intervention process
Contents
1. Demonstrate active techniques Problem solve barriers Encourage use of Weekly Recording Form Discuss review first component of stress management module signal breath and techniques attempted Introduce well being module 1 component 2 music 30 min Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 1 Encourage use of stress management techniques signal breath and music Encourage use of tracking forms Weekly Recording Form and Stress Diary Reinforce use of caregiver network and social support group Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 23 Session 5 Week 6 7 Home Session Scheduled Date Materials Needed Session Activities Date Notes OUCOCOCOCLUOD Q Q Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form Stress Diary ABCs Problem Behavior Probes for the ABC Process Brainstorming Form Negotiation script Refer to decision rules if CG did not try or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about2. Materials Needed Session Activities Date Notes OoOooooo Ooo Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form ABCs Problem Behavior Probes for the ABC Process Brainstorming Form Stress Diary My Pleasant Event This Week List of Pleasant Activities for CR and Me The Pleasant Event We will Do this Week OR Home Practice Practicing a Thought Record 3 columns Home Practice Practicing a Thought Record 5 columns Refer to decision rules if CG did not try or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Reinforce participation in social support groups Review modify relevant prescriptions and well being module techniques provided in previous sessions Review Modify Target behavior 2 strategies Review Modify well being module 2 either pleasant events or mood management component 1 Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and well being techniques Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution que
3. Remind the CG of the importance of doing things that they enjoy e Mood Module Review the 5 column Thought Record and how it can help the CG overcome negative thoughts Remind the CG that how he she thinks about a situation can make the situation better or worse Social Support Review the on line support group Discuss what the CG learned from the group Inform the CG they can take part in other community support groups that can provide continued support Problem Solving Acknowledge that new problems may occur and remind the CG that they have the skills needed to handle the situation Remind CG of the brainstorming activity and let them know that this technique is useful in response to most any situation and can be accomplished alone or with a friend Remind CG of brainstorming rules For example you might say Alzheimer s is a constantly changing disease and you may face new problems with your loved one You can use the brainstorming skills to solve future problems You might also want to revisit the behavioral prescription s and reinforce the continued use of the strategies Additional Review Options It might also be helpful to briefly revisit the list that you ve just created on the worksheet and identify strategies that both you and the caregiver think were the most helpful for the CG Some options for review with the caregiver include the following remember that these are options only and do not necessarily have to be used
4. Home Session Scheduled Date Materials Needed Session Activities Date Notes Oooco Oooooo Risk Priority Worksheet CG Notebook DA Form Intervention Note Form ABCs Problem Behavior Probes for the ABC Process Brainstorming Form Some Effects of Stress Steps You Can Take Stress Diary Negotiation script Refer to decision rules no too many problems Q Oooo Ooo Introduce session Check in with CG as to how they are doing Provide overview of session purpose and structure Review use of caregiver network Reinforce 1st support group session Review use of Health passport safety recommendations Identify and initiate problem solving module Target behavior 1 Review Risk Priority Worksheet Jointly decide priority Complete ABC s of Problem Behaviors Probes for the ABC Process Form for Target behavior 1 Refer to Section 8 What is the behavior Why is this behavior a problem How would you like this behavior to change Why do you think this behavior happens When does the behavior happen Where does the behavior happen Who is around when the behavior occurs What have you tried Additional information such as physical problems like hearing or vision Conduct brainstorming session with CG Discuss effects of stress Introduce Well being Module 1 stress management component 1 signal breath 30 mins Identify technique Complete tension
5. and safety recommendations Introduce target behavior 1 use active teaching techniques and provide written behavioral prescription Review behavioral prescription Assess caregiver s responsiveness Provide examples for use Demonstrate active techniques Problem solve barriers Encourage use of Weekly Recording Form The interventionist reviews the behavioral prescription with the caregiver covering the entire prescription and assessing caregiver s responsiveness to suggestions For suggestions the caregiver wants to try the interventionist provides multiple examples of how the behavior might be manifested and how the caregiver should respond Active techniques modeling role playing and demonstration should be used when appropriate as much as possible Interventionist and caregiver problem solve any barriers to the use of the strategies The Weekly Recording Form is introduced as a way of monitoring progress The caregiver is encouraged but not required to complete the tracking forms Guidelines on presenting the behavioral prescription to caregivers are provided in Section 8 of the MOP Review modify first component of stress management module signal breath Discuss problems and successes Review home practice Identify potential barriers Problem solve solutions Review and reinforce use of techniques The interventionist and CG will discuss what was attempted what worked what did not and modify and encourage u
6. interventionist shows the caregiver how to record health information for both caregiver and care recipient and encourages the use of the Passport They discuss the importance of making and keeping appointments and preventive health check ups The interventionist will refer back to the Passport in the subsequent two sessions and inquire if the caregiver attempted to use them If not the interventionist will provide encouragement and validation as to their importance 7 Introduce physical well being issues and resources Healthy Lifestyle pamphlet if appropriate REACH II Caregiver Network information tips relevant to self care If any other caregiver specific health related issues were identified on the RPW the interventionist introduces the Healthy Lifestyle pamphlet and the Healthy Living feature of the Information Tips feature of the REACH II Caregiver Network further emphasizing the importance of taking care of oneself as a caregiver NIA NINR REACH II All Rights Reserved V1 0 6 1 02 6 8 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice safety and health tips that were identified in session Reinforce caregiver network use Provide support and encouragement to CG Session 3 Home Visit Week 3 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure 2 Review
7. rating before after practice Practice Identify barriers to practice Encourage use of techniques and stress diary Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to practice health and safety tips stress techniques Suggest CG review CG Notebook and caregiver network information tips that are relevant to problem behaviors Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 22 Session 4 Week 4 5 Home Session Scheduled Date Materials Needed Session Activities Date Notes Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form Stress Diary Refer to decision rules if no too many problems OOOOOOCD Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Remind CG of support group time and encourage attendance Review Health passport amp safety recommendations Introduce Target behavior 1 use active teaching techniques and provide written behavioral prescription to CG Review behavioral prescription Assess caregiver s responsiveness Provide examples for use
