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Running head: EFCMP 1
Ella Faye Childs Memorial Program
Kaylan Wardlaw, Noell Luster, Kelsey Barrett, Ashley Stults, & Chelsea Bessinger
University of North Texas

EFCMP 2
Abstract
The purpose of the Ella Faye Childs Memorial Program, or EFCMP, is to prevent suicide in the
elderly by partnering with nursing homes in Denton County with deficiencies on Medicare
reports. The target population is elderly residents in nursing homes aged 65 and older in Denton,
County. This is a two-part 14 month program, funded by stackholder’s and grants. EFCMP is
divided into a training program with a goal to increase quality of care provided to residents and a
prevention program with a goal to decrease risk factors associated with suicide in the elderly.
Specific risk factors addressed include depression, isolation, quality of life, and life satisfaction.
The goals each have short, medium, and long term objectives. The objectives related to the
program’s goal is to increase the quality of care by reviewing the Medicare report at the fifth,
eighth, and thirteenth month of the program with an increase of 15%, 35%, and 60%
respectively. Related to nursing home staff the objective is to increase the staff’s perceived level
of knowledge by 35% at the sixth month of the prevention program, increase quality of care by
40% at the eighth month of the prevention program as evidenced by the OSI-R, and in the
fourteenth month increasing the quality of care by 60% as evidenced by the OSI-R. For the
residents the objectives are to increase social relationships by 12% at the sixth month of the
prevention program, decrease suicidal ideation or depressive symptoms 15% at the twelfth
month of the prevention program, and to increase the quality of life of the residents as evidenced
by an increase of 30% on the GRRAS at 14 months. The EFCMP includes a training program, a
12 month prevention program with mental health care services such as individual and group
counseling, and a follow up program. Formative and summative evaluation plans will be

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accomplished through the use of empirically-based quantitative, qualitative, and mixed-methods
assessments.
Keywords: suicide, elderly, nursing homes, quality of care, IMPACT

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EFCMP: Ella Faye Childs Memorial Program
Statement of Need
The elderly population in the United States is one of the many demographics
overlooked in the mental health community. As of 2014, in the United States alone, individuals
65 years old to 84 years old constituted 16.2% of the annual suicide rate (American Foundation
for Suicide Prevention, 2016). In the same year, the Center for Disease Control reported that
roughly 1,369,700 residents occupied nursing homes all throughout the United States (Center for
Disease Control, 2016). Mezuk, Lohman, Leslie, and Powell (2015) conducted an investigation
of suicide risk in nursing homes where they found that 14.16 per 100,000 elderly residents in
nursing homes committed suicide. Risk factors that are associated with quality of life and quality
of care are significant contributors to the vulnerability of this population. The Ella Faye Childs
Memorial Program (EFCMP) aims to alleviate the suicide rates in Denton County by
implementing a prevention and intervention program that addresses these risk factors in Senior
Care Centers nursing homes.
Nature and Scope of Concern
In United States, more than one-eighth of the American population is made up of elderly
individuals. Within that 12%, nearly 18% of the elderly make up the annual suicide incident
rates. It is estimated that 40% of such incidents within this demographic are underreported
(American Association for Marriage and Family Therapy, 2016). According to the U.S. Census
Bureau (2012), the elderly population in Texas is about 16% and is expected to increase roughly
2% each decade. Elderly residents that are 55 and older constitute nearly 28 per 100,000
individuals within this population (Centers for Disease Control, 2007). The elderly population of
Denton County, specifically in regard to elderly residents 65 years and older, has a suicide rate of

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9.1% (U.S. Census Bureau, 2015). The elderly population is particularly vulnerable to suicide as
evidenced by the significant statistics of reported suicide rates in conjunction with a large
approximation of underreported cases.
More specifically, elderly individuals who reside in nursing homes have been found three
to four times more likely to suffer from depressive symptoms than nonresidents (Jongenelis et
al., 2004). Unsar and Sut (2010) conducted a study to assess depressive symptoms within the
elderly population. The researchers found a correlation between high levels of depression and the
presence of chronic illnesses. Furthermore, researchers have projected that roughly 65% to 95%
of nursing home residents suffer from a serious mental health disorder (Grabowski, Aschbrenner,
Rome, & Bartels, 2010). Risk factors such as bereavement, financial debt, post-retirement
adjustments, and residential care transition issues play a significant role in increased suicides
rates of the elderly population (Harwood, Hawton, Hope, Harriss, & Jacoby, 2006). Other risk
factors that contribute to increased risk for suicide are loneliness, death of loved ones,
misdiagnoses of mental health disorders, underserved populations, and comorbidity.
Target Population
According to the United States Census Bureau (2015), ethnicity in Denton County
consists of 78.5% Caucasian, 9.8% African American, 8.2% Asian, .9% American Indian, .1%
Pacific Islander, and 2.5% mixed. There is lack of data referencing the specific ethnicities within
Senior Care Centers nursing homes, but it would be reasonable to conclude that most of the
resident population consists of elderly Caucasian individuals. In terms of socioeconomic status,
many of the residents are of lower socioeconomic status due to living off of Social Security
benefits, disability benefits, and/or are monetarily relying on family members. In conjunction to
this, many of the elderly individuals are reliant upon Medicare to supplement nursing home stay.

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According to Kaiser Family Foundation, the median income of individuals ages 65 years old to
74 years old is just under $30,000; as age increases past this age range, median income continues
to decline. Because these individuals rely on Medicare to pay for health care services(Jacobson,
Swoope, & Neuman, 2016)., EFCMP has deduced that this population is of lower socioeconomic
status and therefore cannot afford a higher level of care. For clarification purposes, the
ECMFP’s target population will be elderly individuals ages 65 and older meeting criteria for
program services.
Description of Community Agency
Senior Care Centers (SCC) is an organization that owns and operates nursing homes
throughout the state of Texas. SCC has over 90 skilled nursing facilities within the state of Texas
and nine locations in the state of Louisiana (Senior Care Centers, 2016). Within Denton County,
Senior Care Centers has three nursing homes: Vista Ridge Nursing and Rehabilitation Center,
Vintage Healthcare Center, and Senior Care Health and Rehabilitation. This agency has been
selected by the Ella Faye Childs Memorial Program due to the information provided in
Medicare.gov’s Nursing Home Compare report (Centers for Medicare and Medicaid Services,
2016). For future references, this report will be termed the Medicare report, which indicates a
deficiency in elderly mental health care alongside the quality of the elderly resident’s nursing
home experience. While the SCC nursing homes in Denton County are not in the most
significant need of treatment implementation when being compared to other counties within the
state of Texas, EFCMP has selected Denton County as a starting point due to locality. EFCMP
intends to use this location as a starting point with the intent of expanding the EFCMP program
to other Texas cities, then eventually to a national level depending on the success of this initial
program success within SCC nursing homes and outside of SCC nursing homes.

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Based on current occupancy counts, the number of elderly individuals that would benefit
from this program is 305 residents, with a potential of up to 384 residents depending on
admissions into the nursing homes. The majority of residents in the nursing homes are ages 65
years and older. For a breakdown of risk factors within each nursing home, see Appendix B.
Current prevention and early intervention activities.
According to the Senior Care Centers (2016) website, residents will have access to a
large treatment team consisting of nursing staff, social workers, occupational therapist, physical
therapist, dieticians, and physicians. For residents wanting to use a personal physician that does
not reside in the nursing home staff, Senior Care Centers will arrange transportation of the
resident to the requested physician. Additional services provided are that of Quality of Life
Specialists, Pharmacy and Rehabilitation Services, and Resident Wellness. Each resident is
assessed and provided a treatment plan that is based on individual needs.
In addition to the eclectic staff, Senior Care Centers offers several facilities that attend to
residents who may need skilled nursing, assisted living, and memory care. Also, Senior Care
Centers provides residents with a wellness program called Strive 2 Thrive (S2T) that aims to
address the wellness aspects of body, mind, spirit, and social interaction through physical
exercise (Senior Care Centers, 2016).
Needfor prevention and early intervention activities.
While Senior Care Centers offers numerous services to residents, there are a few key
areas that are missing that would assist in the residents’ nursing home experience. One of the
primary areas of concern is that of staff training. Senior Care Centers does not provide mental
health training to employees. Since many of the risk factors assessed in the Medicare report
indicate a need for education in this arena, it would be beneficial for the nursing home staff to be

