The CRC Caregiver Assessment Tool: Bridging the Gap Between Research and Practice

1. The CRC Caregiver Assessment Tool: Bridging the Gap Between Research and Practice Revised by David Fraser, MSW – Executive Director, Inland CRC From a presentation at NCOA-ASA Joint Conference March, 2003 By: Monique Parrish, Dr. PH, MPH, MSW Formerly with, Statewide Resources Consultant Family Caregiver Alliance Nancy Powers-Stone, MA Executive Director, Redwood Caregiver Resource Center Lorie Van Tilburg, MSW Executive Director, Southern Caregiver Resource Center

2. Guiding Principles ofCalifornia’s CRCs • The caregiver is the client. • Broad focus • Fluid system of care: • Not a traditional caseload model • Access services throughout the caregiving experience. • Family caregivers are the care managers • CRC staff serve as consultants, advocates, coaches and other roles in support of caregivers.

3. History of the CRC Assessment Tools • Caregiver assessment and reassessment tools first developed in 1988 with help from Steve Zarit, Ph.D. • Two previous revisions: 1992 and 1997 • Data from the assessment tools analyzed in numerous studies and reported in CRC Annual Reports to the California Department of Mental Health

4. Purposes of the CRC Assessment Tools • Collect relevant data on caregiver and care receiver and to assess changes in order to prepare and revise the care plan; • To determine quality and effectiveness of services according to an individualized care plan; • To take appropriate action as necessary; and • To measure impact of service intervention and caregiver well-being.

5. Selected Outcome Domains Primary Secondary 1. Knowledge 3. Burden 2. Support 4. Depression 5. Behavior Mgmt. 6. Institutionalization

6. Outcome Measures • Knowledge – measured by caregiver knowledge about available resources and care receiver’s illness. Area of change – increased knowledge about resources and disease/illness. • Support – measured by hours of formal and informal support and self-reported adequacy of support Area of Change -- increased formal and informal supports and self-reported adequacy of support

7. Outcome Measures (cont.) • Burden– measured by 12 Item Short Version of the Zarit Burden Interview Area of Change—maintain or decrease caregiver burden • Depression– measured by 20 item Center for Epidemiological Depression Scale (CES-D) Area of Change– maintain or decrease caregiver depression

8. Outcome Measures (cont.) • Behavior Management – 24 item Revised Memory and Behavior Problems Checklist Area of Change—maintain or reduce caregiver upset in reaction to care receiver’s memory or behavior problems • Institutionalization– measured by living arrangement, IADLs/ADLs of care receiver at intake and reassessment, Differences in service utilization between clients who placed their receivers with those clients whose care receivers remained in the home at the time of reassessment Area of Change --Reduce rate of institutionalization

9. CRC Assessment Tools: An Overview • Integrated open-ended and categorical questions designed to: • Insure flexibility during the interview process; • Increase caregiver comfort with questions; and • Create collaborative partnership between Family Consultant and caregiver

10. CRC Assessment Tools: Standardized Scales • A-tool contains three standardized scales: • Short version of the Zarit Burden Interview, 12-item (Bédard et al., 2001) • Revised Memory and Behavior Problems Checklist, 24-item (Teri et al., 1992) • Center for Epidemiological Studies Depression Scale, 20-item (Radloff, 1977)

11. CRC Assessment Tools:A Walk-Through • Procedural Data and Introductory Question • Conversational opening question • Support/Living Situation • Family/friend involvement • Hours per week providing care: CG, paid, unpaid • Functional Level of the Care Receiver • ADLs and IADLs • Driving status • Revised Memory and Behavior Problems Checklist (RMBPC)

12. CRC Assessment Tools:A Walk-Through • Health • Insurance and out-of-pocket health care expenses • California Advance Health Care Directive • Physical health problems • Depression and suicide • Drinking, drug use, and medication problems • Major stress (e.g. death, job loss, divorce) • Caregiver & Care Receiver Demographics • Durable power of attorney, employment, income

13. CRC Assessment Tools:A Walk-Through • Adapted Zarit Burden Interview • Intimacy and Placement Issues • Information Needs • Care Plan • CES-D questionnaire for depression Note: The RMBPC and CES-D are handed to the caregiver to complete.

14. Use of Data • The assessment tool has been proven reliable. • Family Consultants/social workers must benefit from analyses – they should participate in the development of analyses and receive reports designed to assist them in their clinical work with caregivers.

15. Future Goals • Continue to evaluate the A-tool and its usefulness and impact - on Family Consultants and caregivers • To conduct longitudinal analyses using A-tool data • Strengthen the relationship between research and practice