“evidence-based programs for caregiving families” annual conference

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“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 1

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“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. History of Family Caregiving Research . 30 years of caregiving research - PowerPoint PPT Presentation

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Page 1: “Evidence-Based Programs for Caregiving Families” Annual Conference

“Evidence-Based Programs for Caregiving

Families”Annual Conference

Ohio Association of Gerontology and Education

4-15-11

David M. Bass, PhDVice President for ResearchMargaret Blenkner Research

Institute1

Page 2: “Evidence-Based Programs for Caregiving Families” Annual Conference

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 care2

Page 3: “Evidence-Based Programs for Caregiving Families” Annual Conference

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

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Page 4: “Evidence-Based Programs for Caregiving Families” Annual Conference

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 4

Page 5: “Evidence-Based Programs for Caregiving Families” Annual Conference

Care Consultation Research Studies

1. Cleveland Alzheimer’s Managed Care Demon., 1997-2001

2. Chronic Care Networks for Alzheimer’s Disease, 1998-2004

3. Partners in Dementia Care for Veterans with Dementia and

Their Family Caregivers, 2006-2011

4. Integrated Care Management, 2005-2007

5. Care Network for Depression, 2006-2009

6. Care Consultation in Cleveland, 2009-2011

7. Tennessee Replication of Care Consultation, 2009-2012

8. The Georgia Care Consultation Program, 2010-2013

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Page 6: “Evidence-Based Programs for Caregiving Families” Annual Conference

1. Health & Care-Related Information 2. Family & Friend Involvement

3. Awareness & Use Community Services

4. Coaching & Emotional Support

Four Types of Assistance Provided

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Page 7: “Evidence-Based Programs for Caregiving Families” Annual Conference

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 supportUtilization 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

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Page 8: “Evidence-Based Programs for Caregiving Families” Annual Conference

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? 8

Page 9: “Evidence-Based Programs for Caregiving Families” Annual Conference

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

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Page 10: “Evidence-Based Programs for Caregiving Families” Annual Conference

Model for Implementation of Evidence-Based Programs

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Page 11: “Evidence-Based Programs for Caregiving Families” Annual Conference

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 11

Page 12: “Evidence-Based Programs for Caregiving Families” Annual Conference

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 12

Page 13: “Evidence-Based Programs for Caregiving Families” Annual Conference

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 13

Page 14: “Evidence-Based Programs for Caregiving Families” Annual Conference

Model for Implementation of

Evidence-Based Programs

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