Dementia Caregiver Intervention for Non-Responders

描述（由申请人提供）： 具体目标：（1）确定REACH VA无应答的预测因素;（2）开发和试验一种治疗方法，该方法专为在干预后继续经历临床显著抑郁和负担的家庭照顾者设计。相关性：照顾痴呆症患者是一项非常紧张的任务，需要高度的身体、精神和经济压力。在过去的40年里，已经制定了干预措施，以帮助照顾者科普这些压力。然而，即使是最有效的心理社会干预的结果研究表明，很大一部分人继续经历治疗后的临床显着症状。目前还没有关于预测治疗结果的潜在可变因素的已知研究，也没有针对无应答者需求的干预措施。使用的程序：该项目涉及收集REACH VA干预措施响应预测因素的数据，以制定针对无响应者需求的干预措施。拟议的项目利用快速质量改进和实用传播模式来制定和试行新的干预措施。痴呆症患者的家庭照顾者将完成2小时的访谈和问卷调查，以获得有关他们自己及其照顾对象的基线信息。将为受试者提供REACH VA干预，治疗后将完成结局指标，以评估症状变化。参与者谁继续经历干预后显着的痛苦，将管理一个半结构化的述职访谈。由于收集了治疗反应预测因素的数据，将根据确定的重要预测因素利用专家小组开发新的干预措施。他们还将参与协助编写手册、制定培训计划和制定依从性/能力衡量标准。新的干预措施将在项目过程中对总共30名参与者进行试点，试点数据将作为新开发干预措施的随机临床试验（RCT）的研究者发起研究（IIR）资金申请的基础。潜在新发现的重要性：拟议项目将（1）提供数据，以帮助预测对治疗的反应-降低与提供无效干预相关的成本，（2）开发和试点一种新的干预措施，旨在解决无反应者的独特特征。短期职业目标：这些数据和新开发的干预措施将作为申请HSR&D研究者发起的研究（IIR）资金的基础，通过随机临床试验测试干预措施的有效性，并探索新干预措施的潜在传播。我计划提交这个奖项3年进入CDA奖期间。优异评审奖将使我开始作为一个独立的调查员在心理社会治疗的发展和结果研究的职业生涯。长期职业目标：最终，我希望将从这种干预中获得的知识应用于其他对心理社会治疗没有反应的退伍军人群体。这种研究途径可以为开发创新干预措施提供机会，进一步了解与治疗结果相关的变量，并有机会培训该领域的临床医生和研究人员。研究职业发展计划：研究计划与职业发展计划紧密结合，以便通过指导或正式教学获得的技能将在项目中得到应用，并在五年项目期间越来越独立地运用这些技能。在获奖过程中，我将获得在心理社会干预开发和评估方面具有广泛专业知识的导师的定期监督。培训的目的是导致研究的独立性，重点是：（1）无反应的预测和（2）干预措施的发展。

DESCRIPTION (provided by applicant): Specific Objectives: (1) Identification of predictors of no-response to REACH VA and (2) development and pilot of a treatment designed for family caregivers who continue to experience clinically significant depression and burden following intervention. Relevance: Caregiving for individuals with dementia is an extremely stressful task with high levels of physical, mental and financial strain. Over the past 40 years, interventions have been developed to help caregivers cope with these stressors. However, outcome studies of even the most effective psychosocial interventions suggest that a large proportion of individuals continue to experience clinically significant symptoms post treatment. There is no known research on the potentially mutable factors that predict treatment outcome, nor interventions tailored to the needs of non-responders. Procedures to be Used: The project involves collecting data on predictors of response to the REACH VA intervention in order to develop an intervention tailored to the needs of non-responders. The proposed project utilizes rapid quality improvement and practical dissemination models for the development and piloting of the new intervention. Family caregivers of an individual with dementia will complete a 2-hour interview and questionnaires to obtain baseline information about themselves and their care-recipient. Participants will be provided with the REACH VA intervention and post-treatment will complete outcome measures to assess changes in symptoms. Participants who continue to experience significant distress following the interventions will be administered a semi-structured debriefing interview. As data is collected on predictors of treatment response, an expert panel will be utilized based on the identified significant predictors to develop a new intervention. They will also be involved in assistance with manual writing, training program development and adherence/competence measure development. The new intervention will be piloted on a total of 30 participants over the course of the project and data from the pilot will serve as the basis for an application for Investigator Initiated Research (IIR) funding for a Randomized Clinical Trial (RCT) of the newly developed intervention. Significance of Potential New Findings: The proposed project would (1) provide data to help predict response to treatment - lowering costs associated with providing ineffective interventions and (2) develop and pilot a new intervention designed to address the unique characteristics of non-responders. Short Term Career Goals: The data and newly developed intervention will serve as the basis for an application for HSR&D Investigator Initiated Research (IIR) Funding to test the effectiveness of the intervention through a randomized clinical trial and explore potential dissemination of the new intervention. I plan to submit this award 3 years into the CDA award period. The Merit Review award will allow me to begin a career as an independent investigator in psychosocial treatment development and outcome research. Long Term Career Goals: Ultimately, I hope to apply the knowledge obtained from this intervention to other populations of veterans who do not respond to psychosocial treatments. This avenue of research could provide opportunities for the development of innovative interventions, further understanding of variables relevant to treatment outcome, and opportunities to train both clinicians and researchers in this area. Research Career Development Plan: The Research Plan is closely integrated with the Career Development Plan such that skills obtained through mentoring or formal didactics will be applied in the context of the project with increasing independence in the exercise of those skills over the course of the five-year project. Over the course of the award I will be provided with regular supervision from mentors who have extensive expertise in psychosocial intervention development and evaluation. Training is designed to lead to research independence focused on: (1) predictors of non-response and (2) intervention development.