Current issues of ACP Journal Club are published in Annals of Internal Medicine

Resource Corner

Evidence-Based Behavioral Health Practices for Older Adults: A Guide to Implementation


ACP J Club. 2007 Sep-Oct;147:A10. doi:10.7326/ACPJC-2007-147-2-A10

Levkoff SE, Chen H, Fisher JE, McIntyre JS (eds). Evidence-Based Behavioral Health Practices for Older Adults: A Guide to Implementation. New York: Springer Publishing Company, 2006. This book can be obtained from for $48.

The main purpose of Evidence-Based Behavioral Health Practices for Older Adults by Levkoff and colleagues is to provide guidance on implementation of evidence-based behavioral health practices with the goal of improving service delivery for older adults. The target audience is health care providers for this population, including program administrators, health care professionals in the fields of mental health and/or geriatric services, and those involved in education related to these areas. The book outlines a systems approach to implementation of evidence-based practices (EBPs) in mental health services.

In chapter 1, the authors discuss 4 steps in the identification of EBPs: identifying the target population, researching EBPs for the target population, deciding on the EBPs, and determining what to do if no EBP exists. Chapter 2 focuses on procedures for assessing an organization's readiness to implement EBPs, including barriers to change and maintaining awareness of emerging practices. The next 2 chapters focus on quality management in evidence-based service programs and culturally grounding EBP.

Chapter 5, on the assessment and treatment of depression, anxiety, and substance use disorders, begins with a discussion about the diagnosis and prevalence of depression. This discussion is followed by guidance on the assessment of depression in specific settings (e.g., medical, community-based, and frail populations) for both planning and monitoring treatment. It then discusses effective evidence-based treatments for these patients. The authors follow a similar format to address anxiety and substance use disorders in older adults, and then dementia and schizophrenia.

Other chapters review assessment and screening issues, methods of delivery of evidence-based prevention, and intervention programs for older adults with behavioral problems. The authors point out that there is little empirical evidence for these models to date and highlight the need for further research in this area. The final chapter, on moving toward sustainable services, considers the issue of cost-effectiveness of EBP programs and sustainability using a case review as an illustration.

This book is aimed at the U.S. health care system, which may limit its utility in other settings. However, it could be useful for persons involved in delivering health care to the aged.

Alison Ward, Bpsych, PhD
Department of Primary Health Care, University of Oxford
Oxford, England, UK