Family Telemental Health Intervention for Veterans with Dementia

摘要/摘要 背景：退伍军人事务部服务的近30万退伍军人患有痴呆症。1,2 相关的行为症状，如激动，重复行为和冷漠是人际关系 这些人面临的挑战和与机构化、发病率和死亡率有关。这些 行为也与家庭照顾者的抑郁、负担和挫折感有关。3-5尽管 对护理人员干预措施进行重大投资，以减少行为症状，症状改善， 以及看护者抑郁、负担和沮丧的变化仍然适度。6虽然各种因素 可能会影响治疗反应，我们已经确定人际交往技能缺陷作为一个重要的预测因素， 对护理人员干预的反应。7-10人际交往能力的缺陷可能会干扰照顾者的 成功实施当前护理人员干预措施中教授的行为策略。尽管一些 照顾者自我识别人际交往能力的缺陷，许多人缺乏对这种缺陷如何影响的洞察力， 行为症状11，12现有的干预措施没有充分注重评估照顾者 人际交往技能，并在确定时，在实施前向照顾者提供相关培训 行为管理策略。 目标/方法：该项目涉及两个同时进行的活动：（1）改进和试点测试 基于远程保健的观察编码手册（OCM），用于评估家庭的人际关系技能 照顾者与患有痴呆症的照顾者（以下称为“二人组”）互动， 行为症状，和（2）远程健康家庭干预的开发和试点测试，以改善 照顾者的人际关系技巧。 (1)完善和试点测试OCM：我们将召集一个专家咨询小组（EAP）， 人际和家庭沟通过程和家庭心理治疗，以提供对OCM的反馈。 OCM是对以前建立的可靠编码手册的改编， 评估夫妻、家庭和痴呆症护理者研究中的互动模式。13-15使用 基于EAP反馈的迭代细化过程，来自五个初始二元组的视频的导频编码，以及 从这些二进制的反馈，我们将使用编码方案最初开发的研究和适应他们 临床使用。然后，我们将招募另外15对二人组，并记录他们的互动。五本心理学 受训人员将接受关于OCM的培训。PI和成对的心理学培训生将独立编码 每个视频评估有效性（面部，并发，收敛，判别，内容和标准），可靠性 （替代形式，评分者间和内部一致性）并分析半结构化的定性数据 访谈护理人员、护理接受者和临床医生，以评估OCM的可接受性和实用性。 (2)家庭干预的发展和试点测试：随着OCM的建立，我们将起草一份 家庭干预的治疗手册，由已建立的经验支持的干预措施提供信息， 夫妇和家庭65 -69.治疗手册将特别针对已确定的人际交往技能 OCM中的缺陷。将向EAP提交治疗手册草案，征求反馈意见， 进一步细化。我们将通过远程医疗对接受远程医疗的夫妇进行家庭干预的试点测试。 OCM和评估交付的可行性，二分受益于二分和治疗师报告，以及描述性 分析人际冲突、照顾者抑郁、焦虑和负担的变化。这些数据对 OCM和家庭干预将作为研究者发起的申请的基础 OCM +家庭干预的随机临床试验（RCT）的研究（IIR）资金适用于 远程医疗痴呆症护理管理（DCM）到非远程医疗DCM计划单独用于高风险PWD (i.e.行为评估水平高和医疗保健利用率高的人）。

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).