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well educated in mental health concerns as a means of prevention and early intervention.
Additionally, Senior Care Centers is lacking in providing mental health resources to the
residents. Such resources that are lacking are individual and group counseling services,
psychiatric care, and proper assessments that indicate mental health diagnoses.
Ella Faye Childs Memorial Program
The Ella Faye Childs Memorial Program will implement a didactic approach to suicide
prevention by working with residential medical care staff and management, as well as mental
health resources to raise awareness of suicide risk factors and to implement effective intervention
and prevention methods. Additionally, residents will be provided programming to assist in
helping with risk factors such as loneliness, depressive symptoms, and bereavement. EFCMP is a
two part program with the primary focus of residents’ quality of life which is contingent upon
proper training of the staff within the SCC nursing homes. The structure of this program is
divided into two 14-month cycles. Each cycle will include one month that will be referred to as
the training program. The next part of the cycle is the 12-month prevention program. For more
detailed information of the program structure, refer to Appendix C. This program is structured by
using the Improving Mood: Providing Access to Collaborative Treatment (IMPACT) model to
assist in the reduction of depressive symptoms among nursing home resident (AIMS Center,
2016). This model is a comprehensive and collaborative approach which provides a sound
framework for assessing residents’ needs and measuring treatment effectiveness participating in
EFCMP (Agency for Healthcare Research and Quality, 2014). EFCMP staff will attend a two
day workshop that provides training in how to implement IMPACT into Senior Care Centers
nursing homes. Upon EFCMP staff completing the training, there will be a two day workshop
held for Senior Care Centers staff. All Senior Care Centers staff is welcome to attend the

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training, however, it is mandatory that two senior medical staff and one administrator attend the
two day workshop so that proper training can be provided to fellow staff in IMPACT. Such
training will include evidence-based care strategies, ways to measure treatment effectiveness,
teamwork approaches, ways to keep track of residents, and accountability for quality of care
(AIMS Center, 2016). In order to measure the effectiveness of IMPACT, EFCMP will provide
measurements to staff members and residents. In addition to these measurements provided by
EFCMP, the Medicare report will also be used as a means to assess the efficacy of the program.
For a more detailed conceptualization of EFCMP, please refer to the Logic Model in Appendix
A.
Current Available Financial Resources
Current research reveals scarce financial resource that are available to the elderly
population experiencing mental and behavioral health concerns. The majority of funding is
dispensed by Medicare and Medicaid both on a federal and state level. Aside from governmental
funding, residents can also reverse mortgage, private pay/pay out of pocket, and/or use long-term
care insurance. Needless to say, the funding for this demographic is miniscule.
In regards to the training portion of EFCMP, there are a few available financial resources.
The Employment and Training Administration (ETA) offers up to $338,520,000 in grants in an
effort to aid in staff training to improve the productivity and save the program/company time and
money (Senior Community Service Employment Program, 2016). Centers for Medicare &
Medicaid (CMA) also offers a grant called Christus St. Michael Health System which $1.6
million go towards training nursing home staff to recognize signs of sepsis in Medicare
beneficiaries (Innovation Grant Awarded, 2015). Although both of these grants are current
examples of similar financial resources available for training staff, neither one directly applies to

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training nursing home staff in competencies related to quality of life. This observation shows the
need for more financial resources for the specific training of staff in nursing home facilities.
Purpose of the Ella Faye Childs Memorial Program
The purpose of the Ella Faye Childs Memorial Program is to prevent suicide in the
elderly by collaborating with nursing homes in Texas to increase the quality of care provided by
nursing home staff and improve the quality of life of the residents. The EFCMP partners with
existing nursing homes and hosts the program from the nursing home space. See Appendix A for
the Ella Faye Childs Memorial Program’s logic model. The logic model shows how the purpose
of preventing suicide in the elderly and EFCMP’s priorities influence the inputs and outputs
related to the program along with the evaluation measures.
The Ella Faye Childs Memorial Program will be piloted in two cycles in Denton County
over 28 months to demonstrate effectiveness and produce data with the intention of expanding to
other cities in Texas. As the program expands special consideration will be made for nursing
home franchises that are managed by the same owners because changes made at one location
will generalize to other nursing homes within the same network. Additionally, having one
business owner or ownership team with multiple nursing home locations will increase the level
of collaboration. Since the EFCMP is adapted from the IMPACT trial, a training component and
a mental health follow-up component are included (Unutzer et al., 2006). IMPACT is an
evidence based program that reduced rates of depression for clients over 12 months (Lapierre et
al., 2011). A key component to the IMPACT program was personalized and consistent follow-up
by trained depression care managers (Lapierre et al., 2011). IMPACT was selected due to its
comprehensive nature and fit for adaptation to an inpatient context such as a nursing homes. It
includes training for physical care professionals and a 12-month intervention period which is

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how the EFCMP developed its timeline. During this month of the training program, the EFCMP
staff will be trained and will host a two-day workshop utilizing the 13 IMPACT modules for
nursing home staff obtained at no cost by emailing the AIMS Center. Additionally, the month
will be utilized for rapport building with the leadership teams at each nursing home. After the 12
months of the prevention program, there will be one month for follow-up. Post program data will
be collected and analyzed during this month. This data will be utilized when implementing
changes to the next cycle in the program. See Appendix C for a visual overview of the two
cycles.
Goals and Objectives
The Ella Faye Childs Memorial Program has three overarching goals in order to prevent
suicide in the elderly. These are to increase the quality of care provided within the selected
nursing homes, to increase the competence and general job satisfaction of the nursing home staff,
and to decrease risk factors associated with elderly suicide. The goals each have short, medium,
and long term objectives. For an overview of the goals and objectives of the EFCMP refer to
Appendix D. Refer to the logic model in Appendix A which additionally highlights how these
objectives relate to the EFCMP as a whole, the nursing home staff, and the residents while
acknowledging the external factors that may influences the objectives.
Explanation of Monthly Actions
Due to the length of the Ella Faye Child’s Memorial Program training and prevention
program lasts each month has actions and activities that staff members will implement to reach
the goals and objectives of the program. These activities and actions may take multiple months
for completion such as the nursing home improvement plans. Other actions may take an entire
month to plan and implement successfully such as the staff recognition and roundtable

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discussion. See Appendix E for a timeline showing the actions present in the training program,
the prevention program and during the follow-up month of the program. This timeline briefly
describes actions and activities and which staff will be responsible for carrying these out.
Regardless of the type of action all monthly activities enhance the nursing homes
agency’s existing suicide prevention strategy. The nursing homes selected do not currently have
suicide prevention activities or any mental health policies, so all EFCMP actions serve this
function. However, the EFCMP extends the work of the nursing home partners by first correcting
the severe deficits in basic physical care of residents per nursing homes’ yearly Medicare reports.
For example, Vista Ridge Nursing and Rehabilitation is failing to provide for needs within
Maslow’s lowest order of physiological needs including food for residents. The monthly actions
aim to prevent suicide in residents by first addressing these basic physiological and safety needs
through improvement plans and providing continuing education to staff on care skills like
preventing infection and food safety. According to Maslow, these needs must be addressed
before addressing higher order needs (Kettner, Moroney, Martin, 2017).
In developing a comprehensive list of actions required for the program the EFCMP team
considered best practices in preventing suicide in the elderly including that “physician education
and increased outreach to older adults are key strategies for suicide prevention” (Lapierre et al.,
2011). Ongoing training and equipping the nursing home staff along with the collaborative care
model, IMPACT, became cornerstones of the EFCMP’s actions. Nursing staff that experience
burn-out are less engaged and contribute to poor environment for residents through high
turnover, but those nurses with higher personal resources can remain engaged in caretaking
duties (Garrosa, Moreno-Jimenez, Rodriguez-Munoz, Rodriguez-Carvajal, 2010). Investing and
equipping the staff increases the likelihood of consistent caregivers and provides increased social

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connection for the residents. Choi, Ransom, and Wyllie (2008) found staff shortage, untrained
staff, and high turnover as contributors to depression in elderly. Supporting staff therefore is a
best practice. The EFCMP supports staff through incentives, mental services, mental health
training, surveys, and open discussion. Lapierre et al. (2011) suggested utilizing actions “that
enhance quality of life...coping and adaptive behavior...social skills...sense of belonging...and
meaning in life” to prevent suicide in the elderly (p. 94). The EFCMP enlists community partners
to further support the staff, provide meaningful experiences for the residents, and to address the
need of social connectedness for residents. Group counseling continues to foster the need to
belong. One of the final actions which is to create a relaxation space in each nursing home aims
to enhance the residents’ ability to utilize newly learned coping and self-care skills. This space
gives residents the opportunity to engage in creative activities on one’s own that provide
meaning. The space provides the residents who have the rest of one’s needs met the opportunity
to address esteem and self-actualization needs through creative arts (Kettner et al., 2017).
Each activity within the program is detailed in Appendix F with the problem the activity
aims to address, the goals or outcomes expected, how the activities will be implemented to
achieve the desired goals, and evidence supporting the particular activity. Overall the proposed
activities will enhance the agency’s prevention of elderly suicide by supporting the staff in
improving existing duties, training the staff on the importance of mental health care, and
providing an avenue for mental health care for residents. The logic model in Appendix A
additionally highlights how the actions and activities performed by the inputs impacts the
stakeholders. The logic model reviews the EFCMP’s assumptions.
Collaboration with Stakeholders

