“Evidence-Based Programs for Caregiving Families” Annual Conference

1. “Evidence-Based Programs for Caregiving Families” Annual Conference Ohio Association of Gerontology and Education 4-15-11 David M. Bass, PhD Vice President for Research Margaret Blenkner Research Institute

2. History of Family Caregiving Research 30 years of caregiving research First 15 years, most research on prevalence, consequences, and predictors Recent 15 years, more research on interventions Education and training; counseling and support; multi-component interventions Desired intervention caregiver outcomes Reduced depression, anxiety, health problems, care-related strains; increased efficacy Desired intervention care receiver outcomes Reduced symptoms, strain, health care service use and cost; improved quality of care

3. Interventions as Evidence-Based Caregiving Programs Some interventions became “evidence-based programs” Definition of evidence-based Tested in a randomized controlled trial Statistically significant improvement in outcomes Proven efficacy-(not effectiveness or feasibility) High internal validity-(not external validity) Published in peer reviewed journals Rosalynn Carter Institute identified over 70 interventions that are evidence-based BRI Care Consultation was one

4. BRI Care Consultation: An Evidence-Based Program Telephone and computer support service Framework-standardized components but personalized content Empower consumers for self-management Simple and practical solutions Not disease or severity specific Equal attention to Care Receivers and Caregivers Long-term relationship with clients A way of doing care coordination Immediate problems and crisis prevention

5. Care Consultation Research Studies Cleveland Alzheimer’s Managed Care Demon., 1997-2001 Chronic Care Networks for Alzheimer’s Disease, 1998-2004 Partners in Dementia Care for Veterans with Dementia and Their Family Caregivers, 2006-2011 Integrated Care Management, 2005-2007 Care Network for Depression, 2006-2009 Care Consultation in Cleveland, 2009-2011 Tennessee Replication of Care Consultation, 2009-2012 The Georgia Care Consultation Program, 2010-2013

6. Health & Care-Related Information 2. Family & Friend Involvement 3. Awareness & Use Community Services 4. Coaching & Emotional Support Four Types of Assistance Provided

7. Psychosocial Outcomes-Caregivers and Care Receivers Decreased depression Decreased emotional strain, isolation, relationship strain, physical health strain Decreased unmet needs related to: health and caregiving information, access to services, legal/financial, medical care, emotional support Improved informal support Utilization Outcomes-Care Receivers Decreased hospital admissions and ED visits Delayed nursing home placement Increased satisfaction with care Increased use of primary care, outpatient services, and community services Outcomes Impacted by Care Consultation

8. Gaps in EBP Caregiving Research • Need for effectiveness vs. efficacy research • Larger samples • More representative samples • Multiple sites • Comparative effectiveness • Proven intervention feasibility • Large representative samples • Testing whether interventions can go to scale • Fidelity to original model • Can providers deliver it? • Proven intervention acceptability • Will consumers use it? • Long-term sustainability • Will someone pay for it?

9. Develop “Implementation Science” What variables explain implementation success and sustainability? • Multiple levels of variables • Evidence-based program characteristics • Consumer characteristics • Service provider characteristics • Organizational characteristics • Community characteristics

10. Model for Implementation of Evidence-Based Programs

11. Evidence-Based Program (EBP) Characteristics • Strength of Research Evidence • Efficacy, effectiveness, feasibility, and/or acceptability • Type of study design • Impact on outcomes-statistical vs. clinical significance • Understanding selection bias and attrition • Manuals & Fidelity • Standardized prescriptive protocol • Comprehensive manuals • Recordkeeping tools and information systems • Fidelity monitoring tools • Staffing & Training • Required academic background • Prerequisite skills & experience • Quality of EBP training curriculum

12. Parent Organization Characteristics & EBP • Mission and Reputation • Consistency of EBP with organization mission • Culture for innovation and business planning • Experience and reputation serving EBP target population • Internal Buy-In • Influential internal champion • High level administrative support • Broad-base of staff support • Organizational Resources • Ability/Willingness to make upfront financial investment • Skill set and expertise among existing staff • EBP fit within organization hierarchy and other services • Adequate physical resources and environment

13. Community Characteristics & EBP • Payment Source for EBP • Third party reimbursement • Pricing structure for consumers and/or organizations • Target Populations • Target population clearly delineated and known • Size of target population and scale of implementation • Competitors and Partners • Distinctiveness of EBP from other products and services • Size of client population not being served by others • Extent of competition for clients and resources • Strategic partnerships for enrollment and legitimacy • Marketing • Addressing consumer predisposing, enabling, & need • Advertising

14. Model for Implementation of Evidence-Based Programs