Brief Description

PEARLS (Program to Encourage Active, Rewarding Lives) is 

a treatment program designed to address depression symptoms 

and improve overall quality of life among older adults. The 

program consists of counseling sessions that focus on improving

problem-solving skills, increasing physical activity, and 

promoting participation in rewarding social activities. These

in-person sessions typically take place at home but can be 

conducted in other appropriate community-based settings. 

Follow-up maintenance sessions are conducted over the 

phone. PEARLS is included in ACL’s Aging and Disability 

Evidence-Based Programs and Practices as well as in CDC’s 

2009 issue brief, Addressing Depression in Older Adults: 

Selected Evidence-Based Programs. It was also selected as a 

featured tool by the Suicide Prevention Resource Center.

Is it a good fit for my agency?

PEARLS is suitable for any community-based organization 

providing home-based specialty mental health services to 

older adults (ages 60 or older). Staff requirements include 

service providers willing to be trained as PEARLS coaches to 

deliver counseling sessions. A graduate degree or previous 

counseling experience is not needed to qualify as a coach. 

Trained coaches work under the clinical supervision of a 

mental health professional (psychiatrist, psychiatric nurse 

practitioner, licensed clinical social worker, licensed 

geriatrician, or other primary care provider) who monitors 

participants’ progress, manages medications if needed, and 

determines if more intensive treatment is needed. The 

PEARLS team is also expected to include a staff member 

familiar with existing mental health resources in the 

community for referring participants who need alternative or

more intensive treatment. Program implementation typically 

takes four to five months. The program has been successfully 

implemented by Area Agencies on Aging (AAA), community 

mental health centers, senior centers, and other providers of 

home and community-based services to older adults.

Examples of Successful Implementation

1. Catholic Community Services, the official human service 

outreach arm of the Catholic Church in western Washington

state, uses the PEARLS model in its African American Elders 

Program. The program is located at the Randolph Carter 

Family and Learning Center in Seattle. Coaches visit 

homebound African American older adults to deliver in-home 

counseling services.

2. Maryland Living Well Center of Excellence, a communitybased social service organization partnering with local AAAs, 

healthcare providers, and other community resource providers, 

offers PEARLS services tailored specifically to older veterans 

and their spouses. The program has been especially successful 

in addressing depression in this population. The Center 

reported that 60% of the 50 people served in 2018-19 achieved 

total remission, and 33% reduced their depressive symptoms.

3. Merced County AAA in California offers PEARLS services

to the multicultural older adult population in its catchment 

area. The program provides language assistance and 

interpreter services—including American Sign Language 

interpreters—to all clients who request such assistance. 

Cultural Adaptations 

PEARLS recognizes and accommodates the culturally specific 

nature of aging and elder care. The training encourages 

cultural adaptations and has been implemented in a wide range 

of settings including in tribal, Asian American, Jewish, 

LGBTQIA+, African American, and Latinx communities. 

How Does It Work?

Frontline staff who will deliver services undergo a 2-day 

training in Seattle. During the COVID-19 pandemic, the 

training was adapted to take place virtually over a period of a 

few weeks. Trained PEARLS coaches meet one-on-one with 

participants for one-hour sessions, initially once a week. As 

the participant builds problem-solving skills, the frequency is 

gradually reduced to monthly meetings. The coach works with 

participants using a team-based approach that empowers them 

to actively collaborate in setting the pace and the agenda. 

Emphasis is placed on building problem-solving and coping 

skills, and on planning and carrying out activities that increase 

physical exercise and social engagement. The program 

includes six to eight in-person sessions followed up by 

telephone check-ins over the course of four to five months.

Where to Find Program Information 

The PEARLS implementation toolkit is available for 

download on the University of Washington website. It 

includes a summary of the program’s background and history, 

detailed instructions and guidance for starting the program, 

and all the forms needed to create an organizational 

infrastructure to manage the program and collect evaluation 

data. Further detailed information about PEARLS is available 

on the program’s website. A two-hour online course provides 

an overview of the model. 

 PEARLS: Program to Encourage 

Active, Rewarding Lives

August 2021
Program Costs

The PEARLS coach training costs $500 per person plus the 

cost of travel to Seattle if attending in person. The total cost of 

implementation will vary by staff salaries and unit rate for 

counseling sessions. Counseling costs per person should factor 

in eight hours plus one hour for initial screening and several 

brief maintenance calls over the telephone (the final number 

will depend on need). In addition, cost estimates need to factor 

in the cost of travel to the participant’s home, 1-4 hours of 

clinical supervision per coach, and a similar amount of 

programmatic supervision if a program manager has been 

assigned to the program (recommended). Paperwork takes an 

additional 15-30 minutes per participant per session and 

community outreach and program recruitment may take 1-4 

hours per week. Having well-established community 

partnerships can help reduce recruitment costs; recruiting

existing service recipients into the program further reduces the 

need for extensive recruitment activities. A two-hour online 

informational course is available and costs $95 per person. 

(The informational course is not a training requirement.) 

Potential Funding Sources

The program has been implemented by 133 organizations 

across 26 states. Potential funding sources include: 

 Government or foundation grants

 Older Americans Act Title III-D 

 State or local tax levies (e.g., CA’s Mental Health 

Services Act) 

 Direct billing or fee-for-service payments

 Medicaid waivers

It is also worth investigating whether any local agencies in the 

area offer free PEARLS coach training. One such example is 

the Council on Aging for Southeastern Vermont. 

Value of the Program

Potential funders typically ask how the program will add value 

to the community and help advance individual health and 

well-being and population health, facilitating treatment and 

recovery efforts, and/or reducing overall health costs. The 

following are important program outcomes to note in this 

context. 

In a 12-month randomized control study of 138 older adults... 

 Clinical depression scores decreased to half their 

intake levels or lower for 43% of PEARLS

participants compared to 15% of the control group. 

 Complete remission from depression was achieved 

by 36% of PEARLS participants compared to 12% of 

the control group. 

 Compared to the control group, PEARLS participants 

were significantly more likely to increase their scores 

on functional and emotional wellbeing scales.

Expected Impact on Overall Healthcare 

Costs

 Research1 has shown that ED visits, 

hospitalizations, overall healthcare costs, and 

productivity loss among adults with a depression 

diagnosis increase significantly with the severity of 

symptoms. 

 PEARLS has been shown to decrease depression 

symptoms and facilitate remission and would thus 

be expected to reduce healthcare resource use and 

overall costs for its participants. 

Financing and Implementing PEARLS 

Through Community Collaborations 

1Chow, W., Doane, M.J., Sheehan, J., Alphs, L., Le, H. (2019). 

Economic burden among patients with major depressive disorder: 

An analysis of healthcare resource use, work productivity, and 

direct and indirect costs by depression severity. American Journal 

of Managed Care, 25(2), Supplement.