SWG 571 Module 12 Intervention and Treatment Plan Paper: Three Interventions for a Widowed Older Man Example

Safety, Activation and Connection: A Treatment Plan for Late-Life Depression After Loss

Student Name

Master of Social Work, Arizona State University

SWG 571: Mental Health Aspects of Aging

Instructor Name

Month Day, Year

Safety, Activation and Connection: A Treatment Plan for Late-Life Depression After Loss

Introduction

This plan continues the case of Harold, a 78-year-old widower in Mesa whose initial assessment suggested a depressive episode with suicide risk, increased drinking, social isolation and memory complaints. Following the assignment, I first state the assumptions I have made about the completed assessment, then describe three interventions from a social work perspective.

Assumptions From the Comprehensive Assessment

I assume the following results. On the Columbia Suicide Severity Rating Scale, Harold endorsed passive thoughts of wishing he were dead in the past month, with no plan, intent or past attempts. His Geriatric Depression Scale score was 11 of 15, consistent with depression. His AUDIT-C score was 6, indicating hazardous drinking. His Montreal Cognitive Assessment score was 25, just below the usual cutoff, which his physician attributes provisionally to depression, poor sleep and alcohol rather than dementia; it will be repeated in three months. His physician found no new medical cause for weight loss, adjusted his diabetes medication and agreed to consider an antidepressant. Hearing aids have been ordered. Harold agreed that his daughter may be involved, and he is willing to have a social worker visit his home.

Intervention 1: Lethal-Means Counseling and a Safety Plan

Because suicide risk is the most urgent concern, the first intervention is a collaborative safety plan, a brief intervention in which the client and worker write down warning signs, coping strategies, people and places that provide distraction, trusted people to call, clinicians and crisis lines, and ways to restrict access to lethal means (Stanley & Brown, 2012). In the first home visit, I would ask Harold what he notices when evenings get hardest, list two activities that help, such as working in his garage or calling his brother, and record his daughter's number, his physician's office and the 988 Suicide and Crisis Lifeline. For means safety, I would explain without judgment that firearms in the home raise risk during periods of depression and ask whether his daughter could store the rifles temporarily, framing it as a step he controls and can reverse later.

Measurement: the plan is complete when it is written and stored where Harold can see it; the firearms are confirmed as stored outside the home; and the suicide screening is repeated at every contact.

Intervention 2: Home-Based Problem-Solving and Behavioral Activation With Collaborative Care

The second intervention addresses the depression directly. I would deliver eight home sessions over about four months modeled on PEARLS, a program for older adults that combined problem-solving treatment, social and physical activation and recommendations to physicians about medication. In a randomized trial among older adults with minor depression or dysthymia, 43% of PEARLS participants cut their depressive symptoms at least in half by 12 months, against 15% of those in usual care (Ciechanowski et al., 2004). Harold's depression appears more severe, so I would also coordinate with his physician in a collaborative care model, which in the IMPACT trial doubled the share of older adults with a 50% reduction in symptoms, 45% versus 19% (Unützer et al., 2002).

In sessions, Harold would choose a problem, such as missing appointments or empty evenings, generate options, pick one and try it before the next visit. Activation goals would start small: one walk a day, one call to a friend each week and one visit to the senior center by session four.

Measurement: the Geriatric Depression Scale at each session, a log of planned versus completed activities and the AUDIT-C at sessions four and eight, aiming to keep drinking to one beer or less per day.

Intervention 3: Referral to a Grief Support Group and Reconnection With Community

The third intervention addresses isolation and loss. I would refer Harold to a weekly bereavement support group for older adults at a local hospice, explaining that the group leader would offer a structured space to talk about his wife's death with others facing similar losses and to learn ways of coping. I would also help him re-enter the senior center by arranging transportation and introducing him to its men's breakfast, and, with his permission, contact his pastor about home visits. With hearing aids in place, group settings should become less exhausting.

Measurement: attendance at four of the first six group sessions; at least two community activities a week by month three; and Harold's own rating of loneliness on a 1-to-10 scale at each home visit. If attendance drops, I would ask what got in the way and adjust, for example by finding a group at his church.

Conclusion

The plan moves from safety to treatment to connection. Each intervention is specific, uses Harold's strengths and is measured, so that the team can tell whether he is improving and change course if he is not.

References

Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., Kulzer, J., Gray, S., Collier, C., & LoGerfo, J. (2004). Community-integrated home-based depression treatment in older adults: A randomized controlled trial. JAMA, 291(13), 1569-1577. https://doi.org/10.1001/jama.291.13.1569

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H. B., Areán, P. A., Hegel, M. T., Tang, L., Belin, T. R., Oishi, S., & Langston, C. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288(22), 2836-2845. https://doi.org/10.1001/jama.288.22.2836