权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Family Telemental Health Intervention for Veterans with Dementia

患有痴呆症的退伍军人的家庭远程心理健康干预

基本信息

批准号：
9294492
负责人：
CORY Keryei CHEN
金额：
--
依托单位：
VA NEW YORK HARBOR HLTHCARE/SYS/BROOKLYN
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-05-01 至 2019-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9294492
关键词：
Address Address Affect Affect Agitation Agitation Anxiety Anxiety Area Area Assessment tool Assessment tool Behavior Behavior Behavior Therapy Behavior Therapy Behavior assessment Behavior assessment Behavioral Behavioral Behavioral Symptoms Behavioral Symptoms Caregiver Burden Caregiver Burden Caregiver research Caregiver research Caregiver support Caregiver support Caregivers Caregivers Clinical Clinical Code Code Conflict (Psychology)Conflict (Psychology)Couples Couples Data Data Dementia Dementia Dementia caregivers Dementia caregivers Development Development Effectiveness Effectiveness Face Face Family Family Family Caregiver Family Caregiver Family Sizes Family Sizes Family psychotherapy Family psychotherapy Feedback Feedback Frustration Frustration Funding Funding Goals Goals Health Health Individual Individual Institutionalization Institutionalization Intervention Intervention Interview Interview Investigator-Initiated Research Investigator-Initiated Research Investments Investments Manuals Manuals Mental Depression Mental Depression Mental Health Services Mental Health Services Methods Methods Morbidity - disease rate Morbidity - disease rate Nursing Homes Nursing Homes Pattern Pattern Persons Persons Prediction of Response to Therapy Problem behavior Problem behavior Process Process Protocols documentation Protocols documentation Psychology Psychology Randomized Clinical Trials Randomized Clinical Trials Randomized Controlled Trials Randomized Controlled Trials Recruitment Activity Reporting Reporting Research Research Scheme Scheme Sleep Sleep Structure Structure Symptoms Symptoms Technology Technology Telemental Testing Testing Training Training Travel Travel Veterans Veterans Videotape Videotape Work Work base base care recipients care recipients caregiver depression caregiver depression caregiver interventions caregiver interventions caregiving caregiving dementia care dementia care design design family caregiving family caregiving family support family support health care service utilization health care service utilization high risk high risk improved improved insight insight interpersonal conflict interpersonal conflict interpersonal therapy interpersonal therapy intervention program intervention program medical specialties medical specialties mortality mortality novel novel predicting response predicting response predictive of treatment response programs programs recruit repetitive behavior repetitive behavior skills skills standard of care standard of care success success symptomatic improvement symptomatic improvement telehealth telehealth tool tool treatment response treatment response treatment strategy treatment strategy trial comparing trial comparing

项目摘要

Summary/Abstract Background: Nearly 300,000 Veterans served by the Department of Veteran Affairs have dementia. 1,2 Related behavioral symptoms such as agitation, repetitive behaviors, and apathy are interpersonally challenging and associated with institutionalization, morbidity and mortality for these individuals. These behaviors are also associated with depression, burden, and frustration for family caregivers. 3-5 Despite significant investment in caregiver interventions to reduce behavioral symptoms, symptom improvement as well as change in caregiver depression, burden, and frustration remain modest. 6 Although a variety of factors may impact treatment response, we have identified interpersonal skills deficits as a significant predictor of response to caregiver interventions. 7-10 Deficits in interpersonal skills may interfere with a caregiver’s successful implementation of behavioral strategies taught in current caregiver interventions. Although some caregivers self-identify deficits in interpersonal skill, many lack insight into how such deficits may affect behavioral symptom. 11,12 Existing interventions have not sufficiently focused on assessing caregiver interpersonal skills and, when identified, providing caregivers with relevant training prior to implementing behavioral management strategies. Objectives/Methods: This project involves two simultaneous activities: (1) refinement and pilot testing of a tele-health based observational coding manual (OCM) to evaluate the interpersonal skills of family caregivers interacting with care-recipients with dementia (hereafter referred to as “dyads”) who display behavioral symptoms, and (2) development and pilot testing of a tele-health family intervention to improve caregiver interpersonal skills. (1) Refining and pilot testing the OCM: 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. 13-15 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 (face, concurrent, convergent, discriminant, content, and criterion), reliability (alternate form, inter-rater, and internal consistency) and analyze qualitative data from semi-structured interviews of caregivers, care-recipients, and clinicians to assess acceptability and utility of the OCM. (2) Development and pilot testing of the Family Intervention: As the OCM is being created, we will draft a treatment manual for a family intervention informed by established empirically supported interventions for couples and families65-69. The treatment manual will specifically 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 assess feasibility of delivery, dyad benefit from dyad and therapist report, and descriptive analyses of changes in interpersonal conflict, caregiver depression, anxiety, and burden. These data on the OCM and the family intervention will serve as the basis of an application for Investigator Initiated Research (IIR) funding for a Randomized Clinical Trial (RCT) of the OCM + family intervention applied to tele-health dementia care management (DCM) to a non-telehealth DCM program alone for high risk PWD (i.e. those with high levels on behavioral assessments and high healthcare utilization).

摘要/文摘