REACH OUT II: Revision, Project Funded by RCI/Johnson and ...1).pdf · 10/26/2009 1 REACH OUT II: Revision, Maintenance, and Sustainability Lou Burgio, Ph.D University of Michigan

10/26/2009

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REACH OUT II: Revision, Maintenance, and

Sustainability

Lou Burgio, Ph.DUniversity of Michigan School of Social Work and University of Michigan School of Social Work and

the Institute Of Gerontology

Grant HarrisRebecca Allen, Ph.D

Bettina Schmidt, Ph.DUniversity of Alabama

Project Funded by RCI/Johnson and Johnson

In partnership with the Middl Al b A A Middle Alabama Area Agency

on Aging

REACH I: Cluster of clinical trials

REACH II: Multi-site clinical trial

“REACH OUT” I: Translational trialREACH OUT I: Translational trial

“REACH OUT” II: RCI/J&J-funded translational trial focusing on sustainability (ongoing)

REACH II

NIH‐funded traditional multi‐site, Phase III randomized clinical trial (everything the same across 5 sites)

N= 652N  652

REACH II Intervention

The REACH II intervention was designed to address six areas linked to caregiver risk profile:

Safetyy

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

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REACH II Results

Decrease in behavior problems

Increase in social support

Improved CG self‐care

D i d iDecrease 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), 727-738.

REACH-OUT I: Translational Trial

Funded by AoA to State of Alabama; they partnered with use to complete the trialGoal: Translate clinical-trial derivedGoal: 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),based Participatory Research (CBPR), State of Al. and University of Alabama partnered to modify REACH II clinical trial for feasible use in the communityPhase 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 CoordinatorO 4 th i d th Ad i C itt h dOver 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 programOver 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 Stress2 Health and Safety2. Health and Safety

Home Safety CheckHealth Passport

3. Behavioral ManagementBehavioral Prescriptions

4. Signal Breath Relaxation (stress management)(excluded social support and use of technology)

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REACH OUT I Procedures

4, hour‐long home visits to families over 3‐4 months to introduce treatment components1st home visit: Initial visit includes Risk Assessment

2nd home visit: ~ 3 weeks later

3rd home visit: ~ 4 weeks later

4th 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 onPre- Post-assessmentGeneral 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 caregivingcaregiving

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 dangerousCR 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 g yAgency on Aging Personnel. The Gerontologist, 49 (1), 103-116.

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CDC REACH OUT Action Guide will be available around November 1 for download at UMICH and CDC websitesUniversity of Michigan REACH OUTUniversity of Michigan REACH OUT Training Institute (open December 1)

REACH OUT II: Revision, Maintenance, and

Sustainability

Lou Burgio, Ph.DUniversity of Michigan School of Social Work and University of Michigan School of Social Work and

the Institute Of Gerontology

Grant HarrisRebecca Allen, Ph.D

Bettina Schmidt, Ph.DUniversity of Alabama

REACH OUT II: Revision, Maintenance, and

SustainabilityStudy In ProgressStudy In Progress

Goals of project

Modify REACH OUT Program in response to focus group run at completion of REACH OUT ITest sustainability of REACH OUT II byTest sustainability of REACH OUT II by imbedding it in existing C.A.R.E.STesting 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 anticipatorycommunication and anticipatory bereavementAdded maintenance and follow-up sessions at 6 and 12-monthsREACH OUT is embedded in an existing global services program for sustainability

Lessons Learned During Implementation

Need formal certification in REACH OUTFormal screen for burden (4-item Zarit) as entry criterionRe training of interventionists andRe-training of interventionists and assessors at 6-monthsNow recommending six, in place of four in-home sessionsOriginal maintenance schedule changed for feasibility

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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, 2010.

Participants offered the program 81

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

8Withdrew 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