A successful Telewellness Program is a collaboration of senior-serving organizations using technology-based tools to support the mental health and wellbeing needs of older adults. It should be able to assess baseline measures, produce positive community impacts, and help residents understand, discuss, and address mental health and wellness challenges.

Other reasons for measuring impact through data:

  • Evaluating success
  • Evaluating the areas that need improvement
  • Providing a basis for funding and staff resourcing opportunities

Several key program ingredients will be critical to ensure continued success and sustainability. The engagement and involvement of key community stakeholders as champions will serve as important site organizers and coordinators of their respective communities. Each community will need a staff member responsible for outreach, project recruitment, marketing, and the coordination/delegation of addressing technical support issues–in affordable housing communities, this role typically falls upon a resident/social services coordinator.

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  1. Assessing community culture; establish staff and resident receptiveness

    Assessing your community’s culture is a critical step to creating a safe space for mental health conversations and counseling services. Here are some questions to consider:

    • What’s the need, and how do you identify it?
    • Do service coordinators, management, and/or residents see signs in the community that mental health concerns are not being met?
    • What is the community’s overall reception in discussing mental health?
    • What are the cultural stigma and linguistic barriers to consider?

    Cultural sensitivity to mental health discussions plays an oversized role in deploying your Telewellness Program. It is important to ensure that therapy and counseling providers pay attention to a community’s cultural and linguistic needs because culturally-appropriate approaches build trust, rapport, and reduce stigma—creating these conditions is essential to engaging with residents.

    Establishing a staff champion is key to assessing community readiness. This champion is typically a staff service coordinator; assigning such a role to a resident volunteer can create problems in maintaining privacy and complying with HIPAA regulations. While residents can play a positive role in advocating for mental wellness programs for their peers, a committed staff member working alongside others in a team to lead the program will help build the safe environment necessary to introduce these conversations.

    A community’s reception to launching a Telewellness Program works differently depending on the staff’s own engagement and understanding of mental health support for residents. Staff training is therefore important in sensitizing the language we use to talk about mental wellness, and addressing the cultural nuances in a community that could make or break a successful program.

    Staff champions help link residents to services by acknowledging the early signs of behavioral health issues and residents’ emotional and relational needs. Staff members receiving basic mental health training for non-behavioral health professionals will help advocate for the program, coordinate services, and connect residents to resources.

    The staff champion’s roles and responsibilities include:

    • Understanding the community’s mental health and wellness needs.
    • Developing a basic Telewellness Program plan and advocating for its purpose, values, and beliefs in everyday, non-stigmatic language.
    • Drawing upon own personal recovery experience with telewellness or of mental health experience or someone’s experience with specific mental health issues to validate service candidates’ lived experiences in non-stigmatic ways, which may be more persuasive.
    • Encouraging residents to help develop strategies to reduce self-stigma by being able to identify it, normalizing conversations about mental health, and recommending to others in need of help to seek out the program’s services.
    • Imparting that counseling and therapy are important complements to residents’ faith or religious beliefs.
    • Having an cultural understanding of the residents’ perceptions of mental health and mental health services.

    Staff training on being able to spot, handle, and support mental health needs is important to your program’s success. (We discuss this a little more in Part V, on developing resident and staff trainings.)

    How we did it...

    Our clinical partner SSG SILVER for the Telewellness Program created a guide to support our resident service coordinators on basic training on mental illness. This resource includes updated clinical guidelines to help staff identify early signs of mental illness and respond to residents’ emotional needs in a timely way. The guide can be discussed and studied in a group facilitated by mental health providers before the implementation of the Telewellness Program in the community.

  2. Assessing community need and impact: baseline surveys, behavioral health tools; tracking and reporting during program

    Resident mental health and wellbeing is a critical issue in affordable housing. A 2021 LeadingAge survey of affordable housing providers found that to the question “What do you anticipate as the top operational challenge in the next three months,” over 57.9% responded that resident mental health was the top concern, followed by staffing/workforce (54.5%) and financial challenges (33.9%). An important way to understanding the community’s mental wellbeing needs is to start with the people most connected to the older adults in the community: resident service coordinators, managers, social workers, and other staff.