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The Ella Faye Childs Memorial Program has a collaborative approach to realizing its
vision. The logic model in Appendix A describes all the stakeholders including the Texas
Department of Aging and Disability, nursing home business owners such as Senior Care Centers,
nursing home administrative teams, nursing home care staff, residents, resident’s family
members, volunteers, EFCMP staff, and funders. The EFCMP works to unite all stakeholders
towards a common goal.
Texas has several compliance and accountability measures in place. However, nursing
homes accountability is limited to fines and temporarily fixed deficits. No accountability
measure is taken for nursing homes that consistently fail to maintain regulations. The Ella Faye
Childs Memorial Program would provide an avenue for the Texas Department of Aging and
Disability to bring nursing homes into compliance and maintain that compliance overtime. The
EFCMP aids the nursing home business owners by increasing the ratings on state reports. With
more positive ratings in these areas, profit is likely to increase as families choose these nursing
homes more often. The nursing home administrative teams are equipped with leadership training
and will develop new policies and a better work environment. The EFCMP builds the resumes of
the nursing home staff and medical professionals by providing continuing education in mental
health care. Allowing staff input and collaboration will create a more favorable work
environment.
The program is designed to be an extension of services offered by a nursing home to
benefit the residents and families. The local community is invited to participate in meaningful
volunteer opportunities. This provides students with the opportunity to gain experience and
professionals an avenue to make a difference and pursue purpose in one’s life. The EFCMP

EFCMP 15
creates a synergistic environment working toward the good of the residents in a mutually
beneficial relationship for staff, administration, state, residents, and the community.
For the program to be successful the leadership team and staff at all three nursing homes
must have a voice in the process. By working with a group of homes owned by the same
organization there is opportunity for sharing of best practices and knowledge across staff. For
this reason, all the activities in the EFCMP have a collaborative component. See Appendix F
which describes all the monthly actions and activities related to the EFCMP and including how
each activity includes a collaborative component.
Multicultural Concerns
Along with collaboration, inclusivity and multicultural awareness represent core values
that informed the development of the Ella Faye Child’s Memorial Program. These issues include
age, race, ethnicity, culture, language, sexual orientation, gender, disability, socioeconomic
status, literacy, and family involvement. EFCMP staff will be trained in elderly issues, race,
ethnicity, culture, gender identity, sexual orientation during the training program. Staff meetings
will include these topics and supervisors will periodically broach these subjects with supervisees
to ensure residents are receiving multiculturally competent care. EFCMP staff will look for
discrimination and bullying through official observations and will advocate for residents in these
areas. For instance, if partners are separated due to gender within the nursing home the Licensed
Professional Counselor Supervisor and Licensed Professional Social Worker will be responsible
for advocating to nursing home management to allow the partners to live in the same room.
Refer to Appendix G for how the EFCMP addresses these multicultural concerns.
Gender is especially relevant in the EFCMP as elderly men have higher rates of
completed suicide and lower rates of treatment for depression (Hinton et al., 2006, p.885).

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Hinton et al. (2006) found that traditional masculine values and stigma surrounding chronic
mental illness contributed to older men being underserved. In practice the EFCMP can emphasis
symptoms of depression and stressors rather than diagnosis while training medical professionals
to identify depressive symptoms in older males. Follow-up is especially important for men, and
is an integral part of the EFCMP. In women depression screening and increasing group activities
were found to effectively reduce depressive symptoms and suicidality (Lapierre et al., 2011). For
this reason, the EFCMP includes increasing social relationship, group counseling, and
meaningful self-care activities while training medical professionals and including extensive
follow-up procedures.
Referral Resources
Nursing homes are essentially inpatient facilities with extensive medical care on-site and
limited means for committing suicide. This includes physical care, psychiatric care, and hospice
care when necessary. For this reason, minimal referrals are necessary. However, there may be
residents who experience severe mental disorders or suicidality that need additional resources as
staff will not be able to provide the level of extensive care necessary. For mental health care,
continued case management, suicide hotline, and crisis services the Denton County MHMR
Center would be utilized. Denton Regional Medical Center would be utilized for emergency
services, and Mayhill Hospital’s geriatric services would be utilized for those residents that need
more extensive psychiatric care.
Potential Barriers
The largest barriers to the EFCMP are the unproven nature of the program, the time
length of the program, and the cost per resident. The cycles will be heavily observed and used for
data collection to justify the EFCMP’s effectiveness in that require extensive remediation. The

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EFCMP will be utilized only for nursing homes that are showing extreme deficits. If the program
is proven to be effective more nursing homes can be served per cycle. The financial and time
investment of the program will ultimately be justified by reducing the amount of failing nursing
homes in the state of Texas overtime. Another major barrier is nursing home owners and
administrators’ willingness to fully participate in the program. To promote active collaboration,
it is essential to build rapport with leadership and provide additional training to leaders. Due to
culture, residents may not be receptive to mental health care because of the stigma associated
with mental illness. To combat this, the EFCMP will first improve the residents’ environments
and quality of care while increasing social connectedness. The EFCMP will not utilize diagnosis
with residents and will train staff to recognize depressive and suicidal symptoms without
suggesting mental illness.
Staff
Ella Faye Childs Memorial Program (EFCMP) will employ counselors, administrative
staff, and volunteers who have experience with the geriatric population and grant-funded
programs (refer to Appendix H - Organizational Chart). All positions are vital to the functioning
of EFCMP as the program is complex and implements two-parts; preventative and staff training.
Below are brief descriptions of the positions that EFCMP will utilize; for further details on each
position, refer to Appendix I - Detailed Staff Qualifications Chart.
EFCMP will employ one Licensed Professional Counselor - Supervisor (LPC-S) and
he/she will assist in both the preventative and training portions of the program. The LPC-S will
use clinical and administrative skills to benefit the EFCMP. There will be one Clinical Director
whom will focus primarily on the administrative and maintenance of the program. The Clinical
Director will work closely with the nursing home to improve the program’s effectiveness. The

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Licensed Professional Social Worker (LPSW) will be hired for prescription and case
management to improve the quality of life for the patients in the nursing home. An Accountant
will manage all budgeting and financial decisions for EFCMP. A Fundraiser/Volunteer
Coordinator will work with nursing home staff to assess needs in regards to volunteers, and will
be responsible for coordinating the volunteer’s schedules and managing group sessions/events
that need volunteer assistance. The Data Collection Team will be comprised of five individuals
who will administer and interpret assessments to support both the preventative and training
portions of the program. The Licensed Professional Counselor - Intern will assist the LPC-S and
LPSW with case management and the clinical portion of EFCMP. The five Master’s level Interns
will assist in psychoeducation groups and activities at the nursing homes, as well as assist the
LPC-S and LPSW as needed. Five volunteers will aid in fundraising and charity events to raise
money and advocate for quality treatment and depression awareness in the elderly population.
Quality Control Mechanisms
In an effort to reach the goal of maximum quality of life for the patients at the nursing
homes, EFCMP will be monitored through quantitative and qualitative assessments administered
throughout the two 14-month program cycles. For the training piece of EFCMP, the staff at the
nursing homes will receive competency training and will be assessed at intake, six months, and
after the program is complete using the OSI-R and the Training Evaluation Survey and the
Occupational Stress Indicator-Revised, or OSI-R, (Osipow, 1981) an assessment measuring job
stress. The preventative aspect of EFCMP will be monitored through various assessments that
measure the quality of life of the patients in the nursing home. There will be both pretest and
posttest assessments administered in an effort to make adjustments for the overall effectiveness
of the program.

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All staff will attend mandatory training the month prior to implementing the program to
learn how to train the nursing home staff and how to implement the preventative measures to the
patients. As part of the training, EFCMP staff will also undergo debriefings in multicultural
considerations and disability accommodations. The Clinical Director will coordinate bi-weekly
meetings with all full-time and contracted employees of EFCMP to alter and create materials to
be utilized with the elderly patients. The Clinical Director will also organize trainings to the
nursing home staff and the Accountant to prepare for the funding cycles. Once per month, the
Fundraiser/Volunteer Coordinator will host a three-hour new staff psychoeducation training at
the nursing home to increase competency and encourage ongoing training. The
Fundraiser/Volunteer Coordinator will also facilitate bi-annual roundtable meetings that will
include all staff from all the sample nursing home locations to exchange ideas and to maximize
resources and outcomes in the program. The Accountant and Fundraising/Volunteer Coordinator
will organize and facilitate a mandatory monthly staff meeting in an effort to make changes to
and improve the effectiveness of the program.
Performance Assessment and Data
The intent of the 14-month two-part Ella Faye Childs Memorial Program is to improve
quality of care and holistic well being of elderly residents in nursing homes. With empirically-
based quantitative and qualitative assessments, this program will be monitored continuously to
assure constant quality improvement. Such assessments will also be used to assess for program
performance and effectiveness. Both summative and formative evaluation plans will be
implemented to measure overall program effectiveness and quality of program actions.
Training Program Formative Evaluation Plan

