REACH family therapy trial (Eisdorfer)

Name of Intervention: Family Therapy and Technology-based Caregiving Intervention

Principal Investigator (s): Carl Eisdorfer, M.D., Ph.D.; Sara J. Czaja Ph.D.; Jose Szapocznik, Ph.D., Institutional Affiliation: University of Miami Miller School of Medicine

Caregiver Intervention Description

1. Summary of Intervention

The intervention was developed and evaluated by the Miami site of the Resources for Enhancing Alzheimer’s Caregiver Health (REACH I) program. There were two intervention conditions: a structural ecosystems therapy (SET), a family-based therapy intervention; and the SET intervention augmented by an innovative computer–telephone integrated system (SET + CTIS). The goal of the SET intervention was to reduce the distress of managing and living with a person with a dementing illness and enhance the functioning of the family. The aims of the intervention were to identify specific problems caregivers were experiencing; identify efficacious family problem-solving styles and solutions, harness the range of useable family resources available and accessible to the family, and enhance the capacity of caregivers and their families to collaborate in the caregiving effort.

The CTIS system is an information network that utilizes computer–telephone technology. The system was designed to augment the therapeutic intervention by facilitating linkages of the caregivers with both their family and with supportive resources outside of the home. In addition, the CTIS provided the family therapist with enhanced access to both the caregivers and their family members. For example, the system allowed family members who are unable to attend sessions (e.g., those who are at distant locations, physically incapacitated, or too frail to leave their home) to participate in therapy. The system also enabled caregivers, without having to leave their homes, to participate in support groups which were led by a trained facilitator.

The CTIS system was comprised of screen phones (telephone-like device) that were linked to a home computer at the University of Miami. Screen phones marry basic telephones with computer inputs and outputs and allow text and voice to be sent and received during an interaction session. The system was designed to be easy to use by individuals with little or know technical experience. It operated from the caregivers perspective, like a regular telephone. The system was menu driven and the user was guided through the system by verbal prompts in their preferred language (English or Spanish). A number of features were available on the system including: place a call; messaging (both individual and group); conferencing (up to 6 people simultaneously); access to pre-stored educational information; a community resource guide; and caregiver respite functions. A screen phone was installed in the homes of the caregivers who were randomized to this condition.

Treatment involved weekly in-home family therapy sessions for the first 4 months of the intervention period, bi-weekly sessions for months 5 and 6 and monthly booster sessions for months 7-12. The duration of each session is approximately 90 minutes.

The SET + CTIS intervention was effective in lowering the depression scores (CES-D) of Cuban American and White American caregivers at both the 6and 18 month follow-ups. The technology also enhanced the ability of caregivers to access resources, communicate with family members and knowledge about caregiving.

Key words:

On-line support groups, technology-enhanced system, family therapy, caregiving intervention

2. Intervention Materials

The materials for the SET intervention included informational handouts, interventionist training manual and video tapes for the home sessions. The materials for the SET +CTIS intervention also included a screen phone and CTIS training manual and help card. In addition, both conditions included some informational forms and checklists.

For further information, please contact:

Sara J. Czaja, Ph.D. Professor Department of Psychiatry and Behavioral Sciences, University of Miami, Millar School of Medicine, 1695 N.W. 9th Ave, Suite 3208 (D-101). Email: sczaja@med.miami.edu. Phone number: (305) 355-9062.

3. Implementing the Intervention

Training qualifications and guidelines:

An intervention manual is available. The intervention can be delivered by a person with Bachelor’s degree in psychology, or social work. The interventionists must also be trained and certified in the Structural Ecological Therapy process. The intervention requires someone with technical expertise as a member of the intervention team.

Estimated costs of implementing the intervention:

The phone used in the study cost about $60.00. However, the model is discontinued. A newer and upgraded phone is available through www.cisco.com. The other costs associated with the intervention include costs for telephone lines, computer support, video tapes for taping of the intervention sessions, printing costs for questionnaires and intervention materials, training costs for the interventionists and assessors, prep time for the interventionists, and transportation costs associated with home visits.

Other useful implementation information:

The intervention can be implemented for caregivers of other patient populations. We have completed a trial that encompassed the technology component of the intervention with caregivers of spinal cord injured patients. The technology was also used in a pilot study that tested the feasibility of implementing a psychosocial intervention in a community setting. The target population was family caregivers of Alzheimer’s patients.

4. For more information

Finkel, S. Czaja, S. J., Schulz, R., Martinovich, Z., Harris, C., & Pezzuto, D. (2007). E-Care: A telecommunications technology intervention for caregivers of dementia patients. American Journal of Geriatric Psychiatry, 15, 443-448.

Mitrani, V.B., Lewis, J., Feaster, D.J., Czaja, S.J., Eisdorfer, C., Schulz, R., Szapocznik, J.

(2006) The role of family functioning in the stress process of dementia of caregivers:

A Structural family framework. The Gerontologist,46 (1), 97-105.

Bank, A. L., Arguelles, S., Rubert, M., Eisdorfer, C. E., & Czaja, S. J. (2006). The value of telephone support groups among ethnically diverse caregivers of persons with dementia. The Gerontologist, 46, 134-138.

Eisdorfer, C. E., Czaja, S. J., Loewenstein, D. L., Rubert, M. P., Arguelles, S., Mitrani, V., & Szapocznik, J. (2003). The effect of a family therapy and technology-based intervention on caregiver depression. The Gerontologist, 43 (4) 521-531.

Czaja, S. J. & Rubert M. P. (2002). Telecommunication technology as an aid to family caregivers of persons with dementia. Psychosomatic Medicine, 64, 469-476.

Czaja, S. J., (2001). Telecommunication Technology as an Aid to Family Caregivers. In

W. Rogers & A. Fisk (Eds.) Human Factors Interventions for the Health Care of

Older Adults (pp. 165-178). New Jersey: Lawrence Erlbaum Assoc.

Mitrani, V. B., & Czaja, S. J. (2000). Family-based therapy for dementia caregivers: clinical observations. Aging and Mental Health, 4, 200-209.