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10/26/2009
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
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