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The formative evaluation plan includes ongoing field observations of staff and residents.
Direct feedback and recorded observations received from residents regarding quality of care
from staff during training program will also be utilized to monitor and assess for quality
improvements. Staff members will record observations regarding resident holistic well being
through the prevention program. A program created Training Evaluation Survey will be
administered at six months to monitor training program progress. The Training Evaluation
Survey is a mixed-methods self-report survey assessing staff evaluation of knowledge and
training gained through the program. The assessments will occur at each of the three selected
nursing home facilities continuously throughout the EFCMP to ensure quality control measures
and implementation of necessary improvements to both parts of this program.
Training Program Summative Evaluation Plan
To assess staff training, the summative evaluation plan will assess the outcome of
program training effectiveness using both quantitative and qualitative assessments. A team of
external data collectors will administer and report all assessments. The OSI-R(Osipow, 1981)
and the Training Evaluation Survey will be used to assess quality of care, staff knowledge, and
training. The desired outcome is evidence of increased effective and supportive work
environment as well as increased job satisfaction after program completion and follow-up. The
OSI-R will be administered at pretest, eight months, and follow-up for comparison of score
changes and program outcome. The desired outcome of the Training Evaluation Survey is
evidence of increased quality of care given to residents, increased knowledge of proper care, and
increased quality of training. As previously mentioned, this survey will be administered at six
months as a formative evaluation and will again be administered by external data collectors to all

EFCMP 21
staff after program completion as a summative evaluation to assess program outcome and
impact.
Prevention Program Formative Evaluation Plan
A qualitative open-ended interview style questionnaire will be administered by external
data collectors to 20 randomly selected residents from each nursing home six months after start
of program cycle. This is a program created assessment called the Formative Program Evaluation
Survey to assess residents’ view of prevention program quality. For detailed information, see
Appendix J. To monitor the training program quality, the program created mixed-methods assessment
will be administered by external data collectors to all staff members six months after start of program
cycle and again at program completion. This assessment is called the Training Evaluation Survey which
will assess and monitor changes to staff training, knowledge, and provision of care through the training
program through open-ended interview style questions and yes-or-no questions. For detailed
information, see Appendix K. The survey responses will not identify the source of the
assessment taker to protect confidentiality of all staff members. Results of the surveys will be
briefly reviewed one week after completion so that necessary improvements can be determined
and executed for the remainder of the program. These assessments will be administered
following the preceding schedule for each program cycle.
Prevention Program Summative Evaluation Plan
The EFCMP summative evaluation plan will assess for the short, medium, and long-term
outcomes of the objectives and goals listed in the logic model (Appendix A). The program will
be measured using empirically-based quantitative and qualitative assessments to assess the
priorities such as suicide prevention, resident quality of life, and quality of care. A data
collection plan chart of all assessments and relative information is found in Appendix L and

EFCMP 22
Appendix M. The program will use the results of the Medicare.gov nursing home report to
monitor and measure program effectiveness at the three participating facilities (Centers for
Medicare and Medicaid Services, 2016). This assessment is a census rating quality of care,
facility resources, and resident well being. The desired outcome is increased quality of care
received by residents within the nursing homes. The previous year’s results will be reviewed and
measured at four months, seven months, and 12 months of program cycle.
Quantitative assessments will be used to provide statistical results to assess long-term
program outcome. The Beck Scale for Suicidal Ideation (BSS) will be used to assess the primary
goal of preventing suicide in the elderly (Beck, 1991). The desired outcome is evidence of
decreased suicidal ideation in the residents after program completion and follow-up. The
associated risk factors of suicide include depression and social relationships. Depression will be
assessed using the Beck Depression Inventory, or BDI (Beck & Steer, 1993). The desired
outcome is evidence of decreased depressive symptoms in the residents after program
completion and follow-up. Social relationships will be assessed using the Coping Scale for
Adults, or CSA (Frydenberg & Lewis, 1997). The desired outcome is evidence of increased
social relationships in the residents focusing on factors such as the use of social support, healthy
coping skills, isolation, and improvements to existing relationships. Resident quality of life will
be assessed using the Mind Body Wellness Geriatric Rehabilitation and Restorative Assessment
System (GRRAS) to administered to all resident participants (Clifford, Roper, & Cipher, 2008).
The desired outcome is evidence of increased resident quality of life after program completion
and follow-up.
The BDI, BSS, and GRRAS will be administered at pretest, posttest, and follow-up of
program completion. The CSA will be administered at pretest, six months into the program, and

EFCMP 23
at follow-up one month after program completion. The OSI-R will be administered at pretest,
eight months into program, and at follow-up one month after program completion. The EFCMP
has been granted special approval for the use of all assessments at designated times. To comply
with the Protection of Human Subjects Regulations (45 CFR 46), which requires Institutional
Review Board (IRB) approval, the Ella Faye Childs Memorial will submit to all necessary IRB
procedures prior to and throughout program implementation.
Budget
Ella Faye Childs Memorial program will be requesting grant funding over 28 months for a total
of $764,693.90 amount. The grant will be funded over 28 months to provide our program a chance to
run the program through twice and give us a chance to collect data and reevaluate in between. This will
cost our program $1004.65 per resident per first cycle and $986.74 the second cycle. The program
is projected to cost $385,786.95 for the first cycle, 14 months, the second cycle is projected to
cost $378,906.95. The total amount will change because the program will continue to use what
was bought at startup, for example, computer, scanner, printer, tablets.
The EFCMP will include four grants; Dr. Wilson’s Grant which will be designated for
our clinical director’s salary, Community prevention/early intervention Grant, Geriatric of Texas
Grant, and Denton Community Grant. Our program will benefit from community partners such
as, Matthew Mcconaughey, Sandra Bullock, Woody Harrelson, for a total of $17,323.92 amount.
Target, Kroger, and Cinemark graciously donated a total of $2,530 a cycle which will fund
incentives for participants of residents and staff in groups, food supplied for activities and
sessions. Best Buy donated tablets at the amount of $5,000 to help the program more effectively
access and collect data.

EFCMP 24
The EFCMP will be spending a total of $346,300 per cycle on salary to employ our staff.
We are going to take interns which will increase our staff numbers but not our budget. This
program requires five different assessments to administer which will cost $6,920.95 per cycle.
This cost includes the packages with the manuals for each assessment and the extra forms needed
to administer to each resident and staff member and score each assessment. Our program is going
to rent a room from the nursing home as a place to keep all of our office supplies and run our
daily tasks. This will require us to pay $1,100 in rent a month and supply our own phone and
internet line at $50 a month. Our clinical director and volunteer/fundraising coordinator will
conduct business in this room. The office is going to include office supplies which will cost
$1,000 a cycle plus $1,880 of start up expenses to supply the office with 2 computers, a scanner,
and a printer. The budget is going to include $3,000 per cycle in art supplies for the counselors to
use in group sessions, and $2,000 a cycle in disability accommodations in case our counselors
need supplies to make our program more accessible for the residents. The budget also includes
$600 a cycle on relaxation supplies to use in the group sessions with our residents. The EFCMP
is going to keep an electronic filing system, Box, which is HIPAA compliant and will cost $15 a
month. Details of the budget for the EFC memorial program will be included in appendix N.

EFCMP 25
Appendix A
Logic Model

EFCMP 26
Appendix B
Medicare.gov's Nursing Home Compare: Risk Factors
Vista Ridge
Vintage
Healthcare
Senior Health and
Rehabilitation TX Avg U.S. Avg.
City Lewisville Denton Denton
Beds 132 106 146
Occupancy 91 95 91 76.4 86.2
Receiving AP
meds 6.6% (S), 9.4% (L)
0.7% (S),
27.7% (L)
1.7% (S), 18.9%
(L)
3.2% (S),
19.8% (L)
2.1% (S),
16.9% (L)
M-S Pain
18.7% (S), 12.4%
(L)
36.5% (S),
23.7% (L) 4.2% (S), 10% (L)
15% (S),
7.7% (L)
16.4% (S),
7.8%(L)
Mob. Ind.
Decrease 34.8% (L) 19.1% (L) 32.2% (L) 20.9%(L) 18.9% (L)
Help w/ ADL
Increase 35.9% (L) 21.1% (L) 25.6% (L) 19.3% (L) 15.3% (L)
Depressive
Symptoms 5.6% (L) 0.7% (L) 1.2% (L) 5.3 %(L) 5.4% (L)
AA or H
meds 36.3% (L)
21.1% (L) 28.1% (L)
27.1% (L) 23.5% (L)
Avg Staff
time/ Res. 3.87 hrs 3.18 hrs 3 hrs 3.95 hrs 4.27 hrs
Legend
S: Short-term
residents
Mob. Ind.: Mobile
Independence
(Centers for Medicare and Medicaid Services,
2016)
L: Long-term
residents AA: Antianxiety
AP:
Antipsychotic H: Hypnotic
M-S:
Moderate to
Severe Meds: Medications
hrs: Hours Res: Resident

EFCMP 27
Cycle 1
Month 1
Program training for
both EFCMP and
Training Program
Month 2 - 13
12 month suicide prevention
program implemented in nursing
homes
Month 14
Follow-up post tests
and data review.
Research new nursing
home partners
Cycle 2
Month 15
Program alteration
based on data results
Month 16 - 27
12 month suicide prevention
program implemented in nursing
homes
Prevention Program
Month 28
Follow-up post tests
and data review.
Research new nursing
home partners
Appendix C
Visual Overview Timeline
Follow-up

