REACH Into Indian Country: Caregiver Support for Dementia ...

REACH Into Indian Country: Caregiver Support for Dementia ...

REACH INTO INDIAN COUNTRY: CAREGIVER SUPPORT FOR DEMENTIA CAREGIVERS Barbara Higgins, MA REACH Community Program Coordinator, Caregiver Center University of Tennessee Health Science Center and Memphis Veterans Affairs Medical Center QUOTE: Our caregivers changed from viewing the issues with their loved ones as huge problems into thinking proactively by addressing small parts of the issues. The book helped them to break thing down into a doable level. The program in our experience was very user friendly. Program Coach Cherokee Community REACH INTO INDIAN COUNTRY Resources for Enhancing Alzheimer's Caregivers Health in Tribal Communities (REACH into Indian Country) Implement a proven dementia caregiving behavioral intervention Funded for three years by the RX Foundation Focus on the fit and utility of the intervention in Tribal communities

REACH INTO INDIAN COUNTRY CONTIUNED Resources for Enhancing Alzheimer's Caregivers Health in Tribal Communities (REACH into Indian Country) Education, support, and building skills (problem solving, stress management, mood management) Helps dementia Caregivers manage their loved ones dementia and their own stress and coping Four sessions between the Caregiver and a Program Coach (more if needed) Sessions are individualized to the Caregivers and Patients specific concerns A Caregiver Notebook provides suggestions and strategies CAREGIVING RISKS Psychological health depression, anxiety, PTSD, burden, stress, morale, life satisfaction, marital satisfaction, resilience, grief Physical health

morbidity, mortality, blood pressure, insulin levels, impaired immune systems, CVD, health care use for both Caregiving/social time spent on caregiving, social support, isolation, validation, efficacy, frustrations, safety CAREGIVING RISKS CONTINUED Inability to provide care for loved ones Caregiver may not be in the loop Medication errors Lack of follow through on provider recommendations Neglect Burnout Not taking care of self Caregiver health status

Morbidity, mortality Lack of caregiver assessment Isolation SUCCESSFUL CAREGIVER INTERVENTIONS Common topics needed by all Disease and course Targeted Specific needs of the dyad Through assessment Multicomponent Safety Education Caregiver physical well-being

Support Caregiver emotional well-being Social support Management of patient concerns to Skills building Problem solving Cognitive restructuring Stress reduction Communication Clinician-family alliance Focus on COMPONENTS OF THE PROGRAM Problem Solving

Positive Thinking Stress Management PROBLEM SOLVING STEPS 1.Determine problem (patient, caregiver, family) 2.Define/operationalize (frequency, duration, intensity, characteristics) 3.Assess 4.Set previous attempts to address goals and determine realistic outcome 5.Develop

Target Behavior/Issue plan - Determine appropriate topic in Caregiver Notebook - Review materials with Caregiver 6.Review and troubleshoot plan - Barriers 7.Assess plan 8.Modify, if needed PROBLEM SOLVING Problems: Increased dependence in dressing, unable to choose appropriate and clean clothing, increased agitation

Possible solutions: Medication Attendant Lay out clothes Simplify tasks Limit choices Cue, prompt Modify environment STRESS MANAGEMENT: SKILLS BUILDING Pause for a moment, breathe, focus on the breath. Know that you are OK, in this moment. Leo Babauta SIGNAL BREATH Focused Breathing

Simple and Portable Prioritizes Stress Management Step 1: Rate your level of tension Step 2: Take a deep breath and hold it for 3 or 4 seconds Step 3: Breathe out slowly while saying a word or phrase to yourself, such as relax, peace, or calm down. Step 4: While exhaling, let your jaws, shoulders and arms go limp Step 5: Repeat these steps two more times Step 6: Rate your level of tension MOOD MANAGEMENT COGNITIVE REFRAMING Managing the relationship between thoughts and feelings when the problem cannot be changed Identify the situation Identify current thoughts Recognize current emotions/feelings Challenge/replace unhelpful thoughts Match milder feelings to milder thoughts

