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Research Highlight

Partnered Evaluation of the Enhanced Program of General Caregiver Support Services

Over 5.5 million family caregivers provide often unpaid care to aging and disabled Veterans across the United States.¹ Given increasing reliance on family caregivers to maintain the highest quality and least restrictive care for Veterans, VA is expanding services offered through the Caregiver Support Program (CSP), including its Program of General Caregiver Support Services (PGCSS). PGCSS includes peer support mentoring, skills training, coaching, telephone support, online educational programs, referrals to mental health services and other resources, and respite care for eligible caregivers. In FY21, CSP enhanced PGCSS by providing funding to support one PGCSS staff member at every VA site, setting minimum practice standards, and rapidly delivering new supports and services.

Amid national expansion, rigorous evaluation of PGCSS enhancement is critical to optimize services and ensure high quality, inclusive, personalized, and holistic support for caregivers.

Formative Evaluation of Enhanced PGCSS Services and Supports

As part of an ongoing evaluation of CSP, in FY21 – FY22 the VA Quality Enhancement Research Initiative (QUERI) VA Caregiver Support Program Partnered Evaluation Center (VA CARES) evaluated the delivery and impact of two evidence-based PGCSS enhancement services.

• VA S.A.V.E Training for Caregivers – a one- time, locally delivered suicide prevention training for people who work, live with, and/or care for a Veteran. ²

• Resources for Enhancing All Caregivers Health (REACH) VA Program – a one-on- one, or group based coaching program for caregivers focused on stress management, problem solving, self-care, and support for diagnosing specifc issues.³

The VA CARES research team designed a qualitative evaluation to understand caregivers’ experiences with these two services and factors that might have impacted those experiences. The design included collecting information from enrolled caregivers and PGCSS staff implementing these new services. The team engaged a total of 39 caregivers who participated in VA S.A.V.E. and/or REACH VA in a one-time, semi-structured phone interview. The team purposively sampled staff from seven sites that had high or low enrollment volume of new caregivers in early FY21, and invited them to participate in a series of two virtual interviews and a virtual focus group. Eight PGCSS staff members participated in initial semi-structured interviews, six participated in a second interview, and six participated in a single focus group. The VA CARES team analyzed the interviews using rapid qualitative methods.

The team identifed three overarching themes through this analysis.

• Services are valued but the timing of offering services is important and caregiver engagement can be challenging. Participants articulated positive benefts of the trainings (e.g., improved knowledge and awareness about suicide, personal support, and practical caregiving skills). However, caregivers also described a lack of awareness of programming, and discussed their readiness to engage supports. Findings suggest that multiple types of caregiver engagement patterns exist and understanding factors that infuence engagement may assist staff in tailoring approaches to increase caregiver engagement.

• Connection and social support are valued, but so are practical Caregivers and staff recognized the importance of helping caregivers feel they are not alone, but caregivers also emphasized the utility of practical knowledge and skills, and indicated that advanced skill-based and refresher classes would be welcome.

• Uneven initial implementation leveled out in year two of the PGCSS enhancement, but challenges PGCSS staff pointed to tensions between the movement toward more national uniformity and the desire to tailor services using their clinical expertise and understanding of local needs. They also expressed concerns about not having the appropriate resources to keep up with new program expectations.

Caregivers and staff in this evaluation offered the following suggestions for improvement.

• Ensure the availability of continuing opportunities for engagement and inform caregivers of these opportunities after time- limited trainings have ended.
• Help staff develop messaging to different groups of caregivers to improve engagement in VA S.A.V.E.
• Assure additional one-on-one time with caregivers to provide personalized touch points to bring up the topic of suicide.
• Continue to provide and expand venues for staff to share best practices and to problem solve specifc issues around engaging caregivers in PGCSS programming (e.g., shared resources, adaptable scripts).
• Obtain better understanding of caregiver engagement types and develop targeted efforts aimed at different types of caregivers.

Overall, caregivers and staff offered suggestions for improving VA S.A.V.E. and REACH VA, while clearly articulating the value of those trainings for caregivers.

Future Directions

Building on the formative evaluation, VA CARES will conduct evaluations of two other pivotal PGCSS enhancement services: the Caregiver Health and Wellbeing Coaching Initiative (CHWC) and respite care.

Built upon the VA Whole Health framework, the CHWC is a six-day training course designed to equip CSP staff with Whole Health Coaching skills, knowledge, tools, and self-care skill building techniques to better support caregivers on their caregiving journey. The CHWC will be expanded over the next two years with the goal of having at least one CHWC trained staff member at every VA facility by the end of FY23. In partnership with CSP, VA CARES will examine the effectiveness and implementation of the CHWC expansion. Guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR), this evaluation will demonstrate impacts of the CHWC on caregivers and elucidate strategies to improve delivery of these services.

Respite care is designed to provide caregivers a short break from caregiving responsibilities through both formal supports (e.g., paid home-based and nursing home care) and informal supports (e.g., respite goal planning, self-care resources, other members of the caregiver’s social support network). CSP is currently enhancing respite services through innovations such as site-specifc respite champions and self-guided respite planning tools for caregivers. Using mixed methods approaches, combined with rapid feedback from CSP, VA CARES will evaluate barriers to use of respite care and identify areas to optimize respite services offered through PGCSS.

The formative evaluation of PGCSS expansion acts as a stepping stone to determine the reach, delivery, and quality of other expanded caregiver services. Knowledge gained from this multipronged PGCSS evaluation will be used to improve support for caregivers across VA.

References

1. Ramchand R, et Hidden Heroes: America’s Military Caregivers. Santa Monica, CA: RAND Corporation; 2014. https://www.rand.org/pubs/research_reports/RR499.html.
2. Holmes G, Clacy A, Hermens DF, Lagopoulos J. “The Long-term Effcacy of Suicide Prevention Gatekeeper Training: A Systematic Review,” Archives of Suicide Re- search 2021; 25(2):177-207.
3. Nichols LO, et al. “Translation of a Dementia Caregiver Support Program in a Health Care System – REACH VA,” Archives of Internal Medicine 2011; 171(4):353-9.

Disclaimer: This work was completed while Lauren Penney was employed by the South Texas Veterans Affairs Health Care System.

Acknowledgements: We would like to acknowledge the Caregiver Support Program, especially lead operational partners, Dr. Colleen Richardson, Leah Christensen, and Timothy Jobin, for their leadership and effort in relation to this evaluation.