EFCMP 28
Appendix D
Goals and Objectives
Goal 1: To increase the quality of care provided
within the selected nursing homes
Short Term Objective (1a): Increase quality of care within
the three nursing homes selected for the program as evidenced
by a 15 % improvement on the Medicare report from the
previous year reviewed at the 5th month of the program.
Medium Term Objective (1b): Increase quality of care within
the three nursing homes selected for the program as evidenced
by a 35 % improvement on the Medicare report from the
previous year reviewed at the 8th month of the program.
Long Term Objective (1c): Increase quality of care within the
three nursing homes selected for the program as evidenced by a
60% improvement on the Medicare report from the previous
year reviewed at the 13th month of the program.
Goal 2: To increase the competence and general
job satisfaction of the nursing home staff
Short Term Objective (2a): Increase the nursing home's
staff's perceived level of knowledge by 35% as evidenced by a
staff self-report survey at 6th month of the prevention program.
Medium Term Objective (2b): Increase the quality of care
provided by nursing home staff by 40% as reported at 8th
month of the prevention program as evidenced by the
Occupational Stress Inventory-Revised Edition
Long Term Objective (2c): Increase the quality of care
provided by nursing home staff by 60% as reported at 14
months as evidenced by the Occupational Stress Inventory-
Revised Edition.
Goal 3: To decrease risk factors associated with
elderly suicide
Short Term Objective (3a): Increase social relationships in
residents by 12% at 6 months of the prevention program as
evidenced by the Coping Scale for Adults
Medium Term Objective (3b): Decrease suicidal ideation or
depressive symptoms for residents who do not have suicidal
ideations by 15% at the 12th month of prevention program as
evidenced by the Beck Depression Inventory and the Beck
Scale for Suicidal Ideation.
Long Term Objective (3c): Increase the quality of life of the
residents as reported by the residents as evidenced by an
increase of 30% on the Geriatric Rehabilitation and Restorative
Assessment at 14 months.

EFCMP 29
Appendix E
EFCMP Cycle Timeline
Prior to start of any
program cycles
● Hiring of all permanent EFCMP staff.
● LPC-S and Clinical Director familiarization with IMPACT workshop
modules.
● Clinical Director familiarization with all HIPPA, Medicare Quality
Assessments, and GoToMeeting Webinar software.
● Ensure that Accountant is advised of all grant budgeting needs.
● Fundraiser/Volunteer Coordinator has created and input content onto
Survey Monkey.
Month 1:
Training Program
● Training for EFCMP staff in IMPACT, geriatric developmental issues,
and diversity by LPC-S and LPSW.
● 2 day workshop eligible to all nursing home staff in IMPACT by LPC-S
and Clinical Director.
● Building rapport and gaining buy-in by nursing home leadership staff by
LPSW.
● 3 hour once a month new staff psychoeducation focused heavily on
skills taught in IMPACT workshop such as screening for depression,
follow-up, & the referral systems by volunteer coordinator.
● Clinical director will host a 1 hour continuing education webinar for
staff, residents’ families, and volunteers on prevention of elder abuse.
● LPC-I and LPSW will advertise case management and counseling
services to residents and staff by going room by room, making
announcements, and putting up flyers in all 3 nursing home locations.
● All EFCMP counseling staff and social work staff will be available for
counseling or case management services.

EFCMP 30
Month 2:
Prevention
Program
● EFCMP social worker will facilitate at least 2 meetings with each
nursing home leadership staff to develop improvement plans including team
building activities and leadership training.
● 3 hour psychoeducation session with each nursing homes medical staff
and leadership team focused heavily on skills taught in the IMPACT
workshop hosted by the EFCMP’s LPC-S, and LPC-Is.
staff, residents’ families, and volunteers on self-care and caretaker burn-out.
● Volunteer coordinator will give staff a forced rank survey to determine
volunteer needs, recruit for the necessary volunteers, and place volunteers
on a schedule to provide practical assistance within the nursing homes.
● LPC-I or a master’s level counseling student intern and master’s level
counseling student will host a group counseling session once a week at each
nursing home.
Administer pretest assessment(s) at intake to staff:
● OSI-R
Administer pretest assessment(s) at intake to residents:
● CSA, BDI, BSS, GRRAS
Month 3:
Prevention
Program
● EFCMP social worker will work to facilitate each nursing home’s
improvement plans. Actions will vary based on individual improvement
plan, but may include extra trainings, developing new policies, or aiding
stakeholders in implementation.
● EFCMP social worker will attend at least one leadership meeting at
each nursing home to check-in on each nursing home’s improvement plans
and include discussing progress in the improvement plan’s milestones.
staff, residents’ families, and volunteers on advocacy and communication.

EFCMP 31
counseling or case management services
● Volunteer coordinator will analyze results from forced rank survey to
determine volunteer needs and recruit for the necessary volunteers.
nursing home.
Month 4:
Prevention
Program
● EFCMP social worker will host a leadership training at each nursing
home and check-in on each nursing home’s improvement plans including
discussing progress in improvement plan’s milestones.
follow-up, & the referral systems by volunteer coordinator
staff, residents’ families, and volunteers on empathy skills.
● Volunteer coordinator will work with each nursing home’s activity
director to develop a volunteer schedule based on the forced rank staff
survey. Volunteer coordinator will work to create a viable system of
scheduling online to express needs and available slots.
nursing home
Review Medicare.gov
Month 5:
Prevention
Program

EFCMP 32
staff, residents’ families, and volunteers on hand massage for pain
management.
● Volunteer coordinator will facilitate a roundtable discussion and staff
recognition night for sharing of ideas between the 3 participating nursing
homes. Several staff are recognized for excellence and utilized for
knowledge of best practices. Advertising will be done in all 3 nursing
homes throughout the month by the volunteer coordinator.
survey and recruit necessary community partners. Volunteer coordinator
will continue to work to create a viable system of scheduling online to
express needs and available slots.
nursing home

EFCMP 33
Month 6:
Prevention
Program
● EFCMP social worker will attend at least one leadership meeting at
each nursing home to check-in on each nursing home’s improvement plans
and include discussing progress in the improvement program’s milestones.
staff, residents’ families, and volunteers recognizing depressive and suicide
symptoms and resources.
● LPC-I and LPSW will advertise case management and counseling
services to residents and staff by going room by room, making
announcements, and putting up flyers in all 3 nursing home locations.
will continue to improve system of scheduling online to express needs and
available slots.
nursing home
Administer assessment(s) to staff:
● Training Evaluation Survey
Administer assessment(s) to residents:
● CSA and Formative Program Evaluation Survey

EFCMP 34
Month 7:
Prevention
Program
staff, residents’ families, and volunteers on preventing infection and basic
hygiene care skills.
available slots.
nursing home
Review Medicare.gov
Month 8:
Prevention
Program
follow-up, & the referral systems by volunteer coordiantor
staff, residents’ families, and volunteers on first aid, lifting elderly, and
wound care.

EFCMP 35
available slots.
nursing home
● EFCMP Counselor and Social Worker work together to create
relaxation spaces in each nursing home
Administer assessment(s) to staff:
● OSI-R
Month 9:
Prevention
Program
staff, residents’ families, and volunteers on personal care, grooming, and
toileting.
available slots.

EFCMP 36
nursing home
Month 10:
Prevention
Program
staff, residents’ families, and volunteers on safe food practices.
● Volunteer coordinator will facilitate a roundtable discussion and staff
recognition night for sharing of ideas between the 3 participating nursing
homes. Several staff are recognized for excellence and utilized for
knowledge of best practices. Advertizing will be done in all 3 nursing
homes throughout the month by the volunteer coordinator.
available slots.
nursing home
Month 11:
Prevention
Program

EFCMP 37
staff, residents’ families, and volunteers on involving residents in tasks,
promoting mobility, and gauging ability.
will begin transition coordinator position and scheduling system to
volunteers and activity director at each nursing home.
nursing home

EFCMP 38
Month 12:
Prevention
Program
staff, residents’ families, and volunteers on medication management.
Clinical director will begin developing resource booklets, resource sheets,
and making sure all webinars are on all nursing home websites.
● Volunteer coordinator will transition coordinator position and
scheduling system to volunteers and activity director at each nursing home
via training.
nursing home

EFCMP 39
Month 13:
Prevention
Program
staff, residents’ families, and volunteers on dementia and Alzheimer's care.
Clinical director will begin developing resource booklets, resource sheets,
and making sure all webinars are on all nursing home websites.
● Volunteer coordinator will fully transition coordinator position and
scheduling system to volunteers and activity director at each nursing home.
nursing home
Administer posttest assessment(s) at program completion to residents:
● BDI, BSS, and GRRAS
Month 14: Follow-
up
Administer follow-up assessment(s) to staff:
● Training Evaluation Survey and OSI-R
Administer follow-up assessment(s) to residents:
● BDI, BSS, CSA, and GRRAS

