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、重复的行为和冷漠，都是人际间的。 具有挑战性，并与这些个人的制度化、发病率和死亡率有关。这些 对于家庭照顾者来说，行为也与抑郁、负担和挫败感有关。3胜5负，尽管 在照顾者干预方面投入大量资金以减少行为症状，症状改善 照顾者抑郁、负担和挫败感的变化也不大。6虽然有多种因素 可能会影响治疗反应，我们发现人际交往技能缺陷是一个重要的预测因素 对照顾者干预的反应。7-10人际交往技能缺陷可能会干扰照顾者的 成功实施当前照顾者干预中教授的行为策略。尽管有些人 照顾者自我确认人际交往技能的缺陷，许多人缺乏对这些缺陷可能产生的影响的洞察力 行为症状。11，12项现有干预措施没有充分侧重于评估照顾者 人际交往技能，并在确定后，在实施之前为照顾者提供相关培训 行为管理策略。 目标/方法：该项目包括两项同时进行的活动：(1)完善和试行 基于远程健康的观察编码手册(OCM)用于评估家庭人际交往技能 护理者与患有痴呆症的护理接受者(以下称为“二人组”)互动 行为症状，以及(2)开发和试点远程健康家庭干预以改善 护理员的人际交往能力。 (1)提炼和试点测试OCM：我们将召集一个具有以下专长的专家咨询小组(EAP) 人际和家庭照顾过程和家庭心理治疗，以提供对开放式社区管理的反馈。 OCM代表了先前为以下目的开发的可靠的编码手册的改编 评估夫妻、家庭和痴呆症照顾者研究中的互动模式。13-15使用 基于EAP反馈的细化迭代过程、来自五个初始二进制数的视频的导频编码，以及 我们将使用最初为研究开发的编码方案并对其进行调整 供临床使用。然后，我们将再招募15个双子星，并将他们的互动录制下来。五个心理学 受训人员将接受OCM方面的培训。心理实习生的PI和Pair将独立编码 每个视频用于评估有效性(人脸、并发、收敛、判别、内容和标准)、可靠性 (替代形式、评核人之间和内部一致性)，并从半结构化中分析定性数据 对照顾者、护理接受者和临床医生进行访谈，以评估OCM的可接受性和实用性。 (2)家庭干预的开发和试点测试：由于正在创建OCM，我们将起草一份 家庭干预治疗手册，由已建立的经验支持的干预措施提供信息 65-69岁的夫妇和家庭。治疗手册将专门针对已确定的人际交往技能 OCM中的赤字。将向EAP提交治疗手册草案，以征求对 进一步完善。我们将试行通过远程健康与接受 OCM和评估交付的可行性，DYAD受益于DYAD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。这些数据显示在 OCM和家庭干预将作为申请调查人员的基础 用于OCM+家庭干预的随机临床试验(RCT)的研究(IIR)资金应用于 将远程健康痴呆症护理管理(DCM)转变为仅针对高危PWD的非远程健康DCM计划 (即那些行为评估水平高、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).