8. remove screenphone at next visit Review referral numbers Thank caregiver for participation in study Provide support and encouragement to CG Substitution Rules e The program is designed with 12 sessions 9 home sessions and 3 phone sessions e An interventionist can replace up to two phone sessions with home sessions or two home sessions with phone sessions for a range of 7 home sessions and 5 phone sessions to 11 home sessions and 1 phone session e The judgement of the interventionist and research team is to be used to substitute sessions However general rules for substitution include Home sessions can be increased if the caregiver is distressed or if the interventionist needs to introduce a new prescription Phone sessions can be increased if the caregiver is unavailable for one month the caregiver cancels two sessions or if the purpose of the sessions can be easily accomplished in a phone call e Each session is designed to be completed in one contact however an additional 3 contacts are available to the interventionist for a total of 15 e Well being and problem solving activities are BEST initiated on home visits with follow up activities related to these modules during phone visits Possible exceptions to this rule would include working with a bright motivated caregiver who would be willing and able to have a 60 to 90 minute call NIA NINR REACH II All Rights Reserved V1 0 6 1 02 18 SESSION BY SESSION C
9. use of REACH II Caregiver Network and reinforce meeting time for initial support group session 3 Review use of Health passport and safety recommendations 4 Identify and initiate problem solving approach with Target behavior 1 Review Risk Priority Worksheet Jointly decide priority The interventionist and caregiver review Risk Priority Worksheet focusing on CR self care difficulties problem behaviors and social support issues They jointly decide which problem will be the first that is worked on An item on the RPW may seem most critical but upon closer examination turn out to be trivial At the other extreme a problem not even listed or even for which there is no existing category might turn out to be the priority problem e g He doesn t recognize who am anymore As far as determining priority on the form the most critical step is to identify the 1 priority based on negotiation between the CG and the interventionist from the Emotional Well being and Behaviors Social Support components A second priority can be identified at this point but would need to be re negotiated once the 1 priority has been adequately addressed 5 Complete ABC s of Problem Behaviors Probes for the ABC Process Form for Target behavior 1 Refer to Section 8 What is the behavior Why is this behavior a problem How would you like this behavior to change Why do you think this behavior happens When does the behavior happen Wh
10. 02 14 9 Conduct brainstorming session with CG 10 Introduce well being module 2 pleasant events or mood management component 2 30 minutes Describe technique Complete tension rating before and after practice Practice Identify barriers to practice Encourage use of techniques Encourage use of stress diary 11 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and well being techniques Remind CG that CG Notebook may have tips related to target behavior 2 Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG Session 9 Phone Visit Week 16 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure 2 Check in with CG about use of Caregiver Network resource information tips 3 Reinforce participation in social support groups 4 Review modify relevant prescriptions and well being module techniques provided in previous sessions 5 Review modify target behavior 2 Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies Take presc
11. 60 to 90 minute call NIA NINR REACH II All Rights Reserved V1 0 6 1 02 19 SESSION BY SESSION CHECKLIST Session 1 Week 1 Home Session Scheduled Date Materials Needed Session Activities Date Notes Q CG Notebook interventionist badge a Highlighter FORMS Q PI form directions and phone number Risk Priority Worksheet DA Introductory guiding scripts for intervention and caregiver network Q Caregiver network telephone with battery installed Q 3prong adapter Q Screw driver to anchor the adapter to the outlet cover as the AC adapter is heavy 12 ft modular phone cord Installation checklist 4 prong modular adapter for old style jack to modern modular jack Q CG Network Training Questionnaire Q CG Network Training Observation Checklist Q Caregiver network user help card with caregiver access number PIN on front Ooo Ooo Q Introduce intervention 5 mins Goals and scope Q Review Caregiver Notebook 75 mi ns Q Introduce REACH II Caregiver Network and install screenphone 30 min Q Introduce on line social support group 10 mins Q Ask CG to tell story and review Risk Priority Worksheet 20 30 mins Experience of caregiving When did dementia begin How did CG know How did become caregiver Q Obtain closure to session 5 10 mins Summary of session Set date and time for next session Ask CG to review CG Notebook Review caregiver networ
12. CG that CG Notebook may have tips related to target behavior 3 Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 27 Session 9 Week 16 Phone Session Scheduled Date Materials Needed Session Activities Date Notes OUOOOCOOOD D D Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form Stress Diary Negotiation script Identifying Pleasant Events My List of Pleasant Events Form My Pleasant Event This Week OR Three Key Steps for Managing Your Mood Home Practice Practicing a Thought Record Refer to decision rules if CG did not try or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Reinforce participation in social support groups Review modify relevant prescriptions and well being module techniques provided in previous sessions Review modify Target behavior 2 Review modify well being module 2 either pleasant events or mood management component 2 Obtain closure to session Summary of what was accomplished in session Set date and time f
13. DESCRIPTION OF REACH II INTERVENTION OVERVIEW 1 Overview The REACH II intervention is multi component involving various treatment modalities and a range of strategies and techniques to address five potential areas of risk in caregiving safety social support problem behaviors emotional well being self care and preventive health behaviors The basic delivery elements of the intervention are as follows Q Q Q Intervention occurs over 6 months There are 9 home sessions 112 hours in length and 3 telephone sessions up to 1 2 hours for a total of 12 sessions Caregivers CG receive the REACH II Caregiver Network CTIS Computer Telephone Integration system a telephone based system that enables caregivers to access basic information and referral and tips on different aspects of caregiving The system is also used by the interventionist to reinforce in home training sessions Caregivers receive a Caregiver Notebook that contains educational information about dementia taking care of oneself safety and other relevant areas of caregiving as well as other written materials that the interventionist provides during in home sessions see section 5 for table of contents of notebook The notebook serves as a tool to organize intervention materials and as a resource guide for the CG to use during and after intervention Interventionist reviews specific issues related to safety and caregiver health practices using education mate
14. HECKLIST OVERVIEW Session Week Scheduled Actual Type Scheduled Actual Date Actual Date Type Date No more than 15 actual contacts in these two columns 1 1 Home 2 2 Home 3 3 Home 4 4 5 Home 5 6 7 Home 6 8 9 Home 7 11 Phone 8 13 14 Home 9 16 Phone 10 17 18 Home 11 20 Phone 12 21 22 Home Substitution Rules The program is designed with 9 home sessions and 3 phone sessions An interventionist can replace up to two phone sessions with home sessions or two home sessions with phone sessions for a range of 7 home sessions and 5 phone sessions to 11 home sessions and 1 phone session The judgment of the interventionist and research team is to be used to substitute sessions However general rules for substitution include Home sessions can be increased if the caregiver is distressed or if the interventionist needs to introduce a new prescription Phone sessions can be increased if the caregiver is unavailable for one month the caregiver cancels two contacts or if the purpose of the session can be easily accomplished in a phone call There should be no more than 15 actual contacts Well being and problem solving activities are BEST initiated on home visits with follow up activities related to these modules during phone visits Possible exceptions to this rule would include working with a bright motivated caregiver who would be willing and able to have a