EFCMP 40
Appendix F
Monthly Actions and Activities
Monthly
Action
Number
Action Description Goal
&
Objec
tive
Addr
essed
Problem Addressed Expected
Outcomes
How Action Will Be
Implemented
Evidence Collaboration
1 A Licensed Professional
Counselor - Supervisor
and the Clinical Director
of EFCMP will host a 2-
day workshop utilizing
the 13 Improving Mood:
Promoting Access to
Collaborative Treatment
(IMPACT) training
modules to train at
minimum 2 Depression
Care Managers (DCM)
from each nursing home
and 1 nursing home
administrator from each
location. This training
will be open to any staff
member from any of the
3 nursing home
locations.
1a,
2a,
2b,
3b, 3c
Each of the nursing
home locations showed
significant care
deficiencies on state
inspection and Medicare
reports. Lack of
knowledge or
competence is
contributing to this
deficit. Since these
locations have shown
poor physical care skills
and have no mental
health policies it is
highly likely that staff
has no training in mental
health care. This
increases the suicide risk
of residents. This
activity trains workers
for providing better
mental health care along
with physical care.
Decreased
depressive
symptoms in
residents,
decreased
suicidal
ideations in
residents,
increased
quality ofcare
for residents,
increased
nursing home
staff
competence
During the month leading up to
implementation of the prevention
program at the 3 nursing homes
the EFCMP team will be
contacting and building rapport
with the nursing home leadership
staff. A 2-day workshop will be
put on by the EFCMP teamin a
train the trainer model eligible to
all nursing home staff. 3 DCMs
will be required from each nursing
home including 2 medical staff
and 1 administrator from each
nursing home. The 13 module
IMPACT training will be utilized.
All DCMs will be required to be
supervised on 5 pre-recorded test
cases provided by IMPACT from
the EFCMP LPC-S.
Lapierre, Erlangsen,
Waern, De Leo,
Oyama, Scocco,
Gallo, Szanto,
Conwell, Draper,
Quinnett (2011);
Unutzer, Tang,
Oishi, Katon,
Williams, Hunkeler,
Hendrie, Lin,
Levine, Grypma,
Steffens, Fields, &
Langston (2006)
This provides nursing
home staff, the entire
EFCMP team, 2
identified Depression
Care Managers from
each nursing location,
and 1 administrator
from each nursing
home the ability to
come together as
stakeholders in this
training to create a
multidisciplinary
approach.
2 A Social Worker from
the EFCMP team will
meet with the
administrators at each
nursing home to develop
individualized
improvement plans
based on the
deficiencies found on
the Medicare report,
state inspection,
feedback from the
nursing home
adminstrators, and an
informal visual
inspection. These plans
will then be
implemented via the
licensed Social Worker,
nursing home staff,
nursing home
administrators, nursing
home owners, and
across volunteers.
1a,
1b,
1c,
2c, 3c
Each of the nursing
significant care
reports which is
prohibiting the basic
physical care ofresidents
and increasing the
residents' risk for
suicide. By involving the
entire administrative
staff a collaborative and
multidisciplinary
approach is taken to
bring the nursing homes
into compliance and
maintain future
improvement.
Increased staff
competence;
Increased
quality ofcare
provided by
nursing home
staff, increased
quality oflife
for the
residents
The EFCMP will schedule at least
2 meetings within the first month
of the program with the
administrators from each nursing
home to develop internal
improvement plans utilizing the
business excellence model that
includes goals, any policy
changes, milestones, and
accountability measures. The plan
will be facilitated by the EFCMP
team with an in person monthly
check-ins by the EFCMP social
worker and multidisciplinary
meetings during the plan's
milestones. The stakeholders such
as the nursing home staff, the
nursing home administrators,
owners, and volunteers will be in
charge of implementing the
improvement plan to maintain
lasting change after the program
ceases. The EFCMP team will
facilitate this change by building
rapport with the administrative
staff, hosting teambuilding
activities, leadership training,
advocating for the residents and
McAdam & Bailie
(2002)
This activity is
collaborative in that all
nursing home staff,
volunteers, and the
EFCMP team are
responsible for
enacting the changes.
The improvement plans
are collaborative in that
they are developed
with state compliance,
input by the EFCMP
team, and input from
the nursing home
leadership staff.

EFCMP 41
staff, and assisting the teamin
implementing the changes on the
improvement plans.
3 3 hour once a month
new staff
psychoeducation
focused heavily on skills
taught in IMPACT
workshop such as
screening for
depression, follow-up,
& the referral systems
1a,1b,
1c,
2a,
2b,
2c, 3b
Each of the nursing
significant care
reports. Lack of
knowledge or
competence is
and have no mental
health care. This
of residents as
depressive symptoms are
more likely to be
overlooked. Addresses
staff lack of knowledge
in mental health.
Increased
competence of
nursing home
staff, increased
quality ofcare,
decrease in
depressive
symptoms in
residents,
decrease in
suicidal
ideation in
residents
The Volunteer Coordinator will
host a 3 hour new staff training
once a month. The location ofthe
training will rotate each month, so
each nursing home in the program
will receive 4 in person new staff
trainings during the duration ofthe
12 months. Existing staffmay
attend. New staff are required to
attend the training within 2
months of hire. Staff may attend
any training regardless oflocation.
Each nursing home will advertise
the training schedule with their
staff.
Waern, De Leo,
Oyama, Scocco,
Gallo, Szanto,
Conwell, Draper,
Quinnett (2011)
This activity involves
collaboration by the
administration ofthe
nursing homes and the
EFCMP staff.
4 3 hour psychoeducation
session with each
nursing homes medical
staff and leadership
team
1a,
1b,
1c,
2a,
2b,
2c,
3b, 3c
Each of the nursing
significant care
reports. Lack of
knowledge or
competence is
and have no mental
health care. This
of residents as supported
by the IMPACT trial.
Addresses staff lack of
knowledge in mental
health.
Increase
competence of
nursing home
staff, increase
quality ofcare,
decrease
depressive
symptoms in
residents,
decrease
suicidal
ideation in
residents
The EFCMP LPC-S, LPSW, and
LPC-Is will host a 3 hour
psychoeducation training for all
leading medical staff at each
nursing home and leadership staff.
The training would be
individualized to each nursing
home within the program and
expand on the IMPACT training
including mental health, co-
morbidity, referral processes,
screening, depressive symptoms,
medication compliance, follow-up
procedures, and misdiagnosis.
This would be individualized to
each nursing home’s needs and
staff.
Waern, De Leo,
Oyama, Scocco,
Gallo, Szanto,
Conwell, Draper,
Quinnett (2011)
This activity involves
collaboration between
the leadership teamat
the nursing home,
medical leadership, and
the EFCMP LPC-S and
LPSW. This provides
several different
prospective in
providing care for
residents.
5 Clinical director will
host a continuing
education module once
a month online. Each
webinar will be themed
in techniques in care for
the elderly, mental
health, overall physical
wellness, and staff self-
care. At the end ofthe
12 months a resource
booklet will be
generated based on the
1a,
1b,
1c,
2a,
2b,
2c,
3b, 3c
Each of the nursing
significant care
reports. Lack of
knowledge or
competence is
deficit. This is identified
on these reports. This
particular training
element addresses
Increased
competence
and general job
satisfaction of
the nursing
home staff,
increase
quality ofcare
provided by the
nursing home
staff
The EFCMP Clinical Director will
host a continuing education
module once a month online using
GotoMeeting Webinar software.
Each webinar will last 1 hour.
Each webinar will be recorded and
made available on the nursing
home websites for support
networks such as family members
and all new staff. Live web
demonstrations will provide an
avenue for questions fromstaff. At
the end of the 12 months a
Waern, De Leo,
Oyama, Scocco,
Gallo, Szanto,
Conwell, Draper,
Quinnett (2011)
This activity is the first
that extends the
collaboration into the
residents' support
networks. For those
who have caring family
members these
webinars may help the
two groups provide
more comprehensive
care. Volunteer
partners may also
watch these webinars

