Improving Mental Health for Veterans with Dementia: Provider Training in Caregiver Engagement

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Background: This career development proposal is designed to prepare Mary Wyman, PhD for a VA career conducting health services research focused on improving mental health care delivery and access for aging Veterans. Dr. Wyman will accomplish this goal by completing training activities, obtaining expert mentorship, and completing a series of research studies on family caregiver engagement in mental health services for Veterans with dementia. Comorbid mental health conditions (e.g., depression and anxiety) are common in dementia and are associated with worse outcomes if left untreated. To improve care quality and access, it is critical to effectively involve family caregivers in mental health services; however, providers lack the confidence and skills to do so. The primary objectives in this CDA application are 1) to use a qualitative research approach to identify facilitators and barriers to caregiver engagement; 2) develop and test a provider training curriculum to increase skills in engaging caregivers; and 3) use an existing dataset combining longitudinal survey data and VA health care records to explore how caregiving associates to use of mental health services among Veterans with dementia. Significance/Impact: This work has the potential to have significant and meaningful impact on the delivery of mental health care to aging Veterans. Our methodology will support rapid dissemination and implementation of the final, effectiveness-tested intervention, and our findings can inform development of future interventions to address modifiable factors associated with mental health care access and outcomes. This work aligns strongly with VHA and HSR&D priorities, including increased access to care, mental health and suicide prevention, caregiver support, and employee engagement. Innovation: While there are several effective interventions aimed at caregivers, we propose an innovative approach to increasing caregiver involvement in mental health care by training providers in knowledge and skills for effective caregiver engagement. As such, our proposal offers new directions for improving mental health care quality and access for aging Veterans. The resultant systems intervention may be applicable across VHA care settings and could positively impact employee engagement through increased provider self-efficacy. Specific Aims: Objectives will be achieved through three specific aims: 1) Identify patient-, provider-, and system-level factors that support or impede caregiver engagement in mental health care for aging Veterans with dementia; 2) Develop and pilot-test a provider training curriculum and implementation strategy to improve mental health provider engagement of caregivers of Veterans with dementia; 3) Examine associations of intensity of informal caregiving received and cognitive status with MH care utilization by aging Veterans. Methodology: Aim 1 involves semi-structured interviews with Veterans with dementia, their caregivers, and mental health providers and leadership. Aim 2 will use established methodology to develop, refine, and pilot-test a provider training and implementation strategy for the mental health setting. In Aim 3, data from the VA-Health & Retirement Study Aging Veterans Cohort will be analyzed to explore associations between caregiving, cognitive status, and mental health care utilization. Next Steps/Implementation: During the CDA period, a proposal will be submitted to fund an adequately powered “real-world” efficacy trial of the training curriculum. Dr. Wyman will work with local and national VHA dissemination partners to disseminate study results and the final, effectiveness-tested intervention. Embedded in the Madison VA GRECC and the rich environment of the University of Wisconsin, which offers extensive infrastructure to support early stage investigators, Dr. Wyman is in an ideal environment to complete the proposed research and training, allowing her to successfully launch as an independent investigator in VHA.