Fletcher Allen Healthcare
1 S. Prospect Street
Burlington, VT 05401
Contact: Anita L. Royer, LICSW
Mental Health Program Manager
E-mail: Anita.Royer@vtmednet.org
Fletcher Allen Website
Intervention Implemented: New York University Caregiver Intervention
Project Description: This program’s goal was to establish the NYUCI as part of the services of 3 major, regional Primary Care Physician’s offices. In this way, rural caregivers of persons with Alzheimer’s disease would receive needed support as part of their normal medical visits. As translation of the intervention into practice was the end goal, small numbers of caregivers were served during the implementation process. The NYUCI, developed by Dr. Mary Mittelman at New York University School of Medicine, has been demonstrated to lessen caregiver depression and delay nursing home placement of individuals with dementia.
Components of the NYUCI are:
• Scheduled individual counseling sessions
• Scheduled family counseling sessions
• Continuous participation in a support group
• Ad hoc counseling - telephone consultation on request of caregiver or family member
Setting: Primary Care Practice Division of Fletcher Allen Health Care.
Challenges:
• Physicians, patients and families were unaware of the value of supportive services.
• Family members reluctant to call themselves caregivers.
• Family members often didn’t live within commuting distance of the primary caregiver.
Lessons Learned:
• Over time, primary care physicians learned to use the social worker as a resource for their own staff training and consultation.
• Physicians did not want to refer individuals to a randomized control trial.
Translational Process:
In Year 1, the project was run as a randomized control trial with 19 family caregivers receiving referral for services and 10 family caregivers participating. The Intervention group (n=6) received NYUCI,and the Control group (n=4) received 2 short caregiver education/referral sessions and access to telephone support. The program was offered primarily to patients/families at the time they came in to see their doctor. The project interventionist, a licensed social worker, educated the primary care physician's staff, who then referred caregivers into the program.
In Year 2, the randomized control model for enrollment was dropped and a 2 session comparison option was offered for those enrollees who still wanted the service but lived too far away for family to attend meetings. In one of the 2 primary care practices where relationships with the medical team and referral base had been established in Year 1, referrals began to be received and services delivered in collaboration with the Fletcher Allen pilot of the Blueprint for Health chronic care disease management team. With the addition of a 3rd primary care practice site in Year 2, a total of 19 elder couples and their families were able to complete the intervention by the end of project in October, 2009.
Project Outcomes:
Outcomes mirrored those of the original NYUCI
• 29 families completed the intervention during the 2-year pilot
• Treatment group reported improved social support
- Closeness of friends and relatives
- Improvement in satisfaction with social network, daily assistance, emotional support
• Treatment group reported fewer symptoms of depression
• Treatment group reported better self-rated health
• Treatment group had less severe reaction to problem behaviors caused by the illness
• Control group got worse or remained the same on all these outcomes
Community Based Organization: Fletcher Allen Health Care is both a community, non-profit hospital, and in partnership with the University of Vermont, the state’s academic health center. Its mission is to improve the health of the people in the communities they serve by integrating patient care, education and research in a caring environment. Fletcher Allen is committed to providing excellent clinical care to elders in their service area to enable them to live healthy, active and independent lives. In its community hospital role for the past 150 years, Fletcher Allen serves approximately 150,000 residents in Chittenden and Grand Isle counties and provides primary care services at nine Vermont sites. The organization also offers the community a wide range of free health, prevention, and wellness programs. As a regional referral center, Fletcher Allen provides advanced-level care to a population of one million people throughout rural Vermont and northern New York.
Presentation:
The NYU Caregiver Intervention: From Efficacy to Effectiveness in 20 Years
