Specific Objectives: (1) Identification of predictors of no-response to REACH VA and (2) development and pilot of a treatment designed for family caregivers who continue to experience clinically significant depression and burden following intervention. Relevance: Caregiving for individuals with dementia is an extremely stressful task with high levels of physical, mental and financial strain. Over the past 40 years, interventions have been developed to help caregivers cope with these stressors. However, outcome studies of even the most effective psychosocial interventions suggest that a large proportion of individuals continue to experience clinically significant symptoms post treatment. There is no known research on the potentially mutable factors that predict treatment outcome, nor interventions tailored to the needs of non-responders. Procedures to be Used: The project involves collecting data on predictors of response to the REACH VA intervention in order to develop an intervention tailored to the needs of non-responders. The proposed project utilizes rapid quality improvement and practical dissemination models for the development and piloting of the new intervention. Family caregivers of an individual with dementia will complete a 2-hour interview and questionnaires to obtain baseline information about themselves and their care-recipient. Participants will be provided with the REACH VA intervention and post-treatment will complete outcome measures to assess changes in symptoms. Participants who continue to experience significant distress following the interventions will be administered a semi-structured debriefing interview. As data is collected on predictors of treatment response, an expert panel will be utilized based on the identified significant predictors to develop a new intervention. They will also be involved in assistance with manual writing, training program development and adherence/competence measure development. The new intervention will be piloted on a total of 30 participants over the course of the project and data from the pilot will serve as the basis for an application for Investigator Initiated Research (IIR) funding for a Randomized Clinical Trial (RCT) of the newly developed intervention. Significance of Potential New Findings: The proposed project would (1) provide data to help predict response to treatment - lowering costs associated with providing ineffective interventions and (2) develop and pilot a new intervention designed to address the unique characteristics of non-responders. Short Term Career Goals: The data and newly developed intervention will serve as the basis for an application for HSR&D Investigator Initiated Research (IIR) Funding to test the effectiveness of the intervention through a randomized clinical trial and explore potential dissemination of the new intervention. I plan to submit this award 3 years into the CDA award period. The Merit Review award will allow me to begin a career as an independent investigator in psychosocial treatment development and outcome research. Long Term Career Goals: Ultimately, I hope to apply the knowledge obtained from this intervention to other populations of veterans who do not respond to psychosocial treatments. This avenue of research could provide opportunities for the development of innovative interventions, further understanding of variables relevant to treatment outcome, and opportunities to train both clinicians and researchers in this area. Research Career Development Plan: The Research Plan is closely integrated with the Career Development Plan such that skills obtained through mentoring or formal didactics will be applied in the context of the project with increasing independence in the exercise of those skills over the course of the five-year project. Over the course of the award I will be provided with regular supervision from mentors who have extensive expertise in psychosocial intervention development and evaluation. Training is designed to lead to research independence focused on: (1) predictors of non-response and (2) intervention development.
The proposed CDA develops and pilots a treatment for the large proportion of family caregivers of individuals with dementia who do not respond to current treatment (>50%). Over the next 20 years, dementia caregiving responsibilities will primarily impact three groups relevant to VA: (1) families of veterans (2) veterans caring for a spouse (3) veterans caring for parents. In that time period, nearly 200,000 more veterans utilizing VA will be diagnosed with dementia (Krishnan et al., 2005). Additionally, veterans themselves serve as caregivers and as 73% of veterans are currently married, these veterans may take on the role of caregiver (NSV, 2001). Finally, adult children are the most common caregivers (Wolff &Kasper, 2006). As parents of OIF/OEF veterans develop dementia, those veterans will take on caregiving responsibilities;a fact particularly relevant for the increasing numbers of female veterans (which has grown nearly 7 fold in <10 years). The ability of the VA to provide services for these caregivers is critical.