Family Telemental Health Intervention for Veterans With Dementia
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/4/2019 |
| Start Date: | September 18, 2017 |
| End Date: | April 15, 2020 |
| Contact: | Cory K Chen, PhD |
| Email: | Cory.Chen@va.gov |
| Phone: | (212) 686-7500 |
Dementia impacts Veterans, their families, and other Veterans who serve as caregivers. One of
the most stressful aspects of caregiving is the management of behavioral problems (e.g.
wandering, agitation, and sleep difficulties), which exacerbate health issues for both
caregivers and persons with dementia (PWD). Existing VA caregiver treatments for caregiver
stress and behavioral problems are often ineffective. Many caregivers do not realize their
interactions with PWD contribute to behavioral problems and thus do not ask for help to
improve their interpersonal skills. The aim of this project is to develop an assessment of
interpersonal skills deficits and a related treatment strategy to assist family caregivers of
PWD who are challenged by a lack of interpersonal skills and are not helped by existing
family caregiver treatments. This project, will develop and test (1) a video assessment of
caregiver/PWD interaction that clinicians will use to identify interpersonal difficulties and
(2) a family therapy for the interpersonal difficulties clinicians identify in the
assessment.
the most stressful aspects of caregiving is the management of behavioral problems (e.g.
wandering, agitation, and sleep difficulties), which exacerbate health issues for both
caregivers and persons with dementia (PWD). Existing VA caregiver treatments for caregiver
stress and behavioral problems are often ineffective. Many caregivers do not realize their
interactions with PWD contribute to behavioral problems and thus do not ask for help to
improve their interpersonal skills. The aim of this project is to develop an assessment of
interpersonal skills deficits and a related treatment strategy to assist family caregivers of
PWD who are challenged by a lack of interpersonal skills and are not helped by existing
family caregiver treatments. This project, will develop and test (1) a video assessment of
caregiver/PWD interaction that clinicians will use to identify interpersonal difficulties and
(2) a family therapy for the interpersonal difficulties clinicians identify in the
assessment.
Background:
The increase in prevalence of dementia over the last 50 years has resulted in a concomitant
rise in the number of families facing the physical, emotional, and psychological stress
associated with caregiving. Behavioral symptoms that occur in persons with dementia (PWD)
lead to negative mental and physical health outcomes for caregivers and predict caregiver
decisions to institutionalize PWD. Resources to Enhance Alzheimer's Caregiver Health - VA
(REACH VA), has demonstrated its ability to improve caregiver burden, emotional and physical
well-being, social support and management of behavioral symptoms. Although REACH VA
represents one of the best available approaches to help caregivers, treatment non-response
and modest treatment effects remain significant issues. A variety of factors may be
associated with non-response to behavioral intervention - one particularly robust predictor
of non-response is interpersonal skill and communication.
Objectives:
The goal of this research project is the first step toward systematically identifying and
addressing caregiver interpersonal challenges using telehealth technology. This project
involves three interrelated activities: (1) refinement and pilot testing of a video based
observational coding manual (OCM) to evaluate interpersonal skills of family caregivers
interacting with PWD (2) development of a treatment manual integrally linked to the OCM and
(3) assessment of the feasibility of delivering the treatment.
Methods:
1. We will convene an Expert Advisory Panel (EAP) with expertise in interpersonal and
family caregiving processes and family psychotherapy to provide feedback on the OCM. The
OCM represents an adaptation of previously established and reliable coding manuals
developed for assessing interaction patterns in couples, families, and dementia
caregiver research. Using an iterative process of refinement based on EAP feedback,
pilot coding of video from five initial dyads, and feedback from those dyads we will use
coding schemes originally developed for research and adapt them for clinical use. We
will then recruit 15 additional dyads and videotape their interactions. Five Psychology
Trainees will be trained on the OCM. The PI and pairs of Psychology Trainees will
independently code each video to assess validity, reliability, and analyze qualitative
data from semi-structured interviews of caregivers, care-recipients, and clinicians to
assess acceptability and utility of the OCM.