    Data is an important part of our story. When we share the successes of our project at FPCIW, we mention that 95% of residents in our pilot said that their counseling sessions helped them address their emotional concerns, or that 71% said that their online counseling experience was just as good as in-person sessions. Data helps us measure the impact of our work.

    What data we collect, when we collect it, and how we collect it depend on factors such as time, cost, and privacy considerations. There is an array of data tools that measure impact and help craft a narrative of serving the mental health needs of older adults using technology: pre- and post-surveys, focus groups, interviews, and other tracking information to help establish baseline conditions and the effectiveness of your program. Whether you’re simply counting the number of people attending a workshop on depression or anxiety, or evaluating behavioral health changes through Patient Health Questionnaire (PHQ) screeners, data is important to linking impact to stories—and providing these surveys in-language to all of your residents is paramount.

    Following are some examples of survey tools we created:

    Using data tools that are publicly available will help to further shed light on the impact of your Telewellness Program on social engagement and loneliness. Note that if you’re going to use a survey or part of a survey formally created by a researcher, be sure that the tool is royalty-free or that you have permission to use it. Participants of our Telewellness project used the following surveys such as:

    When evaluating the impact of your program, depending on your goals, reporting of your findings is an important part of your story. A number of survey tools are available to provide you with a brief analysis of data such as SurveyMonkey. Another important resource to consider would be to partner with a local research university—faculty and student researchers are sometimes open to providing pro bono research services to community-based efforts.

    Your mental health service provider is a critical source of data. Once you’ve identified your provider, be sure to ask them to report on the number of clients and therapy sessions conducted, and any general information they can offer that comply with patient privacy and HIPAA regulations.  One important challenge to consider is striking the right balance between collecting meaningful data and residents’ concerns for privacy and time. Your community members may sometimes find that surveys and forms are intimidating and invasive. While data is necessary to assessing your program’s impact, it needs to take a measured tone in length and sensitivity.

    How we did it...

    FPCIW hosted a series of mental health webinars between June and November of 2021. The topics presented by a community health agency included “Dementia and Brain Health”, “Hoarding and Decluttering”, “Depression”, “Alcohol Use Disorder”, and “Sleep”.

    The live webinars were offered at a Front Porch community in Northern California in English and Cantonese through a large screen monitor in a meeting room. This form of livestreamed educational content served to encourage resident socialization after months of social distancing and lockdowns, educate residents on mental wellbeing, and increase their comfort level with virtual meetings.

    Evaluation surveys were provided after each session. All five seminars proved to be very popular, though the most valuable sessions rated “very valuable” by the participants were on hoarding (65.5%), alcohol use disorder (65.2%), sleep (61.9%), and depression (60%). The first webinar focused on dementia was rated as “very valuable” by only 52% of the participants and had the most people who didn’t find value in it (12%). The webinars were generally perceived as highly valuable by nearly all participants and seen as a tool for making or reinforcing friendships within a community where feelings of loneliness were common.

    To read the full program pilot evaluation at the community by Dr. Aaron Hagedorn, click here.

    According to a summary of issues our clinical partner provided us, our older adult residents discussed a wide range of conversations and subjects with their counselors and therapists:

    • Relationship conflict with family
    • Caregiving role for adult child and grandchild
    • Loneliness
    • Adjustment difficulty to sudden diagnosis on memory loss
    • Grief issues
    • Loss of function (i.e. driving)
    • Conflict with management
    • Dealing with life-long trauma
    • Abuse and neglect
    • General aging issues
    • Health deterioration
    • Sudden illness

    are intimidating and invasive. While data is necessary to assessing your program’s impact, it needs to take a measured tone in length and sensitivity.