Psychosocial Intervention for HIV/AIDS Caregivers (Pakenham)
Kenneth Pakenham, Ph.D.
Clinical & Health Psychology
School of Psychology
The University of Queensland
Brisbane, QLD 4072
Telephone: + 61 7 3365 6677
Facsimile: + 61 7 3365 4466
OVERALL SNAPSHOT OF CAREGIVER INTERVENTION/PROGRAM:
An individual and dyadic eclectic psychosocial supportive intervention for caregivers and their partners with HIV/AIDS
BACKGROUND RELATED TO THE DEVELOPMENT OF THE INTERVENTION/PROGRAM:
The intervention was developed to assist caregivers of people with HIV/AIDS with psychosocial issues related to caregiving. Two variations of the intervention approach were developed and compared: (1) intervention for caregives and (2) intervention for caregiver and care recipient dyads. The intervention was developed to be flexible so as to accommodate any of a wide range of problems that may arise in the context of HIV/AIDS caregiving.
TARGETED CAREGIVER POPULATION
Adult caregivers of persons with HIV/AIDS
MANUAL OF PROCEDURES:
General guidelines only
INTERVENTION/PROGRAM SPECIFIC OUTCOME MEASURES:
A variety of assessments may be used including HIV Problem Checklist, self monitoring forms, knowledge of HIV/AIDS scale. For more information on these measures refer to Pakenham, K. I., Dadds, M. R., & Lennon, H. V. (2002). The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: A controlled treatment outcome study. AIDS Care, 14, 731-750.
LENGTH OF INTERVENTION/PROGRAM
NUMBER OF SESSIONS:
8 weekly sessions
LENGTH OF EACH SESSION:
DESCRIPTION OF SESSION CONTENT:
An individual and dyadic eclectic intervention approach is used and includes providing information, coping skills training, a non-judgmental approach, explore/expression of feelings, cognitive reframing, empowerment, and affirmation of coping abilities. The intervention is guided by Rogerian client centred strategies and also includes a high reliance on a structured problem solving approach using psychoeducational and cognitive-behavioural intervention techniques including cognitive restructuring, contingency management, communication skills training, time management, and out of session behavioural assignments. The specific strategies employed are determined by the nature of the target problems selected by clients. Prior to the first session, therapists should have undertaken an assessment of clients. It is not possible to provide detailed prescriptive treatment protocol because of variability in target problems and caregiving contexts, however, written intervention guidelines have been used.
The first session involves a review of the initial assessment, follow up inquiry where necessary, overview of the intervention, target problem identification and investigation into target problem history. Caregivers and or their partners are asked to select up to two HIV-related problems (from the HIV Problem Checklist [Pakenham, Dadds & Terry, 1996]) to work on jointly in treatment and to prioritise them. The first priority target problem is called Target Problem 1 and the second priority problem is called Target Problem 2. Target Problem 1 is focussed on first in treatment, and if the problem is resolved before the eighth session, then Target Problem 2 is addressed.
A range of problems have been targeted including: relationship difficulties (e.g., communication problems and disclosure of HIV status concerns), health/infection control concerns, (e.g., care-recipient’s declining health and cross infection concerns), care-recipient’s problems (e.g., drug/alcohol use and mood changes), emotional distress (e.g., helplessness and emotional exhaustion/burnout), existential concerns (e.g., finding meaning for the future and concerns about death), social difficulties (e.g., stigma and dealing with health professionals), grief/bereavement, and competing caregiving and employment demands.
In session two, based on responses to an HIV/AIDS knowledge questionnaire, participant’s deficits in HIV/AIDS knowledge were addressed. Self monitoring data is collected. Target problems are further clarified and agreement on treatment is negotiated. Sessions three through to seven are typically less prescribed because intervention depends on the nature of the target problem. In session eight the content of prior sessions and progress is reviewed. Where appropriate “relapse prevention” strategies are discussed.
METHOD OF ADMINISTRATION/DELIVERY:
Individual or couple sessions delivered at home or in clinic
Sessions conducted by a registered psychologist
COST AND TIME CONSIDERATIONS:
Nil cost and approximately 12 hours client contact
BRIEF DESCRIPTION OF EVIDENCE:
The comparative efficacy of intervening at the caregiver/care-recipient dyadic level, versus the individual caregiver level, for caregivers and their care-recipients with HIV/AIDS was examined . Participants were randomly assigned to a Dyad Intervention (DI), a Caregiver Intervention (CI), or Wait List Control group (WLC), and assessed by interview and self-administered scales immediately before treatment and eight weeks later. Participants in the intervention groups also completed a four-month follow up assessment. Dependent variables included global distress, social adjustment, dyadic adjustment, subjective health status, HIV/AIDS knowledge, and target problem ratings. Results showed that caregivers in the DI group showed greater improvement from pre- to post-treatment on global distress, dyadic adjustment, and target problems than the CI and WLC caregivers. The CI and DI caregivers showed greater improvement than the WLC group on all dependent variables except social adjustment. Care-recipients in the DI group improved significantly from pre- to post-treatment on dyadic adjustment, social adjustment, knowledge, subjective health status and Target Problem 1, whereas the CI and WLC care-recipients failed to improve on any of these measures. The treatment gains made by the DI caregivers and care-recipients on most dependent variables were maintained at a four-month follow up.
Refer to the following published trial of the intervention: Pakenham, K. I., Dadds, M. R., & Lennon, H. V. (2002). The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: A controlled treatment outcome study. AIDS Care, 14, 731-750.
HIV/AIDS Caregiving, dyadic intervention