EFCMP 42
information covered in
the modules and will
include disability
resources. A resource
sheet will be placed in
each nursing home with
key services for disabled
and key numbers such
as a suicide hotline.
deficits in physical skill
training, new evidence
supported techniques for
pain management, and
mental health care skills
for residents, family
members, and staff
members.
resource booklet and resource
sheet will be generated based on
the information covered in the
modules. It will be placed online
on the nursing home websites and
distributed to each nursing home
location. These webinars will be
incentivized via a $15 gift card
during each live demonstration
through a drawing based on
participation and at the end ofyear
an incentive of$100 will be made
available in a drawing to any staff
member who has 12 points. These
points may be accumulated by
participating in any continuing
education opportunity such as the
in person new staff training,
webinars, watching the recorded
webinars, going to the 2 day
IMPACT workshop, or attending
the roundtable discussions.
Administrative staffis not eligible
for the rewards.
and the webinars will
be available even after
the program ends.
After the webinars are
complete the residents
receive specific
resources in a booklet
and on a resource
sheet. All nursing
home staff, the
volunteer coordinator,
and residents all
participate in this
activity in some form.
6 Twice a year the
Volunteer Coordinator
will host a roundtable
discussion for the
exchange of ideas
between all 3 nursing
home locations and all
of the staff. This
supports autonomy and
creating a conducive
social context for
caretaking. The goal of
this activity is sharing of
best practices, training,
and techniques while
allowing staffto make
changes in the
organization based in
culture. The Volunteer
Coordinator will
facilitate the discussion.
During the roundtable
discussion excellent
staff will be recognized
to provide positive
reinforcement.
2a,
2b, 2c
The Medicare report
showed a deficit in the
area of staff training.
The level ofhighly
skilled staffis lower than
is necessary. The skilled
staff and excellent staff
are able to share industry
best practices at a
roundtable.
Increased
competence of
nursing home
staff and
general job
satisfaction of
the nursing
home staff,
increased
quality ofcare
provided by the
nursing home
staff
host a staff member roundtable
discussion twice a year with
dinner or breakfast provided at
one of the nursing home locations.
Each roundtable will be hosted by
a different nursing home. The
location will be determined in
order of the nursing home with the
lowest Medicare inspections at the
start of the program. Up to 6
excellent staff members may be
recognized at this event at a rate of
2 per location. Each excellent staff
member will be given a gift of
$50. Advertising will be done at
all 3 locations by EFCMP staff. A
recording made available after the
roundtable and posted online.
Each roundtable will be
incentivized with a raffle of $75
worth ofCinemark movie tickets.
Creasey & Hiatt
(2009); Lapierre,
Erlangsen, Waern,
De Leo, Oyama,
Scocco, Gallo,
Szanto, Conwell,
Draper, Quinnett
(2011); McDermott
& Keating (2012)
This activity utilizes
collaboration across all
three nursing home
locations in the
program. All nursing
home staff are able to
collaborate on industry
best practices and share
their knowledge.
7 Individual counseling
services and case
management services
available to staff
members made by
appointment on
counselor or social
worker’s days at the
nursing home
2b, 2c One contributing factor
to low quality ofcare is
staff burnout and low
personal resources from
the nursing home staff.
This activity will address
the nursing home staff's
personal coping
resources.
Increased
general job
satisfaction of
the nursing
home staff,
increased the
quality ofcare,
increased
quality oflife
for the
residents
In the first month of the program
and the sixth month the EFCMP
staff will advertise in all three
nursing homes. Announcements
will be made in each training. Any
staff member from the locations
within the programcan participate
in either case management
services or up to 12 individual
counseling sessions at no cost with
confidentiality fromthe
administrative staff and owners of
the nursing homes. The individual
counseling sessions and case
Garrosa, Moreno-
Jimenez,
Rodriguez-Munoz,
Rodriguez-Carvajal
(2009)
This activity promotes
collaboration between
the EFCMP staff,
administrative staff,
owners ofthe nursing
homes, and nursing
home staff.

EFCMP 43
management must terminate in the
12th month ofthe program. After
that, a request can be made via the
ellafayechildsmemorialprogram@
yahoo.com email address or with
the EFCMP Licensed Professional
Counselor or Social Worker
directly.
8 Volunteer Coordinator
will give staffa forced
rank survey to
determine volunteer
needs, recruit for the
necessary volunteers,
and place volunteers on
a schedule to provide
practical assistance
within the nursing
homes.
1a,1b,
1c,
2b,
2c, 3c
One contributing factor
to the low quality ofcare
according to the
Medicare report is a low
amount of time spent
with each resident per
day. Increasing
volunteers in strategic
positions will increase
the amount of time staff
can spend on skilled
duties. Increasing
volunteer involvement
should address caretaker
burnout. An additional
risk factor for elderly
suicide is social
isolation. This activity
addresses that risk
factor.
Increased
quality ofcare,
increased
general job
satisfaction by
nursing home
staff, increased
resident quality
of life for
residents,
increased
social
relationships
with
community
give willing staffa forced rank
survey using Surveymonkey and
the results from the individual
improvement plans to determine
volunteer opportunities at each
nursing home. Based on the
results, the Volunteer Coordinator
will recruit volunteers from
various community organizations
such as churches, high schools,
specialized individuals such as
physical therapists, and
universities. Potential community
partners could be undergraduate
and graduate students at UNT and
TWU, businesses, mental health
volunteers, and social advocacy
groups such as Junior League.
This would be to increase
community involvement in the
nursing home and fundraise for
the organization. The EFCMP
Social Worker and Interns may
work closely with the Volunteer
Coordinator to advocate for
specific services needed by
population for difficulties such as
varied spiritual guidance, ASL
classes, music performances,
gardening groups, physical
therapy, speech therapy, or visits
by daycare specific to the needs of
the individuals at each group
towards therapeutic or enhancing
the services for residents with
disabilities. Once volunteers have
been recruited, the Volunteer
Coordinator will develop
volunteer positions, a potential
need schedule for 12 months, and
develop a weekly scheduling
template that can be utilized in
each nursing home. The EFCMP
Volunteer Coordinator will work
closely with each nursing home to
Activities Director to develop
leadership volunteer positions,
applications, a volunteer
paperwork process, and online
scheduling process. A part ofthe
nursing home website will be
designed for volunteers.
Choi, Ransom,
Wylie (2008);
Kettner, Moroney,
Martin (2017);
The Volunteer
Coordinator works
closely with
community partner and
the activity directors at
each nursing home
with input fromthe
nursing home staff to
better serve the
residents at the nursing
homes.
9 At least 1 group
counseling session is
3a,
3b, 3c
Risk factors for elderly
suicide are social
isolation and a stressful
Increased
social
relationships
Weekly support group will be led
by the LPC-I or a Master's level
Counseling student in Internship
Zerhusen, Boyle,
Wilson (1991)
Collaboration between
university student

EFCMP 44
run at each nursing
home per week
life event in the previous
week. By hosting
ongoing support groups
residents can build social
connections and receive
support after difficult life
events.
for residents,
increased
coping skills in
residents,
increased
quality oflife
for residents,
decreased
depressive
symptoms in
residents,
decreased
suicidal
ideation
and co-led by a Master's level
Counseling student.
partners, EFCMP staff,
and residents
10 Individual counseling
and family counseling
offered to every nursing
home resident and
available every week by
appointment.
3b, 3c Due to disabilities,
financial situation, and
culture nursing home
residents are not likely to
receive mental health
care. The IMPACT trial
showed evidence that
training medical staff
and providing follow-up
through a counseling
type relationship reduced
suicidality. Individual
counseling is meant to
increase coping skills,
decrease depressive
symptoms, and decrease
suicidal ideations
Decreased
depressive
symptoms in
residents,
decreased
suicidal
ideations in
residents,
increased
quality ofcare
for residents
At least one counselor fromthe
EFCMP is present at each nursing
home every week for individual
counseling or family counseling
by appointment. These staff
members include LPC-S, LPC-I,
or Master's level counseling
students in internship. Session
number is based on the counselor's
clinical assessment and is free as
long as completed within the 12
months of the program. Twice in
the program, an EFCMP team
member goes by every roomto see
if any resident would like to sign
up for counseling. Residents may
also sign a form saying they would
not like to be asked about
receiving services. Services can be
obtained by contacting the
counselor via submission through
the nursing home staff, or through
email at
yahoo.com. Residents may be
referred for further evaluation for
counseling through the nursing
home medical staff or through
results ofassessment. Utilizing
individual counseling in
conjunction with screening
training by medical professionals
is from the IMPACT trial.
Waern, De Leo,
Oyama, Scocco,
Gallo, Szanto,
Conwell, Draper,
Quinnett (2011);
Unutzer, Tang,
Oishi, Katon,
Williams, Hunkeler,
Hendrie, Lin,
Levine, Grypma,
Steffens, Fields, &
Langston (2006)
This activity is
collaborative in that
medical staff working
at the nursing home,
nursing home staff,
DCMs, counseling
master's students, the
LPC-S will, and
volunteers will be
involved in the referral
process and then in the
care process. As the
program comes to a
close volunteers may
be routed into this
process to continue
mental health care. It is
also collaborative in
that it involves the
opportunity for
families to connect
with residents.
11 Case management
services are offered to
every resident within the
program and made
available every week by
appointment.
3b, 3c Nursing home residents
receiving Medicare to
pay for nursing home
care and being at a
nursing home in the
county that has
consistently shown
deficiencies on Medicare
reports and state
inspections over the
previous 3 years may
have few financial or
social resources.
Nursing home residents
may suffer from chronic
pain conditions or
progressive disability.
Decreased
depressive
symptoms in
residents,
decreased
suicidal
ideations in
residents,
increased
quality oflife
by residents
At least the Social Worker from
the EFCMP is present at each
nursing home every week for case
management services by
appointment. These staff members
include LPSW and Master's level
social work students. Case
management is free as long as
completed within the 12 months of
the program. Twice in the program
a EFCMP team member goes by
every room to see if any resident
would like to sign up for case
management services. Residents
may also sign a form saying they
would not like to be asked about
receiving services. Services can be
Black (2007) This activity is
collaborative in that
nursing home staff and
nursing home medical
staff will refer
residents for case
management by the
social workers Students
will work with the
team's LPSW.

