STAR-C Intervention (Teri)

Name of Intervention: The STAR-Caregivers (STAR-C) Program

Principal Investigator (s): Linda Teri, Ph.D.

Institutional Affiliation: University of Washington

Caregiver Intervention Description

Training community consultants to help family members improve dementia care: A randomized controlled trial

1. Summary of Intervention

The intervention was a behavioral intervention designed to decrease depression and anxiety in individuals with Alzheimer’s disease (AD) and their family caregivers. STAR-C is one of a series of theoretically consistent interventions that have been developed at the University of Washington by Dr. Teri and her research team to treat a variety of mood and behavioral disturbances in dementia (“the Seattle Protocols”). The intervention consisted of 8 weekly in-home sessions followed by 4 monthly telephone calls. Treatment components included: general education about AD, practice using a systematic approach to identifying and reducing behavior problems in dementia (the ABC model of behavior change), communication skill training, information about the relationship between mood and pleasant events, and caregiver support.

The intervention has also been validated for training paid staff working with older adults with dementia in assisted living facilities (the Staff Training in Assisted-living Residences [STAR] program; Teri, et al. 2005a). The STAR staff training program consists of two, 4-hour on-site workshops augmented by four on-site individual staff consultations and three leadership sessions. Workshops include lecture and discussion, role playing observation of video case vignettes, and handouts. Training emphasizes real-life situations of direct relevance to the daily needs of residents and assisted living staff.

Caregivers in STAR-C showed significant improvements in ratings of depression, burden, and reactivity to behavior problems in the person with AD, compared to usual medical care control subjects. There were also improvements in the frequency and severity of dementia-related behavior problems in care-recipients, and improved quality of life. Improvements were maintained at 6-month follow-up.

The STAR staff training program has been shown to improve mood and reduce behavior problems in assisted living residents with dementia.

Key search terms:

Alzheimer’s disease, dementia, behavior management, anxiety, depression, family caregivers, Seattle Protocols, empirically based treatments

2. Intervention Materials

Description of materials used in the intervention:

A treatment manual was followed for both the STAR-C and STAR interventions. Caregiver participants received handouts related to each treatment component. A copy of the STAR-C manual, including handouts, is available from Linda Teri, Ph.D., School of Nursing, University of Washington, 9709 3rd Ave NE, Suite 507, Seattle WA 98115-2053, lteri@u.washington.edu. A videotape training series has been developed to accompany the STAR training program for assisted living residences; persons interested in more information about this training program should also contact Dr. Teri at the above address.

Contact information for further information, materials, and training.

Linda Teri, Ph.D., School of Nursing, University of Washington, 9709 3rd Ave NE, Suite 507, Seattle WA 98115-2053, lteri@u.washington.edu.


3. Implementing the Intervention

The intervention was designed to be delivered by MS-level community-based trainers with experience using behavioral techniques with older adults with dementia. Training workshops are available for both the STAR and STAR-C program; for information contact Linda Teri, Ph.D., School of Nursing, University of Washington, 9709 3rd Ave NE, Suite 507, Seattle WA 98115-2053, lteri@u.washington.edu.

Estimated costs of implementing the intervention:

Delivery costs: The STAR-C intervention is comprised of 8 individual weekly sessions, each one hour in length. It has been implemented in-home but could be delivered in clinic settings. The intervention was designed to be delivered by MS-level mental health or health care professionals. Ongoing supervision should be provided by someone experienced in use of behavioral treatments for persons with dementia and caregivers.

The STAR staff training program consists of two, 4-hour on-site workshops augmented by four on-site individual staff consultations and three leadership sessions. Training workshops are conducted by MS- or PhD-level health professionals experienced in treating mood and behavioral disturbances in persons with dementia. Cost for the STAR program may include covering assisted living staff’s time to enable them to participate in the training classes.

Caveats/ limitations on the implementation of this intervention:

The published STAR-C study provided a higher level of ongoing supervision for trainers than is normally available in a community geriatric clinic.

4. For more information


Alzheimer's Disease Supportive Services Program

RG Logsdon, SM McCurry, L Teri (2005). STAR-Caregivers: A community-based approach for teaching family caregivers to use behavioral strategies to reduce affective disturbances in persons with dementia. Alzheimer's Care Quarterly, 6(2), 146-153.

L Teri, P Huda, LE Gibbons, H Young, J van Leynseele, J. (2005a) STAR: A dementia-specific training program for staff in assisted living residences. The Gerontologist, 45(5), 686-693.

L Teri, LG Logsdon, SM McCurry (2005b) The Seattle protocols: Advances in behavioral treatment of Alzheimer’s disease. In: Vellas, B., Grundman, M., Feldman, H., Fitten, L.J., Winblad, B., Giacobini, E. (Eds.), Research and practice in Alzheimer’s disease and cognitive decline, 10, 153-158. New York: Springer Publications.

L Teri, G McKenzie, D LaFazia (2005c) Psychosocial treatment of depression in older adults with dementia. Clinical Psychology: Science and Practice, 12(3), 303-316.

Teri, L., Logsdon, R.G. (2000) Assessment and management of behavioral disturbances in Alzheimer’s disease. Comprehensive Therapy, 26(3), 169–175.