REACH II Resources for Enhancing Alzheimer s Caregiver Health The Texas Experience Alan B. Stevens Vernon D. Holleman-Lewis M. Rampy Centennial Chair in Gerontology Scott & White Healthcare
REACH II Clinical Trial Sponsored by the National Institute on Aging (NIA), National Institute of Nursing Research (NINR) Second in a series of multi-site research programs to develop and test effective caregiver interventions Ethnically diverse sample of 642 care recipient/ caregiver dyads in six sites Intensive intervention of home visits and phone calls Standardized assessments at baseline and 6-months
REACH II Intervention Number of therapeutic contacts 9 in home, 1.5 hour sessions 3 telephone sessions, one-half hour each 5 structured telephone support groups Delivery by Interventionist certified in the treatment protocol Bachelor or Master s in social science disciplines (e.g., psychology, social work) Intervention strategies allowed tailoring of the intervention to meet specific needs of the caregiver
Reach II Intervention Domains Depression Burden Self-care and healthy behaviors Social support Problem behaviors
REACH II Outcomes 5 Measures central to caregiver s quality of life and closely linked to intervention components modeled into a single primary outcome Depression Caregiver burden Self-care Social Support Problem Behaviors of the CR Clinical Depression Institutional Placement of CR at 6 months
REACH II Implications Intervention had a meaningful impact on quality of life and rates of caregiver depression were halved Translations into real-world settings 4 Area Agencies on Aging in Alabama (Burgio, et al.) Intervention differed from trial, but the evaluation demonstrated significant pre-post effects on domains similar to the original clinical trial. 24 VA medical centers in 15 states (REACH VA, Nichols, et al.) Intervention was similar to trial and achieved similar outcomes.
Scott & White s Approach Use implementation research methods to embed an evidence-based intervention for family caregivers (Resources for Enhancing Alzheimer s Caregiver Health II -- REACH II) Leverage characteristics of an integrated healthcare system to target, identify, and enroll family caregivers in need of support Deliver and evaluate the innovative support program on caregiver quality of life indicators Position the Family Caregiver Program as an asset to Scott & White s Mission and Vision
REACH II Adaptations for the Healthcare Setting Identified champions within the healthcare system to foster identification of caregivers Package REACH II intervention components into a user friendly format, A Caregiver s Notebook Use REACH II RAM to identify risks and measure outcomes FCP based in an internal medicine primary care clinic for in-person and one-on-one contacts
Accomplishments of Phase I Significant decrease in overall caregiver risks reported by caregivers, including the domains of caregiver stress, burden, and safety. Findings are in press at Translational Behavioral Medicine as Implementing an Evidence-based Caregiver Intervention within an Integrated Healthcare System 2009 Rosalynn Carter Leadership in Caregiving Award
Phase II is in Process Family Caregiver Program has been expanded into other Scott & White Healthcare delivery settings (2 hospitals and 26 clinics) Conduct a cluster randomization trial with the REACH II Quality of Life measure as the main outcome measure Continue program in Phase I sites (i.e., skills training and support intervention) Randomize service regions 1 skills training and support intervention 1 education group comparison
Special Thanks from Scott & White Healthcare to our Partners
Implementation of REACH II in a Community-Based Setting: The Tarrant County/Texas Experience Donald R. Smith Vice President, Community Development Division, United Way of Tarrant County Director, Area Agency on Aging
Tarrant County, Texas Largest cities: Fort Worth and Arlington Total Population: 1.8 million County Population: larger than 12 States Third largest County in Texas Gaining on 2nd largest (Dallas)
United Way of Tarrant County The designated Area Agency on Aging One of few United Ways designated Allows for leveraging of AAA federal monies Alignment of Strategic Goals Expansion of services to older adults and caregivers
United Way Strategic Planning Process Healthy Aging and Independent Living (HAIL) chosen as focus by UW Strategic Planning Committee Summer, 2009 HAIL Strategic Design Group formed Sept. 2009 Five Meetings Nov 18, 24, Dec 1, 9 & Jan 12 of 2009 Review of evidence-based programs and services Prioritization of strategies and partnerships
Alzheimer s Disease Identified as a Target Target population Mid-Stage Alzheimer s Disease and Family Caregivers Ranking of Strategies Respite Care Caregiver Education and Training Resources for Enhancing Alzheimer s Caregiver Health (REACH II)
Partnering with Community Organizations to Meet our Goals Alzheimer s Association: North Central Texas Chapter $200,000 grant awarded July 1, 2010 REACH II design and training August, 2010 Grant renewed at $300,000 July 1, 2011 Probable funding in FY 13
Future Funding for REACH II Re-engineering of Healthy Aging and Independent Living Initiative (Fall of 2011) Expanded program to other chronic conditions Original initiative three years (2010-2012) Pending expansion to ten years (2010-2020) $18.5 million
HAIL REACH provided by the Alzheimer s Association - North Central Texas Chapter Susanna Luk-Jones, MS Director of Programs and Services Alzheimer s Association - North Central Texas Chapter 19
About HAIL REACH Funding through the United Way of Tarrant County s Healthy Aging and Independent Living Initiative Partnering with Easter Seals of North Texas and University of North Texas - Health Science Center as the project evaluator Staffing with Dementia Care Specialists (LPC or LPC-i) Providing REACH II intervention components via counseling and structured skills training to dementia caregivers over a 6-month period 20
HAIL REACH Impact Outcomes Quality of Life Evaluation Pre and Post intervention assessment Assesses caregivers strength in key areas: Depression Caregiver Burden Self-Care Social Support Problem Behaviors/Safety Prevent premature long-term care placement of the person with dementia 21
REACH Enrollment Process Referral sources: Alzheimer s Association 24/7 Helpline, case management program and educational programs Area Agency on Aging and ADRC Home health and hospice agencies HAIL screening criteria Families living in Tarrant County facing a dementia diagnosis or Early On-set Alzheimer s 22
Client Assessment and Care Plan Risk Appraisal Measure (RAM) 16-item questionnaire Determines client risk level for caregiver burnout from low to moderate to high REACH II Intervention Components tailored to Caregiver s needs Between 4-6 therapeutic sessions At least 2 telephone contacts between sessions 23
Year 1 August 2010 - June 2011 Staffing 2 Dementia Care Specialists Added third specialist in April 2011 217 Caregivers Enrolled 435 Home visits 1,515 Follow-up contacts 24
Year 2 July 2011 - February 2012 Staffing 3 Dementia Care Specialists (3 FTE) 2 Interns (1 FTE) 233 Caregivers Enrolled 597 Home visits 1,932 Follow-up contacts 25
Preliminary 20-Month Outcomes 26
Preliminary Outcomes of Quality of Life Inventory Clinical impressions indicated that the program is positively impacting caregivers depression, burden, self-care and social support Caregivers reported decrease in problem behaviors Data analysis of the REACH II QoL measure will begin soon 27
Lessons Learned Dementia Care Specialists must resist the urge to become social workers for the sake of fidelity Clients need more tangible reminders to focus on the key domains Broad referral base Program screening tool More consistent & regular program review to detect and correct problems Accountability and on-going support to ensure fidelity 28