15. ake prescription to be modified for next visit 5 Review modify stress management techniques stretching music signal breath Discuss problems and successes Review home practice Identify potential barriers Problem solve solutions Review and reinforce use of techniques 6 Introduce target behavior 2 use active teaching techniques and provide written behavioral prescription Review behavioral prescription Assess caregiver s responsiveness Provide examples for use Demonstrate active techniques Problem solve barriers Encourage use of Weekly Recording Form 7 Introduce well being module 2 component 1 pleasant events or mood management 30 minutes NIA NINR REACH II All Rights Reserved V1 0 6 1 02 12 Describe technique Complete tension rating before and after practice Practice Identify barriers to practice Encourage use of techniques Encourage use of stress diary 8 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and stress management techniques Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG Session 7 Phone Visit Week 1 ale 4 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in
16. aregiving and encouragement and praise of the caregiver Session 2 Home Visit Week 2 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure At the beginning of each session the interventionist reestablishes contact with the caregiver and continues the process of rapport building This is not necessarily a problem identification request but rather a human to human interaction If any special activities such as trips parties visits were mentioned at the last visit the interventionist can inquire about them The interventionist can also ask the caregiver how he she has been doing since the last visit and provide an opportunity for the caregiver to identify any new or pressing issues or concerns The interventionist then provides an overview of what will be covered and how during the session NIA NINR REACH II All Rights Reserved V1 0 6 1 02 5 2 Review and practice use of the REACH II Caregiver Network The interventionist and caregiver should practice use of the REACH II Caregiver Network If needed the caregiver will be rated on the CG Network Training Observation Checklist or take the CG Network Training Questionnaire The Family Respite Enrollment Form should be also be completed 3 Inform CG about social support group initial meeting time If the social support group has been set up the interventionist will inform the caregiver If not the inte
17. articipation in REACH II has ended To accomplish this the Interventionist should review and reflect on what was covered during the intervention Review the components of the Intervention by briefly discussing each area of emphasis Talk about what the caregiver has learned and help them to integrate their knowledge Remind the caregiver that dementia is a progressive illness which will present many new challenges to them as time goes by Encourage the CG by reminding them that the knowledge and skills that they have gained will help the next time a problem arises Reinforce to the CG that they are a wonderful caregiver and praise them for having increased their skills to be an even better caregiver There are several things to be aware of during the closure session in order to make it productive and beneficial Be careful not to sound as if you are quizzing the CG Instead you should engage them in a conversation Having the closure worksheet completed before the closure session will give you a chance to think about what you covered with the CG and will make it easier for you to review these points rather than asking the CG to recall them for you Stay focused By this session the Interventionist and the CG may be very comfortable with one another which can lead to the CG becoming chatty Remember that you are the professional and in control of the session Keep the CG focused by casually bringing the CG back to topic e Don t get bo
18. at baseline interview or at first or second intervention visit or caregiver indicates risks identified at baseline were resolved 1 Use general probe question Are there things that bother you about caregiving or things that you would like to learn about 2 If no response then use more specific probes listed below until receive a yes response then go to 3 If no response to all probes go to 4 Are there things that bother you or things you would like help with related to your CR s loved one s behaviors or need for assistance with everyday activities Are there things that bother you about friends or family or not being about to take care of yourself or everyday chores Are there things that worry you about the safety of CR 3 If yes revisit relevant item s on risk appraisal and follow standard procedure 4 If no response to probes in first second session then a Review general educational materials provided in sessions 1 and 2 b Review REACH II Caregiver Network G Discuss support group participation 5 If no response to probes in second third session then a Review educational material b Ask if using REACH II Caregiver Network and have any questions 6 If no response to probes by third attempt session 3 or 4 then a Use one or more of the following probes Part of this project involves helping caregivers learn different strategies and what works best Would you share with us what works best for
19. cial support groups 4 Review modify relevant prescriptions and well being module techniques provided in previous sessions 5 Discuss any final issues of caregiver 6 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behaviors and well being techniques Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG Session 12 Home Visit Week 21 22 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure In this session the interventionist must obtain closure with the caregiver The interventionist reviews everything that has been accomplished and reinforces the use of the Caregiver NIA NINR REACH II All Rights Reserved V1 0 6 1 02 17 Notebook as a resource to address newly emerging problem areas or concerns The interventionist also assures that the caregiver has appropriate referral information e g emergency numbers Alzheimer Association and AAA telephone numbers 2 Review target behavior problem areas covered and strategies that worked 3 Review well being modules and strategies that worked 4 Validate CG use of strategies 5 Encourage use of available formal and informal support services 6 Obtain closure Suggest continued use of CG Notebook Remind caregiver that interviewer will
20. e hearing or vision 8 Conduct brainstorming session with CG 9 Introduce well being module 1 stress management component 3 stretching 30 minutes Describe technique Complete tension rating before and after practice Practice Identify barriers to practice Encourage use of techniques Encourage use of stress diary Provide support and encouragement to CG NIA NINR REACH II All Rights Reserved V1 0 6 1 02 11 10 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 1 and stress management techniques Reinforce use of Caregiver Network and social support groups Remind CG that CG Notebook may have tips related to target behavior 2 Provide support and encouragement to CG Session 6 Home Visit Week 8 9 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure 2 Check in with CG about use of Caregiver Network resource guide information tips 3 Reinforce social support groups 4 Review modify target behavior 1 Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies T
21. e intervention back to the caregiver s issues and experiences The interventionist will use open ended probes such as Experience of caregiving When did dementia begin How did CG know How did become caregiver An important part of this session is a review of areas of caregiving concerns as identified at baseline safety health stress behavior training support Detailed guidance for presentation of the high moderate and low risk items to the caregiver is found in Section 4 Specific Guidelines for use of Risk Priority Worksheet The interventionist engages the caregiver in a discussion of key areas and explains how each will be addressed in future intervention visits relating the areas to the caregiver s story The interventionist asks the caregiver to think about the particular areas to target in the intervention The interventionist explains that the focus of the next session will be on home safety and the caregiver s own health care needs and physical well being 6 Obtain closure to session 10 minutes Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to review CG Notebook Review Caregiver Network user help card Encourage use of Caregiver Network Provide support and encouragement to CG Closure provides a means of summarizing what happened reinforcing lessons learned and what the caregiver should practice It should always end with recognition of the difficult task of c
