Title: Louis D' Burgio, PhD, CoPI
1 The Alabama REACH Demonstration Project
- Louis D. Burgio, PhD, Co-PI
- Bettina Schmid, MS
- The University of Alabama
2The Alabama REACH Demonstration ProjectAlabama
2004 - 2007
- Alabama Department of Senior Services
- Irene Collins, Commissioner
- The University of Alabama
- Center for Mental Health and Aging
- Louis D. Burgio, Director/Co-PI
- Bettina Schmid, Project Manager
- Alan Stevens, Consultant
3The Alabama REACH Demonstration ProjectAlabama
2004 - 2007
-
- In 2004, the Alabama Department of Senior
Services received an Alzheimers Disease
Demonstration Grant to States (ADDGS) award which
includes the following goal -
- Implement a 3-year program to improve direct
services available to family caregivers by
incorporating REACH-like evidence-based, in-home
social and behavioral interventions which promote
skill building.
4The Alabama REACH Demonstration ProjectAlabama
2004 - 2007
-
- The University of Alabama Center for Mental
Health and Aging (Louis D. Burgio, Director) was
included to provide training and consultation for
the case workers in each of the Area Agencies on
Aging participating in the project. -
-
5Resources for Enhancing Alzheimers Caregiver
Health REACH I and REACH II NIH-funded studies
- REACH I
- Multi-site feasibility study started in 1995
- Explored the effectiveness of different
interventions to reduce burden and distress of
family caregivers in 6 participating sites - Detailed analyses of these data suggested
specific components of the REACH I interventions
may be efficacious in improving caregiver
outcomes.
6Resources for Enhancing Alzheimers Caregiver
Health REACH I and REACH II NIH-funded studies
- REACH II
- Built upon the findings of REACH I, REACH II was
funded in 2001 to refine and test multi-component
psychosocial behavioral interventions. - The REACH II intervention seeks to increase
caregiver knowledge, skills, and well-being. The
intervention process involves administering a
risk appraisal, prioritizing the risk areas, and
then using a stepped intervention approach that
addresses risk in multiple domains.
7REACH Investigators
- Principal Investigators of REACH I
- Louis Burgio, Ph.D.
- Robert Burns, M.D.
- Carl Eisdorfer, Ph.D., M.D.
- Dolores Gallagher-Thompson, Ph.D.
- Laura N. Gitlin, Ph.D.
- Diane Mahoney, Ph.D.
- Richard Schulz, Ph.D.
- Principal Investigators of REACH II
- Louis Burgio, Ph.D.
- Robert Burns, M.D.
- Sara Czaja, Ph.D.
- Dolores Gallagher-Thompson, Ph.D.
- Laura N. Gitlin, Ph.D.
- Richard Schulz, Ph.D.
8NIH-funded REACH II Components
- Risk Assessment
- Education
- Information on Alzheimers Disease and
dementia, caregiving, and home safety/health
passport - Caregiver Network (Computer Telephone Integration
System CTIS) - Access to resources, social support,
information/educational materials, and respite - Caregiver Health/Environmental Safety
-
- Behavior Management Skills
- Behavioral prescriptions
- Physical and Emotional Well-being
- Stress reduction and relaxation (signal
breath, music therapy, stretching), managing
mood, and increasing pleasant events
9How were these components of REACH studies
selected for the Alabama REACH Demonstration
Project?
- August 2004 Recommendations from Lou Burgio ?
a principal investigator for the REACH
projects director of the University of Alabama
Center for Mental Health and Aging (e.g., funds
not available for CTIS). - August 2004 Initial planning meeting of Advisory
Board at the Alabama Department of Senior
Services (ADSS), Montgomery, AL and AAA
representatives. Four components chosen by the
advisors. - November 2004 Teleconference Advisory Board
offered additional confirmation of four
components agreed on feasibility of length of
training workshop, number of in-home sessions,
etc. - January 2005 Teleconference Formal meeting of
Advisory Board which consisted of Director of
ADSS, representatives of the four pilot AAAs and
their directors to give final approval for the
proposed plan.
10How were these components of REACH studies
selected for the Alabama REACH Demonstration
Project? cont.
- September 2004 February 2005
- The Center for Mental Health and Aging
(CMHA) developed a training - program for case workers of pilot AAAs who
are providing direct services - to families living with Alzheimers
disease. - March 2005
- CMHA provided initial training to case
workers of pilot AAAs -- 2 day - intensive workshop incorporating active
learning strategies - Ongoing
- Training new case workers to accommodate staff
turnover - Hotline 2 half days per week in order to
provide individual consultation for - case workers on an
as-needed basis - Monthly Conference Calls between the
Alabama Department of Social Services, Center for
Mental Health and Aging, and each of the 4
participating AAAs
11REACH II Alabama REACH Demonstration
Project
- Practical elements of REACH II have been selected
for the Alabama REACH Demonstration Project in
order to bring useful interventions into everyday
practice to improve the lives of Alzheimers
patients and their caregivers. The focus was on
feasibility, translating findings from the NIH
clinical trial to a real world setting. - Initially a Risk Assessment is conducted to
inform tailored interventions. - Interventions include
- 1. Education about AD, Caregiving, Stress
- 2. Health and Safety
- Home Safety Check
- Health Passport
- 3. Behavioral Management
- Behavioral Prescriptions
-
- 4. Signal Breath Relaxation
12Direct Services to Families Living with
Alzheimers Disease
- Target 250 families
- 4 home visits to families over a period of 4
months - 1st 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 between home visits
13Direct Services to Families Living with
Alzheimers Disease (cont.)
- Project Assessment
- ADSS Client Enrollment form
- Caregiver burden
- Caregiver health
- Care recipient memory, behavior, mood
- Caregiver satisfaction survey
- Interest in upgrading accountability of
programs (more in-depth assessment)
14Alabama REACH Demonstration Project
- Center for Mental Health and Aging staff
worked with each site to - address questions and concerns in starting
up the program - 102 families have been enrolled in the
project (Feb 2006) - Case workers had a positive response to the
training - Interventions have been well-received by
families -
-
15Demographics Caregivers(Data received by Feb
2006)
16Home Visits and Therapeutic Phone Calls
17Home Visits and Therapeutic Phone Calls
18Caregivers Overall Satisfaction
- Service are helpful for care recipients
- average rating of 3.59 out of 4.0
- (4.0 strongly agree)
- Services are helpful for caregivers
- average rating of 3.66 out of 4.0
- (4.0 strongly agree)
19Average Rating of Services
- 1 very helpful, 2 somewhat helpful, 3 not
helpful - Info about AD 1.19
- Info about caregiving/stress 1.19
- Safety 1.44
- Health Passport 1.59
- Behavioral Prescription 1.50
- Signal Breath 1.53
20Outcome Measures
- Care Recipient Behavior
- In the past 4 months, have you seen any overall
improvement in behavioral problems? - Pre-intervention Post-intervention
- Yes 5 Yes 6
- No 27 No 26
-
- (n 32)
21Outcome Measures
- Care Recipient Mood
- In the past 4 months, have you seen any
improvement in the CRs mood overall? - Pre-intervention Post-intervention
- Yes 5 Yes 2
- No 27 No 29
- Unknown 1
- (n 32)
22Outcome Measures cont.
- Caregiver Health
- In general, would you say your health is
- Excellent, Very Good, Good, Fair, Poor?
- t (32) -1.875, p .07
- Caregiver Burden
- Zarit Burden Scale (total score)
- t (27) -2.171, p .039
23Thank you