Building Resilience In SKilled nursing facilities (BRISK): Development and Pilot Testing of a Dyadic Intervention for Psychological Distress in Post-Acute Skilled Nursing Care

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Background: The timing of a skilled nursing facility (SNF) stay is met with significant psychological stress for both patients and family care-partners (CPs), which can negatively impact recovery as well as long-term health and psychological outcomes. These consequences may be magnified among socioeconomically disadvantaged patients (i.e., dual-eligible beneficiaries) and their CPs, who experience multiple health disparities. Dyadic psychological interventions promote coping skills to improve short-term distress and reduce the risk of chronic psychological symptoms for both patients and CPs, but are untested in SNFs. To address this limitation and to progress the field toward improving psychological care in SNFs, I will develop and pilot “Building Resilience In SKilled nursing facilities” (BRISK), a dyadic intervention designed to reduce psychological distress among socioeconomically disadvantaged patients and CPs during a post-acute SNF stay. Specific aims and research design: (1) iteratively develop BRISK with multi-level stakeholder input by conducting semi-structured interviews with up to 20 patient-CP dyads and 4 focus groups with SNF clinical and leadership staff (NIH Model Stage 1a); (2) refine and optimize BRISK by conducting a single-arm open pilot study with 5 patient-CP dyads and exit interviews with 5 SNF staff (NIH Model Stage 1a); and (3) test the feasibility, acceptability, and fidelity of BRISK by conducting a pilot cluster randomized controlled trial with patient-CP dyads completing BRISK (N=30 dyads) or minimally enhanced usual care (N=20 dyads) in 3 SNFs (NIH Stage Model 1b). A diverse stakeholder advisory council will convene throughout the award period to collaboratively guide intervention development and refinements to enhance the relevance and real-world adoption potential of BRISK. Training: I have developed a rigorous training plan designed to support the research aims and end goal of this proposal, as well as help me launch my career as an independent patient-oriented investigator with the long-term career goal of improving psychological care for socioeconomically disadvantaged patients and families in SNFs. The specific training goals are to: (1) develop skills in intervention development and optimization; (2) acquire skills for clinical trials research, including statistical analysis, with dyads in SNFs; and (3) acquire skills for research with socioeconomically disadvantaged older adults and families, with the goal of promoting health equity. The research environments at Massachusetts General Hospital and Harvard Medical as well as my multidisciplinary mentorship team with distinct and complementary areas of expertise will help ensure the successful achievement of training goals. Impact: I am a clinical geropsychologist with expertise in residential post-acute and long-term care settings. My ultimate mission is to develop a feasible, scalable, and sustainable psychological intervention that improve care among dual-eligible patients and their CPs receiving post-acute SNF care. The research and training goals outlined in this K23 proposal will provide the foundation for future clinical trials to test the efficacy-effectiveness and, eventually, dissemination and implementation of BRISK with socioeconomically disadvantaged patient-CP dyads receiving post-acute care in SNFs, a high-need and under- studied population. This work is well aligned with NIA's goal of improving coping ability and reducing caregiver, family, and patient stress (Strategic Goal C; Objective C-4) with a NIA priority population.