22. egiver Guide Booklet that is in the CG Notebook to learn about strategies specific to the problem area The interventionist also informs the caregiver that s he will develop a specific set of strategies a prescription Behavioral Prescription Form described in Section 8 based on the information provided by the caregiver Upon return to the office the interventionist meets with the research team refers to the resource materials general prescriptions see Appendix A REACH Web page for other site prescriptions and the set of educational materials orochures each site will have to develop a prescription that is tailored to the particular situation of the caregiver 7 Discuss effects of stress The interventionist discusses the effects of stress including physical blood pressure immune system psychological irritability frustration depression anxiety and social relationship strain social isolation The interventionist has handouts to give the caregiver 8 Introduce well being module 1 stress management component 1 signal breath 30 minutes Describe technique Complete tension rating before and after practice Practice Identify barriers to practice Encourage use of techniques Encourage use of stress diary The interventionist then introduces signal breath the first of three components of the first well being module stress management The interventionist discusses how to do the signal breath has the care
23. ere does the behavior happen Who is around when the behavior occurs What have you tried Additional information such as physical problems like hearing or vision After the interventionist and caregiver negotiate first target behavior the interventionist asks general open ended probes of the caregiver to identify the antecedents behavior and consequences of the identified problem area The caregiver s story will also be important in this NIA NINR REACH II All Rights Reserved V1 0 6 1 02 7 discussion Guidelines on the use of problem solving techniques such as the ABCs of Problem Behaviors and Brainstorming are provided in Section 8 of the MOP One area of concern is that the interventionist and caregiver develop concrete realistic expressions of the caregiver s expectations Goals may be problem focused goals actual changes in the targeted problem behavior or emotion focused goals managing the emotions or feelings of the caregiver that are linked to the target problem behavior appraisal Sometimes the problem may not be a care recipient issue but rather something like communication and the interventionist will need to be flexible in the ABC questioning as all questions may not be germane 6 Conduct brainstorming session with CG Caregiver and interventionist brainstorm solutions and rule out any unacceptable solutions The interventionist suggests that the caregiver refer to the Caregiver Network features and the NIA Car
24. f you are finding it helpful Refer caregiver to REACH II Caregiver Network to find AAA Alzheimer s Association etc lil A problem is identified but caregiver chooses not to work on it 1 2 If identified problem is an alert item then implement alert protocol using alert script If identified problem is not an alert item then hand them appropriate educational material orescription but do not go beyond that Here is some material that you might find useful Please let me know if at any time you want to learn more about this issue IV Caregiver identifies too many problem areas 1 2 Prioritize items alert items first Negotiate to help identify most important area for caregiver to work on Refer caregiver to support group and REACH II Caregiver Network features to obtain information about select problem areas Near end last two sessions of intervention provide caregiver with relevant education material for remaining issues NIA NINR REACH II All Rights Reserved V1 0 6 1 02 33 Vi Vil VIII Determining how to move on to the next problem area 1 Using Intervention Notes Form evaluate caregiver progress in effectively using strategies and or if problem has been resolved Refer to Section 8 Problem Solving for protocol If no progress use no progress script and move on to the next problem area and periodically check in with caregiver as to status of problem Involvement of other
25. family members in intervention 1 Other family members can be involved in an intervention session if this is initiated by the caregiver The interventionist would document other family involvement on the Delivery Assessment Form 2 A family member may share their CTIS pin with other family members if they choose However the telephone must remain in the home of the primary caregiver REACH II Caregiver Network CTIS issues 1 A lost or misplaced CTIS phone will not be replaced 2 The grant will pay for the purchase of a tonal phone for caregiver if they only have a pulse Drop out status from Support Group 1 A group session will be conducted regardless of the number of caregivers attending Guidelines for working with a caregiver with low literacy 1 Provide behavioral prescriptions using bullet points and minimal wording 2 Use demonstration more and review in more detail pertinent written materials 3 Provide the CG Notebook but indicate that each section is discussed on the CTIS show caregiver how to access specific information found in Notebook on the CTIS 4 Identify other family friends neighbors who may help with reading material if appropriate NIA NINR REACH II All Rights Reserved V1 0 6 1 02 34 CLOSURE SESSION Goal of the Closure Session The primary goal of the closure session is to praise caregivers for their accomplishments and encourage them to continue the skills they have learned after their p
26. formance using The REACH II CG Network Training Observation Checklist form The caregiver also completes the REACH II Caregiver Network Caregiver Training Questionnaire Introduce On Line Support group 10 minutes The interventionist explains that an important feature of the intervention is an opportunity to participate in support groups see support group introduction script Section 4 of the REACH II Caregiver Network User Manual The support groups will occur via the network so the caregiver can participate without having to leave home Each group will involve information on a significant topic and opportunities for exchange of information and experiences among participating caregivers see Section 7 and Section 4 of the REACH II Caregiver Network User Manual for details on support group topics and importance of caregiver participation The interventionist will provide information on structure and schedule identify group language NIA NINR REACH II All Rights Reserved V1 0 6 1 02 4 preference and time preference and complete support group enrollment form This form must be faxed to the coordinator at the University of Miami 5 Ask CG to tell story and review risk priority worksheet 20 30 minutes The interventionist will ask the caregiver about experiences as a caregiver This information will be used to lead in and to reinforce the items from the Risk Prioritization Worksheet as well as to relate each of the other components of th
27. gged down on one topic As the Interventionist you may have spent a lot time ona particular component such as safety or CG well being During the review do not spend too much time in one area but rather highlight points the CG should remember and emphasize their value Encourage the caregiver to use the core skills and strategies This will need to be individualized based on your past interactions with the caregiver For example If you have a caregiver who did not use the Health Passport point out that although they did not use it during the project there are other ways to utilize the passport One example might be having it available for another person to access who cares for the CR occasionally Also the information in the passport can be helpful in an emergency situation Using the Closure Session Worksheet The Closure Session is guided by the attached worksheet As the Interventionist there may be parts of the program you feel the CG should remember Use the worksheet to write these ideas down Have your ideas and suggestions already noted on the worksheet prior to the closure session and add to them as you discuss the topics with the CG Introduction Inform the CG that this is the last session and you will be reviewing the materials that were discussed during the project You may say something like Today is our last session and what we will do is review what we have accomplished over the past six months Caregiver Notebook Summa