THOUGHT RECORD EXAMPLE Step 1 Step 2 Step 3 Step 4 Step 5 Situation Current Thoughts Current Feelings Challenge & Replace New Feelings My sister was supposed to help me and didnt come

She always does this to me I shouldnt depend on her Trapped Shes been there for me in the past Stressed Less trapped Understanding The day is not over I never have time for myself Disappointed Annoyed Angry

Hopeful My day is ruined Sad STRESS MANAGEMENT: SKILLS BUILDING Additional stress management techniques Power of Music Pleasant Events Stretching Guided Imagery/Visualization REACH FLOW CHART Eligibility Caregivers are usually a family member or someone with a significant personal relationship who provides substantial, necessary, regular or long-term care of a person with dementia receiving services at your organization. Enrollment and Risk Priority The Interventionist completes Caregiver Assessment forms (Demographics and Risk Priority Inventory). The Interventionist explains the program to the Caregiver and sets a date for Session 1. Intervention Sessions

The Interventionist will complete Active Intervention Phase -Four core sessions with the Caregiver over two to three months -Additional sessions if necessary based on goal attainment, Caregiver need/desire, or Interventionist clinical judgment for Active Intervention Phase Discharge from Active Intervention Phase -Obtain closure to Active Phase by reviewing previous sessions and ways to contact Interventionist if problems arise Maintenance Intervention Phase - If problems arise, Interventionist works with Caregiver on additional problems/stress issues REACH PROGRAM PUTTING IT TOGETHER TO HELP THE CAREGIVER Active Phase Four individual core sessions over 23 months Risk Assessment Program Coach Manual

Face to face or by telephone Optional additional sessions based on caregiver need, desires and goal attainment, and REACH Coach judgment Maintenance Phase Additional problems/stress issues as needed Key Tools Caregiver Notebook Focus Education Problem solving Mood management Stress reduction

May-17 Mar-17 Jan-17 Nov-16 Communities Reached Cumulative 50 45 40 35 30 25 20 15 10 5 0 Total Communities May-17

Mar-17 60 Jan-17 0 Nov-16 80 Sep-16 10 Jul-16 20 100 May-16 160

Mar-16 50 Jan-16 180 Nov-15 60 Sep-15 Enrolled Caregivers Cumulative Jul-15 Total CGs May-15 30

Sep-16 40 Jul-16 May-16 Mar-16 Jan-16 Nov-15 Sep-15 Jul-15 May-15 Jul-15 Aug-15 Sep-15 Oct-15

Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 REACH PROGRESS Trained & Certified Program Coaches Cumulative

140 120 Trained INTs Certified INTs 40 20 0 CHALLENGES AND CONCERNS Program Implementation Staffing Resources Caregiver Awareness

Program Incentives Time Limit PROGRAM INITIATIVES Community Expanded Specific Modifications to Program Format Training Opportunities Provided additional support staff Soliciting Community Wide Feedback CONTINUING EDUCATION (CE)

For Nursing CE: To obtain a CE certificate you must registered, attend the activity in its entirety and submit a completed electronic evaluation form. The electronic evaluation link will be provided to registered participants and must be completed within one week of the educational activity. The Indian Health Service Clinical Support Center will mail CE Certificates to those Nurses who successfully complete the criteria for receiving CE. This activity is designated 2.75 contact hours for nurses. UPCOMING TRAINING DATES September 25, 2017 2:00 pm to 5:00 pm ET October 6, 2017 11:00 am to 2:00 pm ET October 17, 2017

2:00 pm to 5:00 pm ET November 17, 2017 11:00 am to 2:00 pm ET November 29, 2017 2:00 pm to 5:00 pm ET December 14, 2017 11:00 am to 2:00 pm ET BECOME A REACH PROGRAM COACH Access to these resources to help you help your caregivers Barbara Higgins, MA REACH Community Program Coordinator (901) 523-8990, dial 1 and ext. 5078 [email protected] Memphis Caregiver Center Website

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