Presentation Outline
       1.   Why Minimum Data Set (MDS) 2.0 Mood Section was 
            Changed to use the PHQ 9?
       2.   Homecare Depression Care Management  (DCM) 
            Protocol
            a.    A Model for Nursing Home Social Work 
       3.   Role of the Social Worker in DCM
            DARE Criteria:                                                     
                  A Tool for Interdisciplinary Planning
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         Why were MDS 2.0 Mood Items 
         Replaced in the MDS 3.0?
       Old mood item:
            Repeatedly shown to have poor correspondence 
             with independent mood assessment
                Does not comport with accepted standard of 
                self-report
                Requires time consuming systematic 
                observations of ALL residents across all shifts.  
                Difficult to achieve.
            Questionable utility for gauging response to 
             treatment, since appropriate approach is targeting 
             DSM-IV signs and symptoms
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         Why Mood Items Replaced (Cont’d)
       New cognitive item (PHQ-9) 
            Based on DSM-IV criteria
            Validity well established in other settings
            Increasing use and recognition by clinicians
            Allows threshold definition AND severity definition 
             that can track change over time
            Has been used in outpatient elders, hospital, 
             rehabilitation (post stroke) and home health 
             populations in addition to younger adult populations
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          Research and NH Validation Study Staffs 
          rated MDS 3.0 Section Improved 
         87% nurses and interdisciplinary facility staffs rated 
          the mood section as improved over 2.0 section
             Only 22% reported that 2.0 section was easy to 
              complete accurately
         88% felt PHQ-9 interview was better than 2.0 
          observation for capturing resident mood
         84% felt the items could inform care plans
         86% reported that items provided new insights into 
          mood
         77% felt that all residents who answered understood 
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          items (6% disagreed)
         78% rated ability to calculate score helpful (4% 
          disagreed)
           Evidenced-Base for the Homecare Depression 
           Care Management  (DCM) Protocol
         Training in Assessment of Depression (TRIAD) trial found 
           that HHA nurses can be effectively trained in depression 
           assessment.   
                           - Martha Bruce, Journal of the American Geriatric Society, 2007
         Depression care management (DCM) protocol, called the 
           Depression CARE of PATients at Home (CAREPATH) 
           intervention, can be used as part of routine care and can 
           be integrated into HHA software. 
                                                - Bruce, Home Healthcare Nurse July 2011 
         Components and utility of DCM and CAREPATH, the PHQ 9 
           cut points and antidepressant are described in a follow-up 
           article.                           - Bruce, Home Healthcare Nurse Sept. 2011
           08/27/2022                                                                  6