28. giver do a tension rating before and after helps the caregiver to identify barriers to practice and encourages the use of a stress diary In each subsequent session the interventionist reviews and reinforces use of techniques The interventionist also refers to the Stress Management feature of the Healthy Living Menu on the Caregiver Network this feature reviews the signal breath technique 9 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice health and safety tips Ask CG to review practice stress management techniques introduced NIA NINR REACH II All Rights Reserved V1 0 6 1 02 8 Inform CG that next session will focus on strategies for managing the target behavior and suggest they should review NIA Caregiver Guide booklet in CG Notebook if relevant to their particular target behavior Refer caregiver to information tips feature of Caregiver Network that is relevant to problem behaviors highlight relevant resource information tip section Provide support and encouragement to CG Session 4 Home Visit Week 4 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of REACH II Caregiver Network resource guide information tips Remind CG when social support groups will begin or encourage attendance Review use of Health passport
29. he caregiver can post those most helpful ideas somewhere accessible Once you have completed the note card the caregiver suggest that the caregiver place the note card in a place that is accessible to the caregiver such as on the refrigerator near the phone near the bed in the Caregiver Notebook pocket etc so he or she can refer to it when needed Review how this technique of using a note card for brainstorming and identifying strategies can be used in the future Do not use the note card with the caregiver The Intervention Review is enough review and information for the caregiver NIA NINR REACH II All Rights Reserved V1 0 6 1 02 37 Kea For Enhancing Alzheimer s Caregiver Health INTERVENTION REVIEW SAFETY Here s some space to list safety issues we discussed during our time together Alzheimer s disease affects your CR s ability to know the difference between what s harmful and what s not Because of this refer to your Caregiver Notebook when checking your home for safety issues HEALTH Here s some space to list health issues we discussed during our time together Remember the Health Passports They can be very useful when keeping track of both you and your CR s health care needs It is very important for you to maintain your own health in order to continue providing the best care for your CR NIA NINR REACH II All rights reserved V1 0 6 1 02 38 CAREGIVER WELL BEING Here s some space
30. ist explains its purpose as a resource and as an organizing tool in which other materials will be placed The interventionist shows each section of the notebook briefly explains its importance and which sections will be reviewed in more depth in future sessions The interventionist helps the caregiver identify a location in the home where the Notebook will be kept for reference in future sessions See Section 5 for contents and more detailed discussion of key information interventionist needs to impart to caregiver Introduce the REACH II Caregiver Network and Install the Screenphone 30 minutes The interventionist introduces the REACH II Caregiver Network and installs the screenphone It is important for the interventionist to demonstrate and practice each feature of the network with the caregiver and stress the benefits of using the network The interventionist should ask the caregiver to think about how they might like to use the respite feature of the network and of some family members or friends they might like to ask to develop respite messages The interventionist reviews the Help card in the Caregiver Notebook The Help Card provides basic directions for use of the system see Section 6 and The REACH II Caregiver Network User Manual for details and protocol for implementing the system and training caregivers Following the demonstration and practice the interventionist observes the caregiving using the network on their own and rates their per
31. k user help card Encourage use of caregiver network Provide support and encouragement to CG NIA NINR REACH II All Rights Reserved V1 0 6 1 02 20 Session 2 Week 2 Home Session Scheduled Date Materials Needed Session Activities Date Notes Q Oooo D PI form directions and phone number Risk Priority Worksheet DA Intervention Note Form Introductory guiding scripts Caregiver Network Training Observation Checklist or Questionnaire Extra Notebook in case caregiver s is lost or misplaced Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Review practice use of REACH II Caregiver Network Inform CG of initial support group meeting time Ask CG if have questions about CG Notebook Review Safety material alerts first if appropriate 30 min Introduce health issues amp Health Passport 30 min Introduce physical well being issues and resources Healthy Lifestyle pamphlet if appropriate Caregiver Network information tips relevant to self care Obtain closure to session Summary of what was accomplished Set date and time for next session Ask CG to practice safety and health tips identified in session Reinforce caregiver network use Provide support and encouragement to CG NIA NINR REACH II All Rights Reserved V1 0 6 1 02 21 Session 3 Week 3
32. llenges If new challenges arise remember to ask yourself a few questions such as e When does the problem occur e How often does it occur e Where does the problem occur e What would make the problem better NIA NINR REACH II All rights reserved V1 0 6 1 02 40
33. n It serves as an on going record of the particular targeted area s addressed and specific strategies introduced in each session and the level of enactment of the caregiver The interventionist also records the status of each targeted area resolved continues but progress made etc which helps the interventionist determine when to stop with a particular problem area and target a new area of concern The form is reviewed at weekly supervisory sessions NIA NINR REACH II All Rights Reserved V1 0 6 1 02 2 Social Support Form This form is used to enroll a caregiver into a social support group session See Section 7 of MOP and Section 5 of REACH II Caregiver Network Manual Social Support Contact Form This form is used by the group facilitator for each of the 5 support group sessions to record delivery aspects See REACH II Caregiver Network Manual REACH Il Caregiver Network CTIS Enrollment Form See Section 6 Refer to Appendix C for a complete listing of the primary forms used ABCs of Problem Behaviors This form serves as a guide to the ABC problem solving process It is used by the interventionist to work with the caregiver to identify the target behavior and its characteristics Behavioral Prescription Form This form is used to develop specific strategies to address a targeted behavioral problem The prescription is reviewed with the caregiver using active engagement e g demonstration role play modeling and is gi
34. n Note Form Relevant Prescription Weekly Recording Form Stress Diary Negotiation script Identifying Pleasant Events My List of Pleasant Events Form My Pleasant Event This Week OR Three Key Steps for Managing Your Mood Home Practice Practicing a Thought Record Refer to decision rules if CG did not try or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Reinforce participation in social support groups Review modify Target behavior 1 Review modify stress management module components signal breath music stretching Introduce Target behavior 2 use active teaching techniques and provide written behavioral prescription to CG Introduce well being module 2 pleasant events or mood management component 1 30 mins Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and stress management techniques Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 25 Session 7 Week 11 Phone Session Scheduled Date
35. ng module 2 pleasant events or mood management session component 2 Discuss problems and successes Review home practice Identify potential barriers Problem solve solutions Review and reinforce use of techniques 7 Introduce target behavior 3 use active teaching techniques and provide written behavioral prescription Review behavioral prescription Assess caregiver s responsiveness Provide examples for use Demonstrate active techniques Problem solve barriers Encourage use of Weekly Recording Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 16 8 Introduce well being module 2 pleasant events or mood management session component 3 Describe technique Complete tension rating before and after practice Practice Identify barriers to practice Encourage use of techniques Encourage use of stress diary 9 Obtain closure to session Briefly review what was accomplished in Session Set date time for next session Ask CG to practice strategies related to target behavior 3 and well being techniques Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG Session 11 Phone Visit Week 20 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure 2 Check in with CG about use of Caregiver Network resource information tips 3 Reinforce participation in so
