REACH II. Procedures. REACH II Intervention. REACH OUT II: Revision, Maintenance, and Sustainability. Project Funded by RCI/Johnson and Johnson

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1 Lou Burgio, Ph.D University of Michigan School of Social Work and the Institute Of Gerontology Grant Harris Rebecca Allen, Ph.D Bettina Schmidt, Ph.D University of Alabama Project Funded by RCI/Johnson and Johnson In partnership with the Middle Alabama Area Agency on Aging REACH I: Cluster of clinical trials REACH II: Multi-site clinical trial REACH OUT I: Translational trial REACH II NIH funded traditional multi site, Phase III randomized clinical trial (everything the same across 5 sites) N= 652 REACH OUT II: RCI/J&J-funded translational trial focusing on sustainability (ongoing) REACH II Intervention The REACH II intervention was designed to address six areas linked to caregiver risk profile: Safety Social Support CR Problem Behaviors (behavior management) Emotional well being (relaxation techniques) Self care and Health Behaviors System that allowed caregivers to be involved in Support Group through the phone Procedures 12 home visits over 6 months 6 therapeutic phone calls 1

2 REACH II Results Decrease in behavior problems Increase in social support Improved CG self care Decrease in depression Decrease in CG burden IMPORTANT: Worked equally well with African Americans, Caucasians and Hispanics REACH II Belle, S., Burgio, L., and the REACH Investigators. (2006). Enhancing the quality of life of Hispanic/Latino, Black/African American, and White/Caucasian dementia caregivers: The REACH II randomized controlled trial. Annals of Internal Medicine, 145(9), REACH-OUT I: Translational Trial Funded by AoA to State of Alabama; they partnered with use to complete the trial Goal: Translate clinical-trial derived REACH II for feasible use in the community (AAAs) N= 256 How was REACH II Clinical Trial Translated to Community? Two Phases Phase I: Using elements of Community- based Participatory Research (CBPR), State of Al. and University of Alabama partnered to modify REACH II clinical trial for feasible use in the community Phase II: Used traditional experimental procedures to test the effectiveness of the translated intervention. REACH OUT Phase I: Elements of CBPR Advisory Committee formed: AAA directors and case managers, Directors of Senior Services, LB, and Project Coordinator Over a 4 month period, the Advisory Committee had a series of face to face meetings and phone conferences to decide treatment components and feasibility of all aspects of the program Over an additional 5 month period, we (UA), with consultation from Advisory Committee, adapted materials from REACH II to produce the REACH OUT materials and to settle on procedures How Did the Translated Intervention Look? Initially a risk assessment is conducted to produce tailored interventions. Interventions include: 1. Education about AD, Caregiving and Stress 2. Health and Safety Home Safety Check Health Passport 3. Behavioral Management Behavioral Prescriptions 4. Signal Breath Relaxation (stress management) (excluded social support and use of technology) 2

3 REACH OUT I Procedures 4, hour long home visits to families over 3 4 months to introduce treatment components 1 st home visit: Initial visit includes Risk Assessment 2 nd home visit: ~ 3 weeks later 3 rd home visit: ~ 4 weeks later 4 th home visit: ~ 4 weeks later (final home visit) Therapeutic phone calls (3) between home visits REACH OUT Phase II: Use of Traditional Experimental Methods to Test Effectiveness Translated REACH OUT program stayed constant from this point on Pre- Post-assessment General Linear Modeling (GLM) used to analyze the data REACH OUT I: Caregiver Outcomes Caregiver improvement in their overall health and depression Reduction in feelings of burden from caregiving CG reported fewer feelings of anger towards the CR REACH OUT I: Care recipient Outcomes Care recipients were less likely to be left unsupervised Less wandering CR less likely to have access to dangerous objects Improvement in care recipient s problem behaviors Burgio, L.D., Collins, I.B., Schmid, B., Wharton, T., McCallum, D., & DeCoster, J. (2009). Translating the REACH Caregiver Intervention for Use by Area Agency on Aging Personnel. The Gerontologist, 49 (1),

4 CDC REACH OUT Action Guide will be available around November 1 for download at UMICH and CDC websites University of Michigan REACH OUT Training Institute (open December 1) Lou Burgio, Ph.D University of Michigan School of Social Work and the Institute Of Gerontology Grant Harris Rebecca Allen, Ph.D Bettina Schmidt, Ph.D University of Alabama Study In Progress Goals of project Modify REACH OUT Program in response to focus group run at completion of REACH OUT I Test sustainability of REACH OUT II by imbedding it in existing C.A.R.E.S Testing the feasibility of adding a maintenance phase and long-term follow up assessment (6 and 12-months after end of main intervention) Changes in REACH OUT II due to Focus Group Use of one person in each AAA to focus on REACH OUT (????) Added modules on physician-caregiver communication and anticipatory bereavement Added maintenance and follow-up sessions at 6 and 12-months REACH OUT is embedded in an existing global services program for sustainability Lessons Learned During Implementation Need formal certification in REACH OUT Formal screen for burden (4-item Zarit) as entry criterion Re-training of interventionists and assessors at 6-months Now recommending six, in place of four in-home sessions Original maintenance schedule changed for feasibility 4

5 Participants offered the program 81 The following slide suggests that the program is sustainable. Funding for REACH OUT ended September, 09; the AAA has committed to continue providing REACH OUT to new dyads. The 12-month data for the cohort represented in the next slide will be collected in August, Declined to Participate 7 (3 CRs admitted to nursing home before starting pro (2: In-home help already in place) (1 CR died) (1: Unable to locate family after initial contact) Ineligible (screener score not met) 12 Withdrew 8 (4 CRs moved into assisted living/nursing home) (4 CRs died) Completed the Intervention Phase 47 Still in the Intervention Phase 7 Still in the Maintenance Phase 32 Completed the Maintenance Phase 15 5