The NC Center for Health and Wellness (NCCHW) at UNC Asheville has received a $1.2 million federal grant to expand programs that help older adults and adults with disabilities manage chronic health conditions while strengthening connections between aging services and behavioral health providers.

The three-year grant from the US Department of Health and Human Services Administration for Community Living (ACL) will support PATH NC: Promoting Access to Total Health NC. The project will expand access to Chronic Disease Self-Management Education, or CDSME, programs while placing a particular emphasis on older adults experiencing depression, anxiety and other stressors.

“The growing population of older adults in North Carolina is at higher risk for depression, anxiety, and other stressors related to chronic conditions, loss of loved ones, and social isolation,” said Vivian Gettys, PATH NC project director for the NCCHW.

Recognizing those mental health challenges can be difficult. Gettys said depression among older adults is often underdiagnosed because symptoms may present as physical complaints, such as headaches or lack of energy, rather than feelings of sadness. Stigma can delay people from seeking help, while behavioral health workforce shortages, transportation challenges and geographic barriers can further limit access, particularly in rural communities.

PATH NC is designed to address some of those gaps by strengthening connections among aging, disability and behavioral health networks and increasing access to community-based health programs.

One of those resources is CDSME, which is offered statewide at no cost through grant funding and is intended to complement, rather than replace, clinical care. Workshops are led by trained peers, including facilitators with lived experience, and focus on helping participants build the skills and confidence to manage their own health.

“CDSME workshops are highly participative and provide mutual support in comfortable, accessible community settings such as senior centers, libraries, and churches,” Gettys said. “Participants learn practical skills and connect with others to empower them to manage their health more proactively and maintain active, fulfilling lives.”

Participants typically meet in groups of eight to 12 for 2.5 hours each week over six weeks. Topics include managing stress, fatigue, depression, pain and isolation; physical activity; medication use; healthy eating; communication with health professionals and family members; and making informed treatment decisions. Participants also create weekly action plans based on their individual priorities and receive support from the group as they work toward their goals.

PATH NC will also support Walk with Ease, an evidence-based Arthritis Foundation program that helps participants develop walking plans, safely incorporate exercise and manage pain, as well as the Program to Encourage Active, Rewarding Lives, or PEARLS.

PEARLS is a one-on-one program for older adults experiencing depression. Trained coaches work with participants on managing depressive symptoms, increasing social engagement and improving overall well-being. The program is offered at no cost and generally includes six to eight one-hour sessions over four to five months.

A central piece of the new grant is bringing together organizations that may currently serve the same older adults without having strong systems for referring people to one another.

“Older adults often have multiple chronic conditions, e.g. diabetes, heart disease, arthritis, that increase vulnerability to depression and anxiety,” Gettys said. “A coordinated approach across aging and behavioral health services networks can address both physical and mental health more effectively through bi-directional referrals.”

Aging organizations may have frequent contact with older adults and therefore opportunities to identify potential depression or anxiety early, Gettys said. Behavioral health providers, meanwhile, may develop relationships with clients that reveal needs for transportation, nutrition assistance, in-home care or health and wellness programs available through aging organizations.

“Collaborative care across sectors will be important to support Whole Person Health that aims to restore overall health, prevent disease, and enhance resilience across a person’s lifespan,” Gettys said.

The grant will fund a learning collaborative bringing together aging and disability service organizations with behavioral health providers. The group will test a training protocol, develop person-centered resources and work to improve referral pathways. NCCHW also plans to create an implementation guide and resource toolkit that can be shared more broadly.

Through previous grant-funded work, NCCHW has partnered with the NC Division of Aging's network of Area Agencies on Aging and other organizations to offer CDSME programming across the state, including in WNC. Libraries, YMCAs and NC Cooperative Extension have also helped recruit program leaders in areas where gaps exist. Under PATH NC, Gettys said NCCHW plans additional outreach to faith communities, National Alliance on Mental Illness NC affiliates and behavioral health providers serving Western North Carolina.

“We plan to develop a Learning Collaborative with partners representing western NC to build on our previous successes and advance efforts to support older adult behavioral health,” Gettys said. “This UNC Asheville funding opportunity is a major investment in supporting this important work to expand our collaborative partnerships statewide that will increase access to services and supports for older adults in North Carolina.” 

NCCHW plans to enroll 2,500 participants in CDSME and supportive programs, with at least 40 percent reporting improvements in anxiety and depression through pre- and post-program surveys. The center also plans to establish 12 new partnerships and two referral pathways involving aging and disability organizations, behavioral health providers and other partners.

“Collaborative partnerships in North Carolina are essential for creating a holistic, accessible, and person-centered approach to promote older adult health and well-being,” Gettys said. “Partner organizations work collectively to improve access to care and empower older adults by bolstering confidence to manage their health, stay independent, and maintain wellness.”

Learn more at unca.edu/ncchw.