36. nist to a Identify particular safety risk areas from which to highlight for the CG the most relevant safety education material in the Caregiver Notebook a Identify particular risk areas in self health care in order to highlight the most relevant sections of the CG Health Passport material when reviewing these materials with the CG a Identify the specific problem behaviors and areas of social support and communication to target a Integrate use of reduction techniques to address target areas a Identify areas of well being of most distress to the caregiver to help inform which modules are introduced e g mood management or pleasant events 2 Structure of Each Intervention Session Each intervention session is structured similarly as follows Q Q Prior to conducting the session the interventionist reviews Risk Priority Worksheet RPW see Section 4 and intervention notes With the caregiver the interventionist first provides brief explanation of the particular focus of the session and how it will be structured Interventionist next reviews use of REACH II Caregiver Network CTIS and troubleshoots if CG has difficulty or reinforces how it may be helpful to CG Interventionist checks in with CG about their enrollment and participation in social support groups Interventionist checks in with CG about strategies educational materials offered in the previous session evaluates if CG has specific questions concerns about the mate
37. nsure consistent application of intervention procedures across sites Web based prescriptions Each new prescription developed by an interventionist will be posted on a secured password protected section of the REACH II web site Interventionists will be able to access and use prescriptions developed at other sites for an identified target behavior On site educational resources including REACH intervention material NIA NINR REACH II All Rights Reserved V1 0 6 1 02 3 Session by Session Description Session 1 Home Visit Week 1 1 Introduce intervention 5 minutes The goal of the first home visit is to introduce the purpose goals and scope of the intervention see guiding script and begin the process of building rapport with the caregiver It is important for the interventionist to set a comfortable and relaxed tone and avoid the use of scientific jargon and research vocabulary The interventionist must strike the right balance between active and empathetic listening and structuring the session to accomplish the session activities For the most part activities will occur in the order presented here However flexibility is allowed in changing the order of presentation For example some caregivers may want to talk about their experiences and review risk areas first prior to learning about the REACH II Caregiver Notebook Review Caregiver Notebook 15 minutes The caregiver is provided the Caregiver Notebook The intervention
38. or next session Ask CG to practice strategies related to target behavior 2 and well being techniques Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 28 Session 10 Week 17 18 Home Session Scheduled Date Materials Needed Session Activities Date Notes OoOoOoooo Oo Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form Stress Diary The Pleasant Event We will Do this Week OR Home Practice Practicing a Thought Record 5 columns Refer to decision rules if CG did not try or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Reinforce support group participation Review modify relevant prescriptions and well being module techniques provided in previous sessions Review modify Target behavior 2 Review modify well being module 2 either pleasant events or mood management component 2 Introduce Target behavior 3 use active teaching techniques and provide written behavioral prescription to CG Introduce well being module 2 either pleasant events o
39. r mood management component 3 Obtain Closure Summary of what was accomplished in session Set date time for next session Ask CG to practice strategies related to target behavior 3 and well being techniques Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 29 Session 11 Week 20 Phone Session Scheduled Date Materials Needed Session Activities Date Notes OUOCOCOCOCLUOD Ovo Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form Stress Diary The Pleasant Event We will Do this Week OR Home Practice Practicing a Thought Record 5 columns Refer to decision rules if CG did not try or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Reinforce participation in social support groups Review modify relevant prescriptions and well being module techniques provided in previous sessions Discuss any final issues of caregiver Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to p
40. ractice strategies related to target behavior 3 and well being techniques Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 30 Session 12 Week 21 22 Home Session Scheduled Date Materials Needed Session Activities Date Notes Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Additional referral phone numbers if appropriate Closure script Oooooo D Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Review target behavior problem areas covered and strategies Review well being modules and strategies Validate CG use of strategies Encourage use of available formal amp informal support services Obtain closure Suggest continued use of CG Notebook Remind caregiver that interviewer will remove screenphone at next visit Review referral numbers Thank caregiver for participation in study Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 31 Intervention Delivery Decision Rules l If caregiver does not identify any risk e g no risks identified
41. rial determines if CG is using strategies and if problem is resolved or continues Interventionist obtains closure to each session by a establishing date time of next session b briefly reviewing problem area s addressed and primary strategies offered in the session c briefly reviewing strategies caregiver agrees to try prior to next intervention contact and d helps caregiver problem solve when and how to practice implement selected strategies At conclusion of session interventionist completes the Delivery Assessment Form and Intervention Note Form described below see forms in Appendix 3 Forms Used by Interventionist The interventionist must complete different forms throughout the intervention below is a brief description of key forms For a complete review see forms in Appendix C or REACH II Caregiver Network Manual as indicated a Delivery Assessment Form This form must be completed within 24 hours of completion of each intervention session telephone or home visit The interventionist records delivery characteristics as well as specific information regarding the mechanisms of delivering the intervention e g didactic role play etc receipt and enactment Completed forms must be submitted to the Project Director weekly and will be entered using the POP system within 2 weeks from intervention session a Intervention Note Form This form is completed during or immediately following the completion of an intervention sessio
42. rial provided in Notebook Interventionist provides specific behavioral prescriptions on targeted care recipient CR behaviors and or issues related to communication and social support prescriptions refer to 1 to 2 page strategies that are action oriented and individualized to address a particular problem area Interventionist provides training in a stress management module composed of three different stress reduction techniques Caregivers participate in 5 structured tele support group sessions using the REACH II Caregiver Network in which they receive topical information by an interventionist and have opportunities to share experiences and areas of concern with other caregivers in the study The intervention is customized to those areas of risk that are identified by the caregiver at the baseline interview To assist in tailoring the intervention interventionists are provided the following information from the REACH II baseline interview e Caregiver and care recipient demographics CG age race gender language preference relationship CG Risk appraisal see Section 4 e CG response to the Revised Memory and Problem Behavior Checklist RMBPC frequency of occurrence of 24 problem behaviors and level of caregiver upset CR Personal Appearance Index and Home Environmental Assessment CG CES D Score CR MMSE Score CG Literacy Level NIA NINR REACH II All Rights Reserved V1 0 6 1 02 1 This information is used by the interventio
