Group-Based Interventions for Caregivers of Individuals with Chronic Health Conditions. Kelly Valdivia, BA and Stacy A.

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2 Group-Based Interventions for Caregivers of Individuals with Chronic Health Conditions Kelly Valdivia, BA and Stacy A. Ogbeide, MS

3 Introduction and Presentation Overview Why focus on caregiving? More than 65 million caregivers the United States Overview Caregiver Burden and Importance of Self-care Importance of Group (vs. Individual) Interventions Stress-based Model of Caregiving Interventions Skills-based Psycho-ed Interventions that follow the Stress-based Model Outcome Measures to Examine Group Effectiveness Implications National Alliance for Caregiving, 2009

4 Caregiver Burden and the Importance of Self-Care Perceived Burden Physical, psychological, emotional, social, and financial problems; embarrassment, overload, feelings of entrapment, resentment, isolation from society, loss of control, poor communication, and, work pressures (Vitaliano, Zhang, Scanlan, 2003). Health Risks Female v. Male Caregivers Elderly Caregivers

5 Importance of Group-Based Interventions Benefits Cultivate hope, provide guidance (thefamilycaregiver.org); Social and emotional support; information on the illness; resources for caregivers; share positive aspects and experiences of caregiving (Mittleman, Epstein, & Pierzchala, 2003)

6 Stress-Based Model Framework Stress-based model: caregiving is innately stressful; coping strategies key 4 dimensions: Target audience (e.g., caregiver) Target domain (e.g., skills, behaviors, affect, knowledge) Intensity Personalization Interventions high on all four dimensions increased chance for effectiveness Schultz et al., 2000

7 Skills-Based Interventions Past programs: Resources for Enhancing Alzheimer s Caregiver Health (REACH I and II) New York University Caregiver Intervention (NYUCI)

8 Skills-Based Interventions REACH: Purpose: The interventions are aimed at reducing burden and depression in caregivers by enhancing family support Strategy: Psychoeducational and skills-based training involving either training the caregiver in care-recipient behavioral-management strategies or teaching the caregiver effective coping strategies. Research Outcomes: The combined family therapy and technology intervention significantly reduced depression in caregivers, with particular benefits for Cuban- American husband and daughter caregivers over the long term (18 months). NYUIC: Purpose: This approach aims to reduce burden and distress in dementia caregivers and to improve quality of care for care recipients Strategy: The strategy combines 6 sessions of individual and family counseling, support group participation, and additional on-call telephone consultations in a flexible counseling approach that is tailored to each caregiving family. Research Outcomes: Studies show the intervention benefits the caregiver s mental and physical health and delays institutional placement of the care recipient into a nursing home. Caregivers report increased support from members of their networks and increased satisfaction with that support. Caregiver, 2011

9 Skills-Based Interventions Current program: Chronic Illness Caregiver Group Purpose: Provide a venue for parents and family members to find support and guidance with and managing day-to-day aspects of their child s, or family members, chronic illness; to provide an opportunity to develop connections with those going through similar situations. Strategy: Psychoeducation (Cycle of Chronic Illness, Impact on Caregivers and Family, Biopsychosocial Model); Skills-based Interventions (Stress, Relaxation, Negative Thinking, Communication).

10 Outcome Measures Stress, Burden, and Coping: Caregiver Self-Assessment Questionnaire (stress and depression) Perceived Benefits of Caregiving Perceived Support Scale Risk Appraisal Measure (Dementia specific; assess needed areas of support) Adult Carer QoL Questionnaire Mental Health: PHQ-9 BDI/BAI GAD-7 Inventory of Complicated Grief Texas Revised Inventory of Grief Caregiver, 2011

11 Practical Implications Reviewing literature for materials that will help guide interventions (e.g., previous manuals) Determine intervention format Open vs. closed? Time-limited? Location? Fees? Effective outcome measures what are you wanting to measure? Nontraditional methods (e.g., video, on-line) Burgio et al., 2003

12 Questions? : Kelly Valdivia Stacy Ogbeide

13 References Adult Carer Quality of Life Questionnaire (2011). The Princess Royal Trust for Carers. Retrieved from Burgio, L., Solano, N. Fisher, S. E., Stevens, A., & Gallagher-Thompson, D. (2003). Skill-building: Psychoeducational strategies. In D. Coon, D. Gallagher- Thompson, & L. Thompson (Eds.), Innovative interventions for reduce dementia caregiver distress: A clinical guide (pp ). New York: Springer. Caregiver briefcase for psychologists (2011). American Psychological Association. Retrieved from Connecting Caregivers (2011). National Family Caregiver Alliance. Retrieved from Czaja, S. J., et al. (2009). Development of the Risk Appraisal Measure: A brief screen to identify risk areas and guide interventions for dementia caregivers. Journal of the American Geriatrics Association, 57, doi: /j x

14 References Mittleman, M. S., Epstein, C., & Perizchala, A. (2003). Counseling the Alzheimer s Caregiver: A Resource for Health Care Professionals. AMA Press: USA. Schulz, R., Gallagher-Thompson, D., Haley, W., & Czaja, S. (2000). Understanding the interventions process: A theoretical/conceptual framework for intervention approaches to caregiving. In R. Schulz (Ed.), Handbook on dementia caregiving: Evidence-based intervention for family caregivers (pp ). New York: Springer. Vitaliano, P.P., Scanlon, Z., & Zhang, H.M (2003). Is Caregiving hazardous to one s physical health? A meta-analysis. Psychological Bulletin, 6,