors for psychologists to contribute to the care given to nursing home residents. It has long been known that psychologists provide valuable, much needed services to older adults. Emerging areas of interest for practitioners and clinical researchers in Division 20 include qualifications of geropsychologists, practice standards for psychologists working in nursing homes, and continuing education opportunities. This column will highlight the ongoing work of two task forces and describe an upcoming conference to be sponsored by Division 20 on Late Life Depression.
Task Force Work Ongoing
George Niederehe has provided the leadership for an interdivisional task force named the "Geropsychology Qualifications Task Force". Its focus is upon defining the field of geropsychology, particularly at the proficiency level. This has included determining what aspects of geropsychology practice are unique, and which aspects are shared with other specialties (i.e. clinical, health or neuropsychology). The task force was split up into two groups: determining aspects of training, and aspects of practice. In the next few months the task force will circulate a draft of their proposal. The work of this task force will ultimately lead to an application for a proficiency in clinical geropsychology.
Deborah Frazer and Royda Crose are leading a task force of Psychologists in Long Term Care (PLTC) to develop practice standards for psychologists who work in nursing homes. A preliminary draft of the task force's work will be published in the February 1996 PLTC newsletter. It includes types of providers, methods of referral, assessment guidelines, the process of treatment and documentation, a focus on outcomes, and ethical principles. The task force will welcome written or verbal feedback from anyone interested in these important issues.
Spring Conference on Late Life Depression
The 1991 NIH Consensus statement on late life depression was a landmark development, and key contributions from psychologists Linda Teri, George Niederehe, and Jane Pearson were made. Nevertheless, psychosocial treatments received relatively less attention than they deserved. It was thus very exciting in 1994 when Forrest Scogin and Lisa McElreath published their quantitative review on the effectiveness of psychosocial treatments for late life depression in the Journal of Consulting and Clinical Psychology. Scogin and McElreath reported that treatments were highly effective, and should be considered as a primary means of treatment. The treatment of geriatric depression is thus ever increasing among practitioners.
Division 20, along with the Institute of Gerontology at Wayne State University and the Rehabilitation Institute of Michigan are building on this interest by sponsoring a one day workshop on late life depression on Tuesday May 21st in Troy Michigan (near Detroit). The workshop was made possible by the Retirement Research Foundation, and in particular, by the support and encouragement of John Santos, Ph.D. an RRF board member, and one of the creators and leaders of Clinical Geropsychology.
The workshop is geared toward practitioners, and will include three plenary sessions and three workshops. The goal of the workshop is to cover a broad spectrum of issues, and will focus on assessment, therapy, gender and practice management issues. Forrest Scogin will provide an overview of the effectiveness of psychosocial treatments of older adults. I will examine pitfalls in the assessment of depression versus dementia. Royda Crose will present on how men and women experience depression, and the implications for treatment. Paula Hartman-Stein will describe how to work with Medicare and provide survival strategies for practitioners. Ann Horgas and I will discuss the special issues that arise in depressed medical and nursing home patients. Finally, Steve Aronson will describe psychiatric treatments for patients refractory to traditional treatments.
The workshop registration will be $95.00. Please call Janice Freytag to receive registration information and a brochure. Her phone number is 313-577-1180, and her Fax is 313-577-7560. Her address is Continuing Medical Education, Wayne State University, 48 UHC DMC, Detroit, MI 48201.
To direct comments about the information contained in these pages, please write to marsiske@ufl.edu