43. ription to be modified for next visit 6 Review modify well being module 2 pleasant events or mood management component 2 Discuss problems and successes Review home practice Identify potential barriers Problem solve solutions NIA NINR REACH II All Rights Reserved V1 0 6 1 02 15 Review and reinforce use of techniques 7 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and well being techniques Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG Session 10 Home Visit Week 17 18 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure 2 Check in with CG about use of Caregiver Network resource guide information tips 3 Reinforce support group participation 4 Review moditfy relevant prescriptions and well being module techniques provided in previous sessions 5 Review modify target behavior 2 Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies Take prescription to be modified for next visit 6 Review modify well bei
44. rize the CG notebook and encourage them to use it after their participation is completed Discuss ways the CG can continue using the notebook Examples include e A place to organize new information such as brochures information on new medications articles on new Alzheimer s research e Share with family and friends who want to know more about Alzheimer s disease NIA NINR REACH II All Rights Reserved V1 0 6 1 02 35 Safety Review areas of safety that were discussed Refer to the RPW s Use the worksheet to write down important information that was brought out during the intervention Remind CG where the safety information can be found in the CG notebook Remind CG that the key to safety is PREVENTION You may say something such as When considering safety think ahead You want to prevent accidents before they occur Health Discuss health issues Refer to RPW s and the Health Passport Use the worksheet to write down important information that was brought out during the intervention Encourage the CG to remember the importance of their health and thinking prevention here as well Caregiver Well Being Review the Well Being Modules and reinforce the value of continuing to incorporate the techniques into daily life e Relaxation Techniques Discuss which technique CG liked best and remind them of the value of the technique Encourage the CG to continue that technique before or during a stressful situation e Pleasant Events
45. rventionist should reinforce the use of the social support groups when they start 4 Ask caregiver if have questions about CG Notebook 5 Review safety material including alerts if appropriate 30 minutes The interventionist begins with an in depth presentation of the safety information in the Caregiver Notebook The interventionist refers to the Risk Priority Worksheet RPW to identify particular areas related to safety risk for the caregiver If there are alert items indicated driving weapon in home these are addressed first and the educational materials in the Notebook are reviewed carefully Otherwise the interventionist addresses other areas identified on the RPW If appropriate specific strategies may be highlighted for the caregiver as a way of emphasizing their importance and encouraging the caregiver to practice The interventionist identifies specific strategies the caregiver agrees to practice in the subsequent two sessions The interventionist will refer back to these identified strategies and inquire if the caregiver attempted them and the outcome The interventionist should also refer to the safety feature caregiving tips submenu of the Caregiver Network 6 Introduce health care issues and Health Passport 30 minutes The interventionist introduces the health passport material emphasizing the importance of taking care of oneself as a caregiver referring to the RPW to highlight caregiver specific health related issues The
46. se of stress management techniques NIA NINR REACH II All Rights Reserved V1 0 6 1 02 9 7 Introduce well being module 1 stress management component 2 music 30 minutes Describe technique Complete tension rating before and after practice Practice Identify barriers to practice Encourage use of techniques Encourage use of stress diary Refer to stress management feature on the Healthy Living feature of the Caregiver Network The interventionist follows the same format asking the caregiver to do a tension rating before and after the practice identify barriers and practice at home The interventionist discusses the use of music to decrease stress and the caregiver identifies music that is soothing and relaxing 8 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 1 Ask CG to practice stress management techniques signal breath and music Encourage use of tracking forms Weekly Recording Form and Stress Diary Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG Session 5 Home Visit Week 6 7 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure 2 Check in with CG about use of Caregiver Network resource qguide information tips 3 Reinforce participation in social s
47. stion asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 26 Session8 Week 13 14 Home Session Scheduled Date Materials Needed Session Activities Date Notes OOUOCOCOOCLOD Oo Risk Priority Worksheet CG Notebook DA Form Intervention Note Form Relevant Prescription Weekly Recording Form Stress Diary The Pleasant Event We will Do this Week OR Home Practice Practicing a Thought Record 5 columns Refer to decision rules if CG did not try strategies or strategies did not work Q Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of caregiver network resource guide information tips Reinforce participation in social support groups Review modify relevant prescriptions and well being module techniques provided in previous sessions Review modify Target behavior 2 strategies Review modify well being module 2 either pleasant events or mood management component 1 Identify and initiate problem solving module with Target behavior 3 Introduce well being module 2 either pleasant events or mood management component 2 Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and well being techniques Remind
48. to list well being issues we discussed during our time together During our time together we discussed several different ways to manage your tension mood and emotions When you are faced with a difficult situation use Signal Breath Music or Stretching to help manage your emotions If applicable add statement about pleasant events and or mood management Also remember it is important to take time out for yourself by choosing a Pleasant Event you can do at least once a week Also remember it is important to continue with your thought record to help with Mood Management SOCIAL SUPPORT Here s some space to list social support issues we discussed during our time together Try to think creatively and entertain new possible sources for support Feel justified in asking your family friends church and other groups for help and take help when it is offered Contact the local Alzheimer s Association or the Area Agency on Aging for information on resources and services which may be helpful to you and your loved one e Alzheimer s of Central Alabama XXX XXX XXXX e Area Agency on Aging xxx XXX XXXKX NIA NINR REACH II All rights reserved V1 0 6 1 02 39 PROBLEM SOLVING Here s some space to list problem solving issues we discussed during our time together As a caregiver you may face many different challenges You area great problem solver and have already solved many of your caregiving cha
49. upport groups 4 Review modify target behavior 1 prescription Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies Take prescription to be modified for next visit At each session following the introduction of a prescription the interventionist asks Compared to when we started is the problem A lot worse A little worse The same A little better A lot better In general prescriptions are not stopped but are modified throughout the life of the project unless there is a rating of A lot worse for two sessions or there is marked increase in CR agitation or marked resistance to the prescription as a whole by the caregiver The interventionist assesses the caregiver s use of the solutions and strategies what was attempted what worked what did not and reviews any tracking forms filled out by the caregiver Together they evaluate the usefulness success of the solutions to answer two NIA NINR REACH II All Rights Reserved V1 0 6 1 02 10 questions How good was the caregiver s effort in the implementation of the prescribed strategies How good was the result The interventionist praises caregiver s efforts Based on these discussions new strategies are suggested and the prescription will be modified after the interventionist ret
