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PPO 16-131 – HSR&D Study

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PPO 16-131
Family Telemental Health Intervention for Veterans with Dementia
Cory K. Chen PhD
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY
New York, NY
Funding Period: May 2017 - October 2019

BACKGROUND/RATIONALE:
The increase in prevalence of dementia over the last 50 years has resulted in a concomitant rise in the number of families facing the physical, emotional, and psychological stress associated with caregiving. Behavioral symptoms that occur in persons with dementia (PWD) lead to negative mental and physical health outcomes for caregivers and predict caregiver decisions to institutionalize PWD. Resources to Enhance Alzheimer's Caregiver Health - VA (REACH VA), has demonstrated its ability to improve caregiver burden, emotional and physical well-being, social support and management of behavioral symptoms. Although REACH VA represents one of the best available approaches to help caregivers, treatment non-response and modest treatment effects remain significant issues. A variety of factors may be associated with non-response to behavioral intervention - one particularly robust predictor of non-response is interpersonal skill and communication.

OBJECTIVE(S):
The goal of this research project is the first step toward systematically identifying and addressing caregiver interpersonal challenges using telehealth technology. This project involves three interrelated activities: (1) refinement and pilot testing of a video based observational coding manual (OCM) to evaluate interpersonal skills of family caregivers interacting with PWD (2) development of a treatment manual integrally linked to the OCM and (3) assessment of the feasibility of delivering the treatment.

METHODS:
(1) We will convene an Expert Advisory Panel (EAP) with expertise in interpersonal and family caregiving processes and family psychotherapy to provide feedback on the OCM. The OCM represents an adaptation of previously established and reliable coding manuals developed for assessing interaction patterns in couples, families, and dementia caregiver research. Using an iterative process of refinement based on EAP feedback, pilot coding of video from five initial dyads, and feedback from those dyads we will use coding schemes originally developed for research and adapt them for clinical use. We will then recruit 15 additional dyads and videotape their interactions. Five Psychology Trainees will be trained on the OCM. The PI and pairs of Psychology Trainees will independently code each video to assess validity, reliability, and analyze qualitative data from semi-structured interviews of caregivers, care-recipients, and clinicians to assess acceptability and utility of the OCM.
(2) We will draft a treatment manual for a family intervention informed by established empirically supported interventions for couples and families. The treatment manual will target the identified interpersonal skills deficits in the OCM. A draft of the Treatment Manual will be presented to the EAP, eliciting feedback for further refinement. We will pilot test the family intervention via telehealth with the dyads who received the OCM and treatment.
(3) We will assess for feasibility of delivery, and dyad benefit from dyad and therapist report, and descriptive analyses of changes in interpersonal conflict, caregiver depression, anxiety, and burden.

FINDINGS/RESULTS:
We have no findings or results to report at present, as study implementation has just begun.

IMPACT:
This study will act as a prevention of clinical disorders that include depression, anxiety, psychiatric decompensation, and enhance conflict management skills of the caregiver with the care recipient that can prevent institutionalized care in hospitals or long-term care facilities.
Clinical disorders will be prevented by improving interpersonal skills of caregivers for people with dementia and providing training that increases behavioral management strategies of caregivers.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Technology Development and Assessment, TRL - Development
Keywords: Caregiving, Dementia, Family, Telemedicine/Telehealth
MeSH Terms: none