Avaliação de Processo do Programa de Atendimento Cognitivo Comportamental para Pessoas Idosas com Depressão (PACCID)

Abstract

On the international scene, especially in the health area, there is a growing concern among professionals about using the best available evidence to base their clinical practices. This direction began in medicine around the 1990s, influencing other areas of health in recent years. In psychology, evidence-based practice (EBP) still faces challenges, such as disagreement among researchers about the best research method. The scenario worsens in the Brazilian context, in which, in addition to the challenges inherent to the area, it is necessary to deal with the deficiencies of national interventions, especially for the elderly, which generates the need for adaptations of international models. The present research aims to contribute to the advancement of EBP in the national territory, focusing on the elderly population affected by depression. Through the establishment of a process evaluation in the Cognitive Behavioral Care Program for Elderly People with Depression (PACCID), a psychotherapeutic program for elderly people treated in a public polyclinic, its implementation on Brazilian soil was evaluated. To achieve this, three works were extended. A book chapter, responsible for explaining how the process evaluation was planned; and two main empirical studies, expanded by quantitative and qualitative methods, responsible for evaluating: dose received; dose delivered; range; demand; fidelity; and contextual variables that impacted the delivery of the intervention. In the first 19 months of implementation of PACCID, 75 referrals from the geriatrics sector were found, with 23 people (30%) receiving psychotherapy through the program. The attendance rate varies between 36% and 100%. The percentage of completion of action plans was 60%. Difficulties were observed in implementing these plans and modifications to the intervention. The most used treatment module was the behavioral one, which was also one of the most modified (25%), along with the initial (25%) and emotions (25%) module. There was high satisfaction and engagement on the part of clients, with engagement being one of the therapist's main objectives when making decisions to change the intervention (71%). The majority of modifications (59%) were made after team meetings/supervision. Process evaluation studies were improved and were valuable for the perception and understanding of the variables that impacted the offering of an intervention in the field of mental health for Brazilian elderly people.