Middle Alabama Area Agency on Aging
15863 Highway 25
Calera, AL 35040
Contact: Kelly Lippert-Flick, MPH
Intervention Implemented: REACH-OUT
Project Description: The first aim of this program was to evaluate the application of REACH (Resources for Enhancing Alzheimer’s Caregiver Health) within the existing Area Agency on Aging (AAA) CARES program with the goal of developing an effective model to mainstream REACH statewide through the Alabama CARES Program. The Alabama CARES staff at Middle Alabama Area Agency on Aging (M4A) identified families in which a member living in the home has dementia and offered REACH-OUT (a translation of REACH II) to those who met screening criteria for caregiver burden.
Participants who accepted the service received four home visits (approximately 1 hour each) and a minimum of four therapeutic phone calls (approximately 30 minutes each) from Alabama CARES staff during the planned three-month intervention. Family caregivers received a workbook at the start of the intervention, and at the last home visit were given information on continuing all successful components covered during the intervention. Staff provided periodic follow-up home visits and phone calls to participants to provide additional support for continuing use of aspects of the program, and additional information is collected from participants at a one-year follow-up appointment.
The REACH OUT Program includes the following components:
1. Home Safety/Risk Appraisal: Education and guidance on ensuring a safe home environment for people living with dementia. Alabama CARES staff walks through the home with the caregiver, making suggestions for improving home safety on the first home visit. Follow-up for home safety is provided as needed.
2. Education about Alzheimer’s disease, caregiving, stress, grief and loss, and communication with physicians: Alabama CARES staff provide printed educational material from organizations such as the Alzheimer’s Association and Alzheimer’s Disease and Education Referral Center. Alabama CARES staff reviews the information with family members and leave the information with them for reference.
3. Caregiver health: Alabama CARES staff address the importance of caregivers maintaining their own health. They are given a booklet (called a health passport) to use as a guide for tracking their medical appointments, medications, etc. Caregivers are prompted to begin filling in their health passports. Alabama CARES staff follow-up (during therapeutic phone calls and/or home visits) to encourage continued use of this tool.
4. Behavior management: Alabama CARES staff use information gathered during the initial assessment to identify disturbing behaviors exhibited by the family member with dementia. Working with the caregiver(s), a plan (called a behavioral prescription) is developed based on principles of cognitive behavioral therapy to address the target problem. Role modeling and role play are used to teach family caregivers more effective means of responding to disturbing behaviors exhibited by their loved one. Case managers follow-up with family members via phone and at each home visit to monitor compliance with and effectiveness of the behavioral prescriptions and to make adjustments as necessary.
5. Signal breath relaxation: Alabama CARES staff teach caregivers a simple and effective relaxation technique called signal breath relaxation. Caregivers are encouraged to practice this technique on their own between home visits and to use it when they begin to feel stressed.
Dr. Lou Burgio, now at the University of Michigan’s School of Social Work and Institute of Gerontology, and one of the Principal Investigators for REACH II, provided ongoing supervision and technical assistance to the project. When the project began, Dr. Burgio was director of the University of Alabama’s Center for Mental Health and Aging (CMHA). The mission of CMHA is to develop new knowledge, test new interventions, and disseminate information related to mental health and aging. The University of Alabama is one of the National REACH intervention sites.
Target Population: The project was implemented to serve rural Alzheimer’s disease caregivers.
Setting: Intervention delivered in the homes of the caregivers.
Challenges:
• Caregivers needed additional services not provided by the intervention (respite care, etc.)
• Follow-up required by the intervention was viewed as excessive by some caregivers and staff
Translational Process
In Year 1, the State of Alabama and University of Alabama used elements of Community-based Participatory Research to modify REACH II for feasible use in the community. An Advisory Committee was formed of AAA directors and case managers, Directors of Senior Services, Dr. Burgio and a Project Coordinator. Over a 4 month period, the Advisory Committee had a series of face-to-face meetings and phone conferences to decide treatment components and feasibility for all aspects of the program. Over an additional 5 month period, the University of Alabama (with consultation from the Advisory Committee), adapted materials from REACH II to produce the REACH OUT materials and develop project procedures. The first year, the program was only offered in Shelby County and served 54 caregivers.
In year 2, the program was offered in all 5 counties served by M4A, and served an additional 27 caregivers. Modules were added on physician-caregiver communication and anticipatory bereavement. Follow-up training sessions of interventionists and assessors were added. A formal screening for burden (4 item Zarit) was added an an entry criterion. were added at 6 and 12 months. The maintenance phase was adapted to lessen the burden on the interventionist and clinic setting: 11 follow-up points of contact (7 phone calls and 4 home visits) over a 1 year period was changed to 2 home visits and 3 contacts (either phone call or home visit).
Project Outcomes:
Caregiver Outcomes:
• Caregiver improvement in overall health and depression
• Reduction in feelings of burden from caregiving
• Caregiver reported fewer feelings of anger towards their care recipient
Care-recipient Outcomes:
• Care recipients were less likely to be left unsupervised
• Less wandering
• Care recipient less likely to have access to dangerous objects
• Improvement in care recipient’s problem behaviors
Community Based Organization: The Middle Alabama Area Agency on Aging’s mission is to be the planning and development commission for senior services in Blount, Chilton, Shelby, St. Clair and Walker counties. In addition to planning for the needs of seniors and caregivers in its five-county area, M4A is also the focal point for senior services in its region. Some of the services provided include medication assistance, nutrition, insurance counseling, legal services, information and referral, case management, caregiver assistance, health promotion, and ombudsman advocacy. The partnership between the University of Alabama’s Center for Mental Health and Aging and the Middle Alabama Area Agency on Aging was initiated by the Alabama Department of Senior Services.
Presentation:
REACH OUT II: Revision, Maintenance, and Sustainability
Implementing a Community-Based Program for Dementia Caregivers: An Action Guide using REACH OUT
Certification Information Click HERE
