PEARLS (Program to Encourage Active Rewarding LiveS)

The Program to Encourage Active, Rewarding Lives (PEARLS), an intervention for adults with a depression or dysthymia diagnosis, aims to reduce symptoms of depression and suicidal ideation and improve quality of life.

Designed to empower clients through behavioral techniques, PEARLS consists of these primary components:

  • Problem-solving treatment: Participants learn to understand the link between unsolved problems and depression and to apply a seven-step approach to solving their problems.
  • Social and physical activation: Participants are encouraged to engage in social and physical activities that most interest them.
  • Pleasant activity scheduling: Participants identify and participate in activities they find pleasurable.

PEARLS is delivered in six to eight 50-minute sessions by a trained health or social service professional (e.g., social worker, nurse, case manager) in the client's home or via telehealth. Sessions are initially held weekly and become less frequent over a four- to five-month period. During sessions, clients choose the problems they would like to discuss, and the counselor guides, teaches, and supports the client in developing action plans that are to be implemented between sessions to address these problems.

Originally developed for older adults, PEARLS has been implemented with a variety of populations, including adults and older adults with chronic conditions, veterans and the spouses of veterans, older adults with minor depression or dysthymia who were receiving home-based social services, and individuals with epilepsy and depression who were already receiving outpatient services.


Before adopting PEARLS, we recommend that your organization consider the following questions:

Does PEARLS align with our organizational mission? Commonly recognized organizational mission factors that support a decision to adopt PEARLS include: improving health (including behavioral health); focusing on the most common issues that people face; and empowering them to direct their own recovery by teaching them self-management skills.

Who will provide PEARLS? PEARLS counselors or coaches are typically existing staff within an organization that are trained to deliver the PEARLS intervention. These may include, but are not limited to, social workers, nurses, therapists, psychologists, health educators, or community health workers. Some organizations train full-time staff to provide PEARLS, while others train multiple providers to deliver PEARLS as one part of their job. Others contract out for PEARLS counselors to provide services that are outside their clinical scope.

How will I screen for depression? Some organizations are currently screening for depression as part of their annual assessment or intake. For others, adding a brief, validated depression screening instrument will be key to identifying individuals who may be eligible for PEARLS.

How will I recruit new clients for PEARLS? PEARLS is designed to reach vulnerable populations by being delivered in the home or other community-based settings. Your organization may already be reaching more isolated populations with other programs and services. If not, you may need to partner with organizations that serve the broad range of members such as the USO, MWR, and others.

Who will provide clinical supervision? The PEARLS model requires a clinical supervisor for ongoing case review and consultation with the PEARLS counselors. The original research studies used a psychiatrist to provide clinical supervision; other options include clinicians who have expertise in depression, medication management, problem-solving treatment and behavioral activation, and can communicate with a participant’s primary care provider as needed (such as licensed clinical social workers, geriatricians or other primary care providers, and psychiatric nurse practitioners). Supervision is typically provided in a group format, in-person or by phone, and occurs 1-2 times a month for 1-2 hours, depending on the number of counselors and clients. Clinical supervision provides ongoing training and support for PEARLS counselors.

How will I collect data? Regular data collection is important for monitoring PEARLS process and outcome measures and adjusting as needed. Tracking data also allows an organization to monitor program fidelity and evaluate program benefits and challenges.

Are we already delivering other evidence-based programs (EBPs)? Organizations that have successfully adopted, implemented, and sustained EBPs are in a good position to deliver PEARLS. Many EBPs include similar “ingredients” as PEARLS – an underlying theory of behavior change, background research studies to develop and test the program, and standardized training tools and implementation manuals and forms for program delivery

For more information, contact me:

CAPT John Bushey, USN (Ret)

Program Manager, EFWF