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  Serving Older Immigrants, Refugees, and Migrants in Illinois

Depression Project Summary

  The Coalition of Limited English Speaking Elderly (CLESE), in collaboration with White Crane Wellness Center and six community-based ethnic organizations, addressed depression in ethnic elderly in four language/culture communities: Chinese, Korean, Polish and Spanish. 

  Various studies indicate that the prevalence of depression is higher among immigrant, refugee and migrant elderly than in the mainstream population, but there is a lack of understanding and acceptance of depression as a treatable illness in ethnic communities.  Misconceptions and the stigma of mental illness prevent depression from being identified and treated.

 The project built on the successful experience White Crane Wellness Center established in addressing depression in mainstream elderly through group sessions that educate, build self-esteem and empower people with depression to cope.  The White Crane Wellness Center geriatric social worker complied an extensive resource manual to provide background information, materials and activities that ethnic-specific, community-based agency representatives could use in facilitating groups sessions.  White Crane provided on-going support through individual mentoring and a total of eight meetings in addition to a one day training.  For the White Crane Wellness Center curriculum used in the eight week small group sessions, click here.

Project Goals and Accomplishments

1. To improve ethnic agency staff knowledge and understanding of depression in older people through training. First, staff from participating ethnic provider agencies attended an initial planning meeting and discussed the words to use to talk about depression with elders in their community. Next, staff attended a day-long training session conducted by the White Crane Wellness Center’s geriatric social worker. Finally, the trained staff conducted sessions on depression for a total of 958 other staff within their agency. The result: the group facilitators expressed the depth and breath of their learning on the training evaluations. The staff that they subsequently trained now show better understanding of clients and have referred potential elders to the program. The ethnic agency leaders compiled a list of culturally and linguistically appropriate mental health resources; most of the lists included at least one psychiatrist or mental health facility.
    
2. To improve knowledge and understanding of depression in ethnic communities through an awareness campaign conducted in ethnic media. Each participating agency had a story published in ethnic media. Several agencies received inquiries on the program as a result.
    
3. To improve the ability of 160 older people to cope with depression through an eight week course that teaches coping strategies, enhances self-esteem and provides socialization. A total of 224 older adults attended at least one session. Facilitators modified the sessions to be culturally appealing; one began with a tea ceremony and another incorporated yoga into the scheduled activities. Pre and post tests asked three questions; participants improved on all three measures after the sessions concluded. Both participants and facilitators rated the sessions a life-changing success.
    
4. To improve 50 primary care physicians’ awareness of depression as a treatable illness through letter and phone call contact. A total of 90 letters were sent and 60 follow-up phone calls made. Two participants began taking anti-depressant medication during the course of the project.

Project Significance

  The initial discussion with the ethnic agency representatives was illuminating: the agencies said they would not use the word depression in recruiting potential participants to the program primarily because of the stigma attached to mental illness in all of the cultures represented. They each created a unique name for their groups; for example, the Polish group was “Happy Bus,” the same as a popular radio program that aired in Poland when the potential participants were young.

  The geriatric social worker conducted a one day training for all the group facilitators in which the participants engaged in activities they would later lead. Each agency received a large manual with an outline for the eight weeks and a variety of handouts for activities designed to improve coping skills and adaptations to loss. The social worker explained methods for engaging groups of older adults and continued the discussion of how depression is manifested in each ethnic community. The training received superlative evaluations.

  As part of the screening to place appropriate elders into the project, all agencies asked two questions of potential participants: “In the past month, have you been bothered by

• little interest or pleasure in doing things?
• feeling down, depressed or hopeless?”

  A total of 934 older adults were screened; 495 answered yes to one or both questions. Some who answered “yes” chose not to attend the sessions; some who answered “no” asked to participate.
Two series of eight week sessions were held. All six participating provider agencies began their first set of sessions in February. Almost immediately, they were overwhelmed at the interest older adults had in participating. One participant walked over a mile to each meeting in very bad weather; more than 25 people enrolled in three of the groups. Pre and post tests were administered at the beginning and the end of each eight weeks; the participants answered more affirmatively after both sets of sessions.
Socialization is effective in alleviating mild cases of depression. In the meetings of the group facilitators, they related group discussions that illustrated how quickly the participants in the groups developed trust, freely shared their experiences and feelings and nurtured growing friendships. One participated shared the story of her attempted suicide, an incident she had carried in secret for decades, and received understanding and comfort from the other participants. In another group, a participant shared a worry he had not felt comfortable telling his family; the group helped him solve his dilemma. Participants in four groups continued to stay in contact after the conclusion of the first eight weeks and the second eight week sessions. One participant said, “Now that we have someone to talk to, we don’t have to be depressed any more.”

  The facilitators became adept at adapting the suggested activities for their own groups, in ways that were culturally appropriate. One Korean group began each meeting with a tea ceremony. The Chinese group incorporated yoga exercises at the end of each meeting. The Polish group brought in speakers; after one meeting a psychologist was approached by several participants who wished to make private appointments with her. The meetings of all the facilitators proved valuable for their borrowing ideas from each other. The Polish group asked participants to list their top five worries; the entire group only generated 13 different responses. Then the participants suggested ways to cope with these worries. One Korean group repeated the exercise at their next session with similar results.
The two goals for which it is most difficult to gauge overall success were the story placed in ethnic media and the letter campaign to the ethnic physicians. There were positive responses to both initiatives and they will be repeated.

  The project has major significance for the Coalition of Limited English Speaking Elderly: it demonstrates that depression can be successfully addressed in ethnic communities. With proper training, staff can be helped to understand the value of talking about depression and encouraged to help the older adults they serve. The group sessions confirmed the value of this process in helping elderly build self-esteem and develop improved coping skills.

  CLESE and White Crane Wellness Center gave a presentation at the Mental Health and Aging Conference on April 20, 2007, sponsored by the Illinois Department on Aging, the Division of Mental Health within the Illinois Department of Human Services and the Illinois Coalition on Mental Health and Aging. CLESE was asked to present information on the project at the Gero-Psychiatric Initiative presentation for the Illinois Department on Aging’s Older Adult Services Advisory Committee the following month.

  The Service Systems Coordinator for the Division of Mental Health invited the CLESE executive director to serve on the Geriatric Advisory Council, which advises the Department of the mental health needs of older adults.  

  In this position, CLESE can effectively advocate for services and programs targeted to immigrant and refugee elderly.

Coalition of Limited English Speaking Elderly
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