Sustaining the practice

Transcription

1 Linda O. Nichols, PhD Jennifer Martindale-Adams, EdD Caregiver Center VA Medical Center Memphis American Society on Aging Annual Meeting Rosalynn Carter Institute Workshop Going to Scale in Provision of Quality Caregiver Supports April 26, 2011 Evidence based programs Agency preparedness Marketing and outreach Sustaining the practice 1

2 Evidence based programs What are evidence based practices Why use an evidence based program Selecting a program How do you find a program How do you assess the evidence and outcomes How do you narrow down the candidates Implementing the program Is your intervention the same one that was tested Are you doing the intervention the way it should be done Practices, skills, techniques, strategies, therapies Strong and valid scientific evidence Randomized clinical/controlled trials Multiple populations Reliably produce desirable outcomes Usable by organizations and by practitioners 2

3 One of the most critical issues impeding improvements in public health today is the enormous gap between what we know can optimize health and healthcare and what actually gets used and implemented in every day practice. Conference statement, NIH 2011 Training Institute on Dissemination and Implementation Research in Health (TIDIRH) Ask yourself How do you find a program? How do you assess the evidence? How do you narrow down the candidates? You are interested in Efficacy, effectiveness, feasibility, acceptability Reliable and valid Program fidelity and integrity Outcomes Translation The Agency s Dilemma, Part I 3

4 Care Recipient Time Out Time out is the best caregiver intervention. Caregiver Journal Journaling is the best caregiver intervention. Price: $20.00 per person Price: $20.00 per person Computer Modules Computer training is the best caregiver intervention. Care Recipient Lock up Lock up is the best caregiver intervention. Price: $20.00 per person Price: $20.00 per person You could shop around Use trusted sources of information Rosalynn Carter Institute National Implementation Resource Network Administration on Aging Centers for Disease Control Agency for Healthcare Research and Quality Evidence-based Practice Centers Veterans Affairs HSR&D Evidence-based Synthesis Program Call someone who has done it 4

5 Hint: Believe none of what you hear and half of what you see. Benjamin Franklin Marvin Gaye Feasibility REACH I NIA/NINR Randomized Controlled Trial REACH II NIA/NINR Translation REACH VA VHA Programs REACH VA Dementia, SCI, TBI REACH VA Dementia 5

6 Look for outcomes that have been replicated in different settings with different populations Outcomes need to be important Negative outcomes also need to be considered Outcomes need to make sense for your organization, your staff and those you serve REACH II Findings Caregiver improvement in burden, patient behavior management, depression, self-care, social support, caregiver frustrations Lower prevalence of clinical depression One hour per day decrease in time providing care Cost of $4.96 per caregiver per day Belle et al., Ann Int Med, 2006; Nichols et al., JAGS, 2008 REACH VA Findings Caregiver improvement in burden, patient behavior management, depression, caregiver frustrations Improved effect of depression on daily life Two hours per day decrease in time on duty Cost of $2.93 per caregiver per day (no travel or caregiver costs) Nichols et al., Arch Int Med,

7 Match the program to your organization Look carefully at what the program entails Look carefully at your mission and vision Think carefully about what your organization can and wants to do Map the intervention onto current practices and see if fits Examine your short term and long term resources Program Parameters Designed for stressed and burdened caregivers In home visits are required Six month intervention Requests Can we do it in day care? Can we do it over the telephone? Can we alter the schedule? 7

8 Ask yourself Is the intervention you are getting the same one that was tested? Are you doing the intervention the way it should be done? You are interested in Standardized protocol Comprehensive manuals Documentation tools Fidelity monitoring tools The Agency s Dilemma, Part 2 First and very important part of fidelity integrity of study/program design How much change is acceptable before the intervention you are using isn t evidence based anymore? Will your staff be performing the same intervention? If changes are made, need to examine them very carefully. 8

9 Six month duration 12 individual sessions Home and by telephone 5 telephone groups Computerized screen phones Structured and targeted Risk based Education Safety Emotional well being Self-care Social support Patient problem behaviors/ caregiver skills Individually prepared prescription REACH II Six month duration 12 individual sessions Home and by telephone 5 telephone groups Regular phones Structured and targeted Risk based Education Safety Emotional well being Self-care Social support Patient problem behaviors/ caregiver skills Targeted components of prepared topics REACH VA Difference Is the intervention a black box? Is the intervention standardized? Is there a protocol? Are there scripts or talking points? Are there manuals? Can your staff do it? 9

10 REACH VA 2 pounds vs. REACH II 26 pounds Is the manual comprehensive, usable and intelligible? Not all that the research study needed Enough for reimbursement Enough for evaluation Enough to assess fidelity REACH II REACH VA Program REACH VA Translation 10

11 Strong, replicable program? Strategies used to monitor and enhance reliability and validity of behavioral interventions Resnick et al., Nursing Research, 2005 Clients acting? Enactment Receipt Design/ integrity Training Delivery Staff prepared? Clients understand? Staff delivering? Delivery (program delivered as intended) All components done? Receipt (participants hear and understand) Participant models and agrees to try behavior strategy Enactment (participants act) Participant tried behavioral management strategy and reports outcome 11

12 Evidence based programs What are evidence based practices Why use an evidence based program Selecting a program How do you find a program How do you assess the evidence and outcomes How do you narrow down the candidates Implementing the program Is your intervention the same one that was tested Are you doing the intervention the way it should be done Helpful resource: Linda Nichols, PhD VA Medical Center (11H) 1030 Jefferson Memphis, TN (901) , ext. 5082, 7439 (fax) Jennifer Martindale-Adams, EdD VA Medical Center (11H) 1030 Jefferson Memphis, TN (901) , ext. 5080, 7439 (fax) jennifer.martindale-adams@va.gov 12

13 Evidence based programs Finding an evidence based program that fits and is replicable is your first step to a successful and sustained implementation And when we try to define evidence we find it very difficult. R.G. Collingwood, The Idea of History 13