50. urns to the office The modified prescription will be provided at the next visit 5 Review modify stress management techniques music and signal breath Discuss problems and successes Review home practice Identify potential barriers Problem solve solutions Review and reinforce use of techniques The interventionist and caregiver discuss problems and successes with the stress management techniques They review home practice identify potential barriers and problem solve solutions 6 Identify and initiate problem solving module with Target behavior 2 if appropriate Review Risk Priority form Jointly decide priority In general new prescriptions are begun two sessions after the start of the previous prescription and the caregiver expresses interest in working on another problem and the interventionist believes the other intervention efforts are not too burdensome It is important to note that not all caregivers will be ready for a second behavioral prescription at this time 7 Complete ABC s of Problem Behaviors Probes for the ABC Process Form for Target behavior 2 Refer to Section 8 What is the behavior Why is this behavior a problem How would you like this behavior to change Why do you think this behavior happens When does the behavior happen Where does the behavior happen Who is around when the behavior occurs What have you tried Additional information such as physical problems lik
51. use of REACH II Caregiver Network resource guide information tips Reinforce participation in social support groups Review modify Target behavior 1 prescription Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies Take prescription to be modified for next visit Review modify stress management techniques music and signal breath Identify and initiate problem solving approach with Target behavior 2 if appropriate Introduce well being module 1 component 3 stretching 30 min Obtain closure to session Summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 1 and stress management techniques Remind CG that CG Notebook may have tips related to target behavior 2 Reinforce use of caregiver network and social support groups Provide support and encouragement to CG If problem resolution question asked of CG transfer score to DA Form NIA NINR REACH II All Rights Reserved V1 0 6 1 02 24 Session 6 Week 8 9 Home Session Scheduled Date Materials Needed Session Activities Date Notes OUOOCOCOUOCOD D Risk Priority Worksheet CG Notebook DA Form Interventio
52. ven to the caregiver to keep in the CG notebook see Section 8 4 Resources used by Interventionist Throughout the intervention the interventionist will need to refer to and use several different types of resources in order to systematically and consistently tailor components of this intervention to the caregiver s unique constellation of risk areas The resources used are as follows Q Weekly on site supervisory sessions Interventionists will meet weekly with on site members of the research team At these meetings each caregiver case will be discussed and guidelines reinforced as to developing appropriate prescriptions Appendix A of MOP This appendix contains a summary table which serves as a quick and easy reference for interventionists It indicates the materials that are available for each risk appraisal and RMBPC item For each item the table indicates whether there exists a specific published educational resources available on site the prescriptions available the specific REACH II Caregiver feature that addresses the item the specific well being module to use and whether there is a relevant social support group session Appendix A also contains resource prescriptions from which interventionists can develop a target behavioral prescription Bi monthly tele conference sessions These sessions will involve interventionists from each research site the purpose of which will be to troubleshoot and review basic procedures and to i
53. view modify target behavior 2 Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies Take prescription to be modified for next visit Review modify well being module 2 either pleasant events or mood management component 1 Discuss problems and successes Review home practice Identify potential barriers Problem solve solutions Review and reinforce use of techniques Identify and initiate problem solving module with Target behavior 3 if appropriate Review Risk Priority form Jointly decide priority Use open ended probes see session 3 to identify specifics of problem area If no problem area then ask probes to identify if appropriate to introduce another well being module Complete ABC s of Problem Behaviors Probes for the ABC Process Form for Target behavior 3 Refer to Section 8 What is the behavior Why is this behavior a problem How would you like this behavior to change Why do you think this behavior happens When does the behavior happen Where does the behavior happen Who is around when the behavior occurs What have you tried Additional information such as physical problems like hearing or vision NIA NINR REACH II All Rights Reserved V1 0 6 1
54. with CG about use of Caregiver Network resource information tips Reinforce participation in social support groups Review modify relevant prescriptions and well being module techniques provided in previous sessions Review modify Target behavior 2 Rate problem Assess CG s use of solutions and strategies Determine what was attempted what worked what did not Review any tracking forms filled out by the caregiver Evaluate usefulness success of solutions Praise caregiver s efforts Suggest new strategies Take prescription to be modified for next visit 1 Review modify well being module 2 either pleasant events or mood management component 1 Obtain closure to session Provide brief summary of what was accomplished in session Set date and time for next session Ask CG to practice strategies related to target behavior 2 and well being techniques Reinforce use of Caregiver Network and social support groups Provide support and encouragement to CG NIA NINR REACH II All Rights Reserved V1 0 6 1 02 13 Session 8 Home Visit Week 13 14 1 Introduce session Check in with CG as to how they are doing Provide overview of purpose of this session and its structure Check in with CG about use of Caregiver Network resource information tips Reinforce participation in social support groups Review modify relevant prescriptions and well being module techniques provided in previous sessions Re
55. with the CG OPTION 1 1 Interventionist uses a 3 by 5 or 5 by 7 note card for discussing a future problem specifically or generally 2 Interventionist writes the caregiver identified problem down on the note card if applicable 3 The interventionist will then ask the caregiver to think of the strategies that he or she identified as helpful to him or her and how those strategies may help this new potential concern NIA NINR REACH II All Rights Reserved V1 0 6 1 02 36 4 7 OPTION 2 1 3 OPTION 3 The interventionist assists caregiver in reviewing strategies and making suggestions about how to deal with this future problem or highlighting strategies the interventionist felt worked well for the caregiver Together the interventionist and caregiver will come up with ideas that can be written down in a few phrases or sentences on the note card Again the interventionist should be the one to write down the strategies Once you have completed the note card the caregiver suggest that the caregiver place the note card in a place that is accessible to the caregiver such as on the refrigerator near the phone near the bed in the Caregiver Notebook pocket etc so he or she can refer to it when needed Review how this technique of using a note card for brainstorming and identifying strategies can be used in the future Interventionist uses a 3 by 5 or 5 by 7 note card for recopying strategies from the Intervention Review so t
56. you in keeping your loved one safe How do you keep in touch with your family and friends or how do you make time for yourself 7 How do you handle difficult behaviors such as repetitive questioning How do you keep from feeling overwhelmed b Use active listening and validation C When possible ask CG to show what they do then go to relevant prescription and highlight other strategies and suggest they may want to try these other approaches as well NIA NINR REACH II All Rights Reserved V1 0 6 1 02 32 d Ask caregiver if you can come back to home to check in on them If yes then repeat probes for 6 above ll If caregiver has a problem that is not identified on the risk appraisal or other forms ds See if problem fits easily with existing prescription items If not bring case back to supervisory meeting and work on another problem first understand this issue is very important to you If problem does not fit or there is no prescription indicate to caregiver This is not part of our intervention We can not help you with this but others may be able to Try to identify with caregiver a relevant resource for caregiver to follow with If problem is relevant to support group or REACH II Caregiver Network suggest those resources think you will find some help with this issue in your support group and on the REACH II Caregiver Network Try using those support resources and will check in with you to see i
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