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Alabama Department of Senior Services Irene Collins, Commissioner

Alabama Department of Senior Services Irene Collins, Commissioner Bettina Schmid, State Project Director The University of Alabama Center for Mental Health and Aging Louis D. Burgio, Director/Co-PI Tracy Wharton, Project Manager and the REACH investigators.

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Alabama Department of Senior Services Irene Collins, Commissioner

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  1. Alabama Department of Senior Services Irene Collins, Commissioner Bettina Schmid, State Project Director The University of Alabama Center for Mental Health and Aging Louis D. Burgio, Director/Co-PI Tracy Wharton, Project Manager and the REACH investigators The Alabama REACH Demonstration Project 2004 - 2007

  2. The Alabama REACH Demonstration Project2004 - 2007 In 2004, The University of Alabama partnered with the Alabama Department of Senior Services and received an Alzheimer’s Disease Demonstration Grant to States (ADDGS) award (thru AoA) which included the following goal: Implement a 3-year program to improve direct services available to family caregivers by incorporating REACH-like evidence-based, in-home social and behavioral interventions which promote skill building.

  3. The Alabama REACH Demonstration Project2004 - 2007 The Center’s tasks were to provide material, training, and consultation for the case worker interventionists in each of the 4 Area Agencies on Aging (AAA) participating in the project, and manage/analyze data.

  4. How was REACH II translated? We provided training in the intervention and procedures, along with the caregiver and therapist Notebooks, to the case managers and Directors during a 2-day workshop at the Center. We continued to train new AAA case workers due to turnover. Hotline: 2 half-days per week Project Manager/ PI were available for consultation. Monthly Conference Calls with Center (Dr. Burgio & Project Manager), ADSS staff (including the Commissioner), and most importantly, caseworkers.

  5. REACH IIAlabama REACH Demonstration Project: Practical elements of REACH II were selected to bring a useful intervention into everyday practice to improve the lives of Alzheimer’s patients and their caregivers. The focus was on feasibility, translating findings from the NIH clinical trial to a real world setting. Initially a Risk Assessment was conducted to produce tailored interventions. Interventions include: 1. Education about AD, Caregiving, & Stress • 2. Health and Safety • Home Safety Check • Health Passport • 3. Behavioral Management • Behavioral Prescriptions 4. Signal Breath Relaxation (stress management) • (excluded social support and use of technology)

  6. Direct Services to Families Living with Alzheimer’s Disease 4 hour-long home visits to families over 3-4 months to introduce treatment components 1st Home Visit: Initial visit includes Risk Assessment 2nd Home Visit: ~ 3 weeks later 3rd Home Visit: ~ 4 weeks later 4th Home Visit: ~ 4 weeks later (final home visit) Therapeutic phone calls (3) between home visits

  7. Direct Services to Families Living with Alzheimer’s Disease (cont.) Project Assessment Alabama Risk Assessment (21 items) ADSS Client Enrollment form (Demographics) Caregiver burden (Zarit 12-item) Caregiver health (Item) Care recipient memory, behavior, & mood (Items) Caregiver Satisfaction Survey (23 items) Focus group with case managers Why do assessment? What do we gain from all those numbers?

  8. This intervention is now being applied in Shelby County, AL, thanks to a grant from the RCI and Johnson & Johnson.

  9. Let’s take a short break, then we’ll talk about details.

  10. Forms(examples are available at www.cmha.ua.edu) Tracking sheet Risk Assessment CG Questionnaire CG Notebook Case Worker Training Manual

  11. Education about AD, Caregiving, & Stress Progression of the disease Research about caregiving & stress The importance of self-care Exercise: (role play) What are some objections that CGs have to self-care? What are some responses to those objections? *This is often the 1st time anyone has asked about the CG.

  12. Health & Safety Home Safety Check & Risk Assessment Exercise: role playing walk-thrus Comments, thoughts, suggestions about this exercise? Following up on suggestions

  13. Stress Techniques Signal Breath Exercise Comments, thoughts, suggestions about this exercise?

  14. Caregiver Self-Care Health Passport Discussion of plans for the CR if CG is unable to continue Tracking the Passport

  15. Behavioral Prescriptions “Prescription” ABC’s Finding the right choice for the family Giving it a chance to work Teaching about applying the technique to other problems

  16. Behavioral Prescriptions Eating Personal hygiene Communication Repetitive questions Losing or misplacing things Talking loudly or rapidly Anxiety or worry Verbal aggression Sadness or depression Wandering

  17. Let’s take another short break, then talk about some challenging issues for interventionists.

  18. Asking tough questions Why ask? When to ask. How to ask (the wording is important!). Preserving your role, getting the information, and valuing the working relationship.

  19. Boundaries & Termination Issues Your role Small communities and dual relationships Leaving the clients Support down the road Grief work

  20. Feedback from previous interventionists Support from advisors/experts very helpful and protective. Tracking forms were helpful to keep track of caseloads and progress. Connection to other interventionists was good.

  21. Thank you for your time and attention. Dr. Burgio & the rest of the staff at the CMHA look forward to working with you in the future! 1 (205) 348-7158 www.cmha.ua.edu Dr. Burgio: lburgio@bama.ua.edu Tracy Wharton: twharton@ua.edu

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