REACH VA: Findings and
Lessons Learned from a
National Clinical Translation
Linda Olivia Nichols, PhD
Jennifer Martindale-Adams, EdD
Health Services Research
VA Medical Center, Memphis
Preventive and Internal Medicine
University of Tennessee Health Science Center
Resources for Enhancing
Alzheimer's Caregivers Health
(REACH II)
• Multi-component 6 month, randomized
clinical trial, 6/02 to 12/04
• Funded by NIA and NINR, additional support
from VA
• Five sites and Coordinating Center
• Recruited 642 caregiver dyads
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African Americans/Blacks
Hispanics/Latinos
Caucasians/Whites
REACH II
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Structured and targeted
Risk based
Education
Safety
Emotional well being
Self-care
Social support
Patient problem behaviors/caregiver skills
Six month duration
12 individual sessions
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Home and by telephone
5 telephone groups
Computer assisted telephones
Individually prepared behavior and stress/coping prescriptions (CG and
CR)
REACH II Findings
• Improvement in quality of life (burden, patient
management, depression, self-care, social support)
for intervention caregivers, compared to control:
o Hispanic/Latino (p < .001)
o White/Caucasian (p = .037)
o Black/African American spouses (p = .003)
• Lower prevalence of clinical depression (p = .001) for
intervention caregivers
• One additional hour of non-caregiving time per day
at a cost of $4.96 per day per caregiver
Belle et al., Ann Int Med, 2006; Nichols et al., JAGS, 2008,
REACH II implemented
into VHA
• Caregiver Assistance pilot program
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Congressional funding to Veterans Health
Administration
VHA Patient Care Services funded
Evidence based, promising clinical interventions
• Home Based Primary Care
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Psychologist, Social Worker, or Nurse
Added to normal duties
REACH II
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Structured and targeted
Risk based
Education
Safety
Emotional well being
Self-care
Social support
Patient problem
behaviors/caregiver skills
Six month duration
12 individual sessions
o
•
Home and by telephone
5 telephone groups
 Computer assisted telephones
 Individually prepared
behavior and stress/coping
prescriptions (CG and CR)
REACH VA
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Structured and targeted
Risk based
Education
Safety
Emotional well being
Self-care
Social support
Patient problem
behaviors/caregiver skills
Six month duration
12 individual sessions
o
•
Home and by telephone
5 telephone groups
 Regular telephones
 Caregiver workbook with
prepared behavior and
stress/coping topics
REACH VA Sites
•Connecticut
•Colorado
•California
• Georgia
• Michigan
•Minnesota
•New Mexico
• New York
•North Carolina
•Ohio
• Pennsylvania
• Tennessee
• Texas
• Utah
• West Virginia
Coordinating Center - Memphis
CC
REACH VA Caregiver
Findings
• Intervention, compared to control, caregivers
over six months, improvement in:
Burden (p = .008)
o Depression (p = .030)
o Effect of depression on daily life (p = .031)
o Troubling patient behaviors (p = .046)
o Caregiver frustrations (abusive behaviors) (p =
.012)
• Two hours per day decrease in time on duty (p =
.055)
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• Cost of $2.93 per caregiver per day
REACH VA Caregiver
Satisfaction
REACH VA Staff
Satisfaction
PARiHS Framework
Elements
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Evidence
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Context
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Facilitation
Weak to strong support for implementation
Promoting Action on Research Implementation in Health Services
PARiHS Framework
Element: Evidence
Evidence Subelements
REACH VA factors
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• REACH II RCT findings
Research
• Clinical experience
• Patient experience
• Local knowledge
• Home Based Primary
Care psychologists,
social workers, nurses,
administrators
Lessons Learned Evidence
• Translation not duplication
• See beyond research model
• Adapt to your setting
• Minimize amount of change
• Actual translation needs to be done by someone
steeped in the intervention
PARiHS Framework
Element: Context
Context Subelements
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Culture
Leadership
Evaluation
REACH VA factors
• Congress directed and
funded
• Patient Care Services,
Office of Home and
Community Care and
Caregiver Support
Program
• Memphis VA Medical
Center funded to develop,
train, and evaluate
Lessons Learned Context
• All levels must buy in
• Has to fit into the system
• Fiscal responsibility - have to capture workload
PARiHS Framework
Element: Facilitation
Facilitation Subelements
REACH VA factors
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Facilitation
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Characteristics
• Manuals, scripts, talking
points
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Role
• Style
• Live and online archived
training
• Technical assistance
calls
Lessons Learned Facilitation
• Human interaction critically important
• Coaching
• User-friendly
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Just-in-time
Customized
• Meet people where they are
• Role play/feedback/examples
Research to
Translation
• From controlled research environment to larger
health care system
• All components in place for successful
implementation
• Outcome evaluation to determine if similar results
• Formative evaluation necessary to identify challenges
and hurdles
• Continuous quality improvement to refine process
Future Efforts and
Directions
• Caregiver legislation – VHA new directions
• All HBPC sites planned
• Additional VHA modalities (in facility, by telephone)
• Additional VHA settings (Adult Day Health Care,
Medical Foster Care)
• Additional populations of VHA caregivers (TBI, SCI,
PTSD, Polytrauma)
• Other programs – AoA REACH interventions,
Rosalynn Carter Institute, other community agencies
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Robert Burns, MD
Celeste Bursi, MSSW
Marshall Graney, PhD
Barbara Higgins, MA
Sarah Kennedy, MA
• Jennifer MartindaleAdams, EdD
• Pat Miller, MA
• Linda Nichols, PhD
• Jeff Zuber, MA