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Louis D' Burgio, PhD, CoPI

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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

2
The 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

3
The 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.

4
The 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.

5
Resources 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.

6
Resources 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.

7
REACH 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.

8
NIH-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

9
How 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.

10
How 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

11
REACH 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

12
Direct 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

13
Direct 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)

14
Alabama 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

15
Demographics Caregivers(Data received by Feb
2006)
16
Home Visits and Therapeutic Phone Calls
17
Home Visits and Therapeutic Phone Calls
18
Caregivers 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)

19
Average 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

20
Outcome 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)

21
Outcome 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)

22
Outcome 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

23

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