Scott & White Program on Aging & Care
2401 South 31st Street
Temple, TX 76508
Contact: Jennifer Thorud, MPHProgram Manager
Email: jlthorud@swmail.sw.org
Scott & White Family Caregiver Program
Intervention Implemented: REACH II – Adapted for a Healthcare Setting
Project Description: This program’s goal was to translate REACH II within an integrated healthcare system. As translation of the intervention into practice was the end goal, small numbers of caregivers were served during the implementation process. The REACH II RAM (risk assessment measure) was used to identify risks and measure outcomes. The REACH II intervention components were packaged into a user-friendly Caregiver Notebook. Based on the needs identified at assessment, a customized plan of support was constructed to engage the caregiver with the Caregiver Notebook and the Family Resource Center, located in Scott & White Memorial Hospital. Face to face and telephone support was provided through the Family Resource Center. Other program goals were:
- Identifying caregivers at a time of great need and stress in hopes they would be more willing to accept services
- Making available evidence-based caregiver supports that are integrated into the healthcare system and the community at large
Dr. Alan Stevens, one of the original REACH II investigators, provided supervision to the project. Dr. Stevens is a Professor in the Department of Medicine and Vernon D. Holleman-Lewis M. Rampy Centennial Chair in Gerontology at Scott & White. Scott & White collaborated with long-time partner the Central Texas Area Agency on Aging to provide additional services deemed critical for at-risk caregivers.
Target Population: The project was implemented to serve family caregivers of individuals with Alzheimer’s disease.
Setting: Scott & White Memorial Hospital, Center for Diagnostic Medicine
Challenges:
• Balancing integrity of original intervention with real-world application
• Integrating within a large healthcare system that is primarily medically focused
• Establishing a program within existing systems and relationships.
• Hospital capacity was met numerous times during initial roll-out (flu).
• Many Alzheimer’s patients admitted into hospital had no identified caregiver.
Translational Process:
In Year 1, the program was launched in nursing units of the hospital that admitted the most individuals with Alzheimer's disease. Nursing staff were trained about the program through staff meetings and reminders via newsletters and emails. Program staff worked with their Information Technology team to place reminder prompts in the nursing electronic medical records to identify caregivers as they or the person they provided care to was hospitalized. A Caregiver Packet was then given to the identified caregiver that contained information about the program, the RAM assessment, and a postage-paid envelope.
As follow-up enrollment into the program did not occur as hoped, in Year 2 it was deemed to be a more effective method of recruitment to have nurses continue to identify caregivers and distribute Caregiver Packets with program staff conducting follow-visits to recruit and enroll them in the program. This change greatly increased enrollment. Ongoing education about the program is still being conducted with the entire nursing staff, and program education has been embedded within ongoing General Nursing Orientation. Another change included implementing the Family Caregiver Program in the main internal medicine/family medicine primary care clinic, The Center for Diagnostic Medicine (CDM). Program staff collaborated with the clinic nurses and physicians to customize the location of the Caregiver Packets. Ongoing education and training occurs throughout the CDM.
Brochures and educational materials relating to caregiving and area services were provided by the Central Texas AAA. Utilizing ServicePoint software, a seamless referral process was initiated to obtain additional identified services such as respite care and mental health counseling.
Project Outcomes:
• 88 caregivers were enrolled in the program in the hospital setting
• 19 additional caregivers have now been enrolled in the program through the clinic setting
• There was a significant decrease in caregiver's overall RAM score
• There were no caregivers with a “high-risk” RAM at 6 month follow up
• Significant RAM questions indicate a reduction in caregiver stress, burden and safety
• Other questions and domains are now approaching significance as well
Community Based Organization: Scott & White’s mission is to provide the most personalized, comprehensive, and highest quality health care, enhanced by medical education and research. Scott & White’s vision is to be the most trusted and valued name in American health care. With 1.5 million patient visits each year, Scott & White is an ideal setting to disseminate and translate clinical research into practice. This project was designed to be viewed by S&W leadership and the community as being supportive of the organization’s mission and vision; resulting in improved health for caregivers and those they provide care for.
Presentations:
S&W Family Caregiver Program: Establishing Organizational Support
Caregiver Comment about Program:
"As my husband passed away shortly I did not have long experience with Dementia. All that time I had a lot of advice and support from you all. The frequent calls from your staff sure helped me through all these hard times. Thanks to everyone involved."