title: Implementation of an evidence-based depression care management program (PEARLS): perspectives from staff and former clients.
abstract: BACKGROUND
  Although researchers develop evidence-based programs for public health practice, rates of adoption and implementation are often low. This qualitative study aimed to better understand implementation of the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), a depression care management program at a Seattle-King County area agency on aging.
  
  
  METHODS
  We used stratified, purposive sampling in 2008 to identify 38 PEARLS clients and agency staff for participation. In 9 focus groups and 1 one-on-one interview, we asked participants to identify benefits and negative consequences of PEARLS, facilitators of and barriers to program implementation, and strategies for overcoming the barriers. Two independent researchers used thematic analysis to categorize data into key themes and subthemes.
  
  
  RESULTS
  PEARLS benefits clients by decreasing depression symptoms and addressing other concerns, such as health problems. For staff, PEARLS provides "another set of eyes" and is a comprehensive program to help them meet clients' mental health needs. Barriers included issues with implementation process (eg, lack of communication) and the perception that eligibility criteria were more rigid than those of other agency programs. Recommended solutions included changing eligibility criteria, providing additional staff training, increasing communication, and clarifying referral procedures, roles, and responsibilities.
  
  
  CONCLUSIONS
  Barriers to PEARLS delivery discourage referrals to what is generally viewed as a beneficial program. Implementing participants' strategies for overcoming these barriers can enhance delivery of PEARLS to a greater number of older adults and help them improve their depression symptoms.
authors.affiliation: University of Washington Health Promotion Research Center, 1107 NE 45th St, Suite 200, Box 354804, Seattle, WA 98105, USA. lesles@uw.edu
authors.forename: Lesley
authors.initials: L
authors.lastname: Steinman
authors.forename: Margaret
authors.initials: M
authors.lastname: Cristofalo
authors.forename: Mark
authors.initials: M
authors.lastname: Snowden
mesh_terms: D019090:Case Management; D003153:Community Health Services; D003863:Depression / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D015397:Program Evaluation; D011635:Public Health Administration; D014861:Washington / Q000453:epidemiology