Care Consultation telephone-based empowerment intervention (Bass)

Principal Investigator: David M. Bass, Benjamin Rose Institute

Care Consultation

Caregiver Intervention Description

1. Summary of Intervention

Care Consultation is a telephone-based, empowerment intervention that helps family caregivers and care receivers by providing information about health problems and available resources mobilizing and facilitating the use of informal supports and formal services; and providing emotional support. Care consultants act as coaches and work in partnership with caregivers, care receivers, and other family members. Care Consultants are typically social workers or nurses, with supplemental assistance by trained volunteers. Versions of this intervention were developed and implemented in collaboration with the Alzheimer’s Association and selected Alzheimer’s Association Chapters.

The Care Consultation Information System was developed to guide the delivery of this supportive intervention and includes: triggers to detect potential problems in medical and non-medical domains; structured assessment of problematic domains; and individualized care plans with goals and action steps. Care Consultants work with caregivers and care receivers in an ongoing fashion, with the frequency of telephone contacts dependent on needs.

The key component of Care Consultation is the action steps, which outline practical, behavioral tasks intended to address problem areas. For each action step, one or more persons are designated as being responsible for task completion, and a date for follow-up monitoring is established with a disposition determined at follow-up. Action steps are added to the care plan throughout the intervention period.

Care consultation is different than case management in its empowerment, consumer-driven philosophy, as well as its use of telephone communication. Caregivers, care receivers, and care consultants collaborate in formulating a care plan and determining priorities. Care consultants are experienced, knowledgeable resources to help caregivers and care receivers identify and manage their own situations, maximize assistance from family members and friends, and facilitate formal service use including formal case management, if needed.

Care consultation has or is currently being tested for feasibility, efficacy, and effectiveness with several samples of individuals with chronic healthcare issues and their caregivers. This program of research at the Margaret Blenkner Research Institute of Benjamin Rose Institute began in 1996 and has involved older care receivers with dementia, depression, and multiple chronic conditions. Several projects examine Care Consultation as a mechanism for creating an effective link between primary care physicians and community services.

Key search terms:

  • Health information and education
  • Facilitating service use
  • Emotional support
  • Empowerment model
  • Dementia, depression, multiple chronic conditions

The effectiveness of the intervention:

The impact of Care Consultation on a wide range of outcomes has and is currently being examined. Outcomes include psychosocial well-being and care-related strain; hospital, emergency department and nursing home service use; and cost of care. Care Consultation has been shown to be a feasible intervention in one large national demonstration that partnered health plans and Alzheimer’s Association Chapters (Chronic Care Networks for Alzheimer’s Disease Initiative). One completed randomized trial (Cleveland Alzheimer’s Managed Care Demonstration) suggested Care Consultation was effective in reducing care-related strain and increasing satisfaction with health care services; decreased hospital and emergency department use were observed for one segment of the study sample. Currently, a large controlled trial is underway to test Care Consultation with persons with dementia and their family caregivers being served by the VA health care system (Partners in Dementia Care). Two smaller randomized trials are underway that explore the effectiveness of Care Consultation for caregivers of persons with depression and persons with multiple chronic conditions.

2. Intervention Materials

The Care Consultation Information System is a computerized or manual record keeping system that guides the delivery of this supportive intervention. It includes triggers, assessment, and care planning tools. Supplemental materials and manuals facilitate two major functions of Care Consultation: (1) sharing of caregiving and health information and (2) facilitating the use of formal services and community resources. Informational materials include a wide array of “consumer ready” brochures and educational materials that correspond with the domains in the assessment. Many of these materials are published by the Alzheimer’s Association, the National Institutes of Health, and other local or national groups/associations. Assistance in accessing services and community resources follows a “service matrix” developed at the local-level and lists programs, services, and other resources that may be helpful for both individuals facing health-related challenges and their family caregivers.

Contact information for further information, materials, and training:

David M. Bass, Ph.D.

Vice President for Research and Senior Research Scientist

Benjamin Rose Institute

Margaret Blenkner Research Institute

11900 Fairhill Rd., Suite 300

Cleveland, OH 44120-1053

216-373-1664

dbass@benrose.org

3. Implementing the Intervention

Care Consultants typically have a bachelor’s or master’s degree in social work or nursing. Trained volunteers are used as a supplemental source of assistance for situations that are stable. There is no formal training program for Care Consultants but there is a written protocol to guide the delivery of the intervention.

The major cost for Care Consultation is salary and benefits for a bachelor’s or master’s level social worker or nurse. One staff member can maintain a large caseload (i.e., 75 – 150 clients) because the intervention is delivered by telephone; trained volunteers can be used as a supplemental source of support. Once the initial assessment and action plan development is completed, the number of contacts with clients is usually not intense except during a crisis period. Monthly or bi-monthly monitoring calls are sufficient for most situations. Limited amounts of additional costs pertain to informational materials, office space, record keeping procedures, and office supplies.

Caveats/ limitations on the implementation of this intervention:

Care Consultation as described in this document represents a refined version of this intervention that is currently being tested in three studies, including a large-scale controlled trial “Partners in Dementia Care” (PDC). It is similar but not identical to Care Consultation as it was implemented in the Cleveland Alzheimer’s Managed Care Demonstration and the Chronic Care Networks for Alzheimer’s Disease Initiative. Notable recent advances include the development of the Care Consultation Information System and its components; the standardization of the intervention protocol; and the breadth of topics covered in the assessment and informational materials. However, the evidence-base for the feasibility and efficacy of Care Consultation comes from the previously completed studies, particularly the Cleveland Alzheimer’s Managed Care Demonstration. Findings from PDC and the other two current studies are not yet available.

Other implementation information:

Care consultation is especially helpful when it can be used in tandem with other support services such as education programs, support groups, and family meetings. Other support services become sources to which care consultants refer and include the use of these other services as components on the Care Consultation action plan.

Most current or previous research studies of Care Consultation have focused on recruiting caregivers through primary health care and the linkage between primary health care and community services. Several studies are restricted to managed health care plans. Recent alternate versions of Care Consultation involve a partnership between a Care Coordinator from a health care setting and a Care Consultant from a community agency such as Benjamin Rose Institute or an Alzheimer’s Association Chapter.

4. Current Translational Efforts

Benjamin Rose Institute

 

5. For more information

Clark, P.A., Bass, D.M., Looman, W.J., McCarthy, C.A. & Eckert, S. (2004). Outcomes for patients with dementia from the Cleveland Alzheimer’s Managed Care Demonstration, Journal of Aging & Mental Health, 8(1), 40-51.

Bass, D.M., Clark, P.A., Looman, W.J., McCarthy, C.A., & Eckert, S. (2003). The Cleveland Alzheimer’s Managed Care Demonstration: Outcomes after 12 months of implementation, The Gerontologist, 43(1), 73-85.

Maslow K, Selstad J. Chronic care networks for Alzheimer's disease: Approaches for involving and supporting family caregivers in an innovative model of dementia care. Alzheimer's Care Quarterly 2001;2:33-46.