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The Alabama REACH Demonstration Project (ARDP) A case example using the RE-AIM model

The Alabama REACH Demonstration Project (ARDP) A case example using the RE-AIM model. Lou Burgio, Ph.D. University of Alabama Center for Mental Health and Aging. RE-AIM. Background.

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The Alabama REACH Demonstration Project (ARDP) A case example using the RE-AIM model

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  1. The Alabama REACH Demonstration Project (ARDP)A case example using the RE-AIM model Lou Burgio, Ph.D. University of Alabama Center for Mental Health and Aging

  2. RE-AIM

  3. Background • 2004, with AoA funds, ADSS started partnership with UA to modify REACH clinical trial protocol so that it is feasible in the community. • Supervision of resulting treatment program would be by four Area Agencies on Aging (AAA), and case managers from AAAs would serve as interventionists.

  4. Role of University • Work with AAAs to design workable program: modify treatment manuals and procedures • Train case workers to use intervention in clients’ homes. • Be available by phone for case consultation • Maintain data management and conduct data analysis

  5. Resulting Intervention • Risk Assessment • Education about AD, Caregiving, and Stress • Caregiver Health(Health Passport) and Home Safety (use of checklist) • Behavior Management • Signal Breath (simple relaxation)

  6. Procedural Modifications • Four, hour-long home visits over a 3-4 month period • Three phone calls interspersed among home visits

  7. RE-AIM Application to ARDP • What we did • Factors to consider (suggested by RE-AIM)

  8. RE-AIM

  9. RE-AIM ELEMENTS: REACH • Definition: The number, percent of target audience, and representativeness of those who participate. • What we did: • Four AAAs chosen by ADSS: two rural and two urban • Of the 272 dyads present at first home visit, 97% attended all four home visits

  10. RE-AIM ELEMENTS: REACH Factors to consider • Need data on total number of caregivers contacted for participation • Characteristics of caregivers who did and did not participate

  11. RE-AIM ELEMENTS: EFFECTIVENESS • Definition: Change in temporally appropriate outcomes, and impact on quality of life and any adverse outcomes.

  12. Treatment Effects on CG Emotional Well-Being

  13. Overall Improvements in Behavioral Problems of the CR A McNemar Chi‐square test was used to evaluate the response to a question about overall improvement in behavioral problems in the CR over the past 4 months, at pre and post‐intervention. A statistically significant change over time was found (N = 221, X2=25.14, p<.001).

  14. Improvement in Behavior Problems • Post-treatment, caregivers reported significant improvement in behavior problems (p<.001)

  15. Treatment Effects on Caregiver Health

  16. Client Satisfaction Survey Part I

  17. Client Satisfaction Survey Part II

  18. Client Satisfaction Survey Part III

  19. RE-AIM ELEMENTS: EFFECTIVENESS Factors to consider • Are any caregiver or case manager factors associated with outcome? • Is there any negative impact of intervention? • Can program be shortened? Component analysis? Input by case managers and caregivers?

  20. RE-AIM ELEMENTS: ADOPTION • Definition: Number, percent and representativeness of settings and clinicians who participate. • What we did: • Near the end of the project, every case manager in Alabama was taught REACH intervention in two-day workshop (all AAAs involved)

  21. RE-AIM ELEMENTS: ADOPTION Factors to consider • How many AAAs were using REACH intervention after the state-wide workshop? • How many case managers within AAAs actually used REACH interventions after state-wide workshop? • What were the characteristics of those who did and those who did not?

  22. RE-AIM ELEMENTS: IMPLEMENTATION Definition: Extent to which a program or policy is delivered consistently; what are the time investment and costs of the program. • What we did: • A form was used by case managers to track the number of home visits/phone calls, but also to record therapeutic activities during the visits • Case managers reported using the treatment components from 88.6% (caregiver passport) to 98.5% (safety checklist) of the time

  23. RE-AIM ELEMENTS: IMPLEMENTATION Factors to consider • The program would benefit from assessment of implementation costs to inform future allocations

  24. RE-AIM ELEMENTS: MAINTENANCE Definition: Individual/member target: Long-term effects and attrition. Setting/clinician: Extent of discontinuation, modification, or sustainability of program. • What we did: • Integrated REACH into Alabama CARES • CARES is long-standing program that offers menu of services; REACH is now one of the services available • All CARES team members attended two-day workshop to learn about REACH intervention

  25. RE-AIM ELEMENTS: MAINTENANCE Factors to consider • Need longer assessment of individual client maintenance • Need assessment of length of time agencies kept REACH “active” within CARES • Need application to other senior services, e.g. Senior Day Services

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