EFCMP 45
Case management may
serve to improve quality
of life of residents
through advocacy.
obtained by contacting a social
worker, via submission through
the nursing home staff, or through
email at
yahoo.com. Residents may be
referred for further evaluation for
case management through the
nursing home staff or through
results ofassessment.
12 EFCMP Counselor and
Social Worker work
together to create
relaxation spaces in
each nursing home.
3b, 3c Nursing homes can
isolate residents from
each other without
usable shared space.
Those residents with
disabilities may not be
able to utilize shared
spaces. This particular
space will promote self-
care activities such as
knitting, watercoloring,
crafting, reading,
listening to music, and
sensory relaxation
activities to promote
residents to use self-care.
Without the proper tools
coping skills may not be
available to residents.
Decreased
depressive
symptoms in
residents,
decreased
suicidal
ideation,
increased
quality oflife
of residents
EFCMP Counselor and Social
Worker work together to create
relaxation spaces in each nursing
home focused on sensory
experiences for the progressively
disabled. The EFCMP staff will
advocate for specific disability
related purchases individualized to
the needs ofthe residents to
nursing home leadership, and
including materials for residents
with various disabilities. These
spaces will continue to serve the
residents after the program ends.
Community partners will be
encouraged to participate through
donation and setting up this space.
Kettner, Moroney,
Martin (2017);
Waern, De Leo,
Oyama, Scocco,
Gallo, Szanto,
Conwell, Draper,
Quinnett (2011)
This activity will be
collaborative in that the
nursing home
leadership team, the
EFCMP team, and
volunteers across the
community will
contribute to creating a
relaxation space for
residents.

EFCMP 46
Appendix G
How the EFCMP Addresses Multicultural Concerns
Multicultural Issue EFCMP's Actions
Age *The program is designed for those over 65 years of age, but services would be available
to any resident of the eligible nursing homes regardless of age to maintain inclusivity.
Those under 65 would not be included data.
*Individual counseling,case management, and family counseling would be individualized
to the needs of the particular resident or staff member. Age would be a component of the
customization of treatment plans for these individuals.
*In the EFCMP team's official observations the teamwould look for differences in age
ranges as elderly could be considered from 65 - 114. Residents may experiences
differences in nursing home care based on this 49 year range.
*The LPC-S and LPSW would be required to have experience with end of life issues
including grief, progressive disability, and end of life care.
*The LPC-S and LPSW would be required to have continuing education hours related to
geriatric development and issues.
*During the training program the LPC-S and LPSW would train the rest of the EFCMP
related to elderly development and end of life issues.
Race/Ethnicity/
Culture
*All EFCMP counselors and social workers including students will be required to have
taken a multicultural or diversity course in master's level coursework that focuses on
culture, race, and ethnicity.
*The LPC-S, LPSW, LPC-I, and clinical director will be required to take continuing
education credits on race, ethnicity, and culture.
*The LPC-S and LPSW during the training program will train the EFCMP staff on race,
ethnicity, and culture issues especially related to discrimination, racism, and the elderly.
Since it is possible that several races will be present at each nursing home and that
residents may have limited previous engagement with other races this will be especially
important. Racial development models will be taught.
*The LPC-S and LPSW will discuss race, ethnicity, and culture in supervision as it relates
to counseling or case management.
*LPC-S and LPSW will utilize a multicultural conceptualization and encourage
supervisees to considerthe interplay of race, ethnicity, and culture including personal
space,eye contact,and willingness to explore mental illness, willingness to talk about

EFCMP 47
family, importance of family in counseling or care taking, and genderroles. These will be
discussed in an ongoing basis.
*During the EFCMP's official observations the team will look for systematic oppression,
discrimination, and cultural conflicts between nursing home staff, residents,and the
nursing home's leadership team. Staff will be expected to advocate for residents or nursing
home staff based on findings.
*During weekly EFCMP staff meetings race, ethnicity, and culture will be an agenda item
to give staff an avenue to explore cultural, race, and ethnicity issues as it relates to
residents and staff as a team.
Language *At least one counselorand social worker will have American Sign Language proficiency
and Spanish language experience.
Sexual Orientation *All EFCMP counselors and social workers including students will be required to have
taken a multicultural or diversity course in master's level coursework that focuses on
sexual orientation and gender identity issues.
*The LPC-S, LPSW, LPC-I, and clinical director will be required to take continuing
education credits on genderidentity and sexual orientation especially as it applies to the
elderly.
*The LPC-S and LPSW during the training program will train the EFCMP staff on sexual
orientation and genderidentity especially related to discrimination and the elderly. Sexual
identity development models will be taught.
*The LPC-S and LPSW will discuss sexual orientation and gender identity in supervision
as it relates to counseling or case management for residents for which this applies.
*During the EFCMP's official observations the team will look for systematic oppression,
discrimination, and conflicts between nursing home staff, residents,and the nursing
home's leadership team. Staff will be expected to advocate for residents or nursing home
staff based on findings.
*During weekly EFCMP staff meetings sexual orientation and gender identity will be an
agenda item to give staff an avenue to explore any discrimination, bullying, genderissues,
or sexual orientation issues as a team.
Gender *Men respond better to suicide prevention programs that screen for depression without
diagnosing, so the EFCMP will train medical professionals to recognize unique depressive
symptoms in men and follow-up extensively without diagnosing.
*Women respond better to suicide prevention programs that provide screening, group
activities, and social connection.The EFCMP utilizes group counseling,increasing social
connectedness,and increasing coping skills along with providing screening.
Disability *EFCMP staff would make any events accessible to all residents and staff by making
accommodations for disabilities such as providing a sound amplifier for group counseling

EFCMP 48
and going by every resident's room twice a year to offer case management and counseling
services.
*EFCMP staff would link nursing home residents and nursing home staff to agencies like
the Texas Talking Book Program that provides access to braille, audio, and large print
books. They also provide music and magazines.
*EFCMP staff would provide extra wheelchairs and disability accommodations for
residents as necessary.
*EFCMP staff would create a relaxation space with disability accommodations such as
puzzles for memory loss.
*EFCMP staff would advocate to the nursing home leadership team for missing disability
accommodations for residents with special attention to mobility, memory loss, and
hearing impairment.
Socioeconomic
Status
*The EFCMP is offered at no cost to residents.
*Skilled volunteers would be recruited by the volunteer coordinator to serve the residents
after the program ends.
Literacy *All advertising materials or resources would be printed at no higher than a 4th grade
reading level.
*Verbal announcements about upcoming EFCMP events would be made EFCMP
functions to keep staff and residents up to date.
*EFCMP staff would visit each room in the nursing homes during the program to ensure
residents receive access to services such as case management and counseling.
*EFCMP staff would link nursing home residents and nursing home staff to agencies like
the Texas Talking Book Program that provides access to braille, audio, and large print
books. They also provide music and magazines.
Family Involvement *Families may be involved at different levels with some coming several times a day or not
coming at all. The EFCMP will enlist volunteers from all ages to provide social
connections for those residents with limited family involvement. Increasing volunteers for
residents with family involvement will serve to reduce the caregiving strain on family
members.
*Family resources will be included on the nursing home's website including the
continuing education webinars.

EFCMP 49
Appendix H
Organizational Chart

EFCMP 50
Appendix I
Detailed Staff Qualifications Chart
Position Job Description Experience Education Salary
Licensed
Professional
Counselor -
Supervisor
(LPC-S)
Licensed Professional Counselor -
Supervisor (LPC-S) will perform
coordinative and supervisory work
in the management of the counseling
services provided by the program.
Responsibilities include, direct
supervision of the Licensed
Professional Counselor - Interns,
overseeing and coordinating the day-
to-day responsibilities of the clinic,
providing one-on-one counseling to
nursing home patients, and
providing administrative support.
He/she will be responsible for
communicating and advocating for
funding of the program. The ideal
candidate will host on-going
trainings with the Clinical Director,
LPSW, and LPC-Is to the nursing
home staff. Since the LPC-S will be
in direct contact with the patients in
the nursing home, this individual is
required to have competencies in the
multicultural aspects that this
population brings. The LPC-S will
need to be fluent in English,
American Sign Language (ASL),
and Spanish-speaking is preferred to
cater to the geriatric population.
Minimum of two
years experience as
an individual
counselor in a
multicultural
environment.
Applicant must have
experience working
with the elderly
population and
advocating on their
behalf. Proof of
grant-writing skills
will be required upon
acceptance of the
position. Fluent in
English, American
Sign Language
(ASL), and Spanish
preferred; applicants
will need to provide
certificates of
completion of
multilingual CEU’s
or transcripts for
course completion.
Knowledge
counseling
principles, and
familiarity with
confidentiality
principles, HIPPA
and other federal and
state laws pertaining
to client protection.
Applicant must have
experience
conducting the 13
Improving Mood:
Promoting Access to
Master's
degree in
Counseling
and updated
licensure in
Texas is
required.
Must show
proof of
hours and
courses
completed to
qualify them
as an LPC-S.
$60,000
per cycle

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