2. We will draft a treatment manual for a family intervention informed by established
empirically supported interventions for couples and families. The treatment manual will
target the identified interpersonal skills deficits in the OCM. A draft of the Treatment
Manual will be presented to the EAP, eliciting feedback for further refinement. We will
pilot test the family intervention via telehealth with the dyads who received the OCM
and treatment.
3. We will assess for feasibility of delivery, and dyad benefit from dyad and therapist
report, and descriptive analyses of changes in interpersonal conflict, caregiver
depression, anxiety, and burden.
Status:
The project team is convening the EAP and implementing the telehealth logistics necessary to
begin recording Wave 1 of dyads.
The increase in prevalence of dementia over the last 50 years has resulted in a concomitant
rise in the number of families facing the physical, emotional, and psychological stress
associated with caregiving. Behavioral symptoms that occur in persons with dementia (PWD)
lead to negative mental and physical health outcomes for caregivers and predict caregiver
decisions to institutionalize PWD. Resources to Enhance Alzheimer's Caregiver Health - VA
(REACH VA), has demonstrated its ability to improve caregiver burden, emotional and physical
well-being, social support and management of behavioral symptoms. Although REACH VA
represents one of the best available approaches to help caregivers, treatment non-response
and modest treatment effects remain significant issues. A variety of factors may be
associated with non-response to behavioral intervention - one particularly robust predictor
of non-response is interpersonal skill and communication.
Objectives:
The goal of this research project is the first step toward systematically identifying and
addressing caregiver interpersonal challenges using telehealth technology. This project
involves three interrelated activities: (1) refinement and pilot testing of a video based
observational coding manual (OCM) to evaluate interpersonal skills of family caregivers
interacting with PWD (2) development of a treatment manual integrally linked to the OCM and
(3) assessment of the feasibility of delivering the treatment.
Methods:
1. We will convene an Expert Advisory Panel (EAP) with expertise in interpersonal and
family caregiving processes and family psychotherapy to provide feedback on the OCM. The
OCM represents an adaptation of previously established and reliable coding manuals
developed for assessing interaction patterns in couples, families, and dementia
caregiver research. Using an iterative process of refinement based on EAP feedback,
pilot coding of video from five initial dyads, and feedback from those dyads we will use
coding schemes originally developed for research and adapt them for clinical use. We
will then recruit 15 additional dyads and videotape their interactions. Five Psychology
Trainees will be trained on the OCM. The PI and pairs of Psychology Trainees will
independently code each video to assess validity, reliability, and analyze qualitative
data from semi-structured interviews of caregivers, care-recipients, and clinicians to
assess acceptability and utility of the OCM.
2. We will draft a treatment manual for a family intervention informed by established
empirically supported interventions for couples and families. The treatment manual will
target the identified interpersonal skills deficits in the OCM. A draft of the Treatment
Manual will be presented to the EAP, eliciting feedback for further refinement. We will
pilot test the family intervention via telehealth with the dyads who received the OCM
and treatment.
3. We will assess for feasibility of delivery, and dyad benefit from dyad and therapist
report, and descriptive analyses of changes in interpersonal conflict, caregiver
depression, anxiety, and burden.
Status:
The project team is convening the EAP and implementing the telehealth logistics necessary to
begin recording Wave 1 of dyads.
Inclusion Criteria:
Either the caregiver or the care-recipient must be a Veteran.
The caregiver must:
- Be the primary unpaid family or friend who helps or supports an individual with
dementia
- Be involved in the care of the person with dementia (at least 4 hours of care per day)
- Report that the care-recipient exhibits behavioral problems that are distressing
- Not be currently receiving the REACH VA protocol
Additionally, the care-recipient must:
- Must have a documented diagnosis of dementia
- Have cognitive impairment (MMSE<23 or SLUMS<20 or diagnosis of dementia based on chart
review)
- Be out of bed and able to respond to a caregiver's instructions or interventions
Exclusion Criteria:
- Caregiver severe cognitive impairment
- Caregiver inability to meet study demands
- Caregiver psychosis
We found this trial at
1
site
New York, New York 10010
Principal Investigator: Cory K. Chen, PhD
Phone: 212-686-7500
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