Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design

N A Boucher,J Dadolf,V Wang,A Choate,L L Zullig,N R Sperber,S N Hastings,E P Mahanna,K A Allen,K P Decosimo,M Shepherd-Banigan,C H Van Houtven

doi:10.1186/s12913-021-06448-7

N A Boucher, J Dadolf + Show 10 more

Open Access

https://doi.org/10.1186/s12913-021-06448-7

Copy DOI

Abstract

BackgroundCaring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge.We describe the application of the Replicating Effective Programs (REP) framework, developed by the Centers for Disease Control Prevention and used in public health program implementation, to scale up an evidence-based family caregiver training intervention in the Veterans Affairs (VA) healthcare system.MethodsFrom 2018 to 2020, clinicians at eight VA medical centers received REP-guided implementation including facilitation, technical assistance, and implementation tools to deliver the training program. The project team used the REP framework to develop activities across four distinct phases – (1) pre-conditions, (2) pre-implementation, (3) implementation, and (4) maintenance and evolution – and systematically tracked implementation facilitators, barriers, and adaptations.ResultsWithin the REP framework, results describe how each medical center adapted implementation approaches to fit local needs. We highlight examples of how sites balanced adaptations and intervention fidelity.ConclusionsThe REP framework shows promise for national expansion of the caregiver training intervention, including to non-VA systems of care, because it allows sites to adapt while maintaining intervention fidelity.Trial registrationNCT03474380. Date registered: March 22, 2018.

Highlights

Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge
The National Academies recommends that Veterans Affairs (VA) health system along with Centers for Medicare and Medicaid Services proactively identify and support family caregivers’ needs [9]
We describe the application of the Replicating Effective Programs (REP) framework to scale up an evidence-based family caregiver training intervention in the VA

Summary

Introduction

Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge. We describe the application of the Replicating Effective Programs (REP) framework, developed by the Centers for Disease Control Prevention and used in public health program implementation, to scale up an evidence-based family caregiver training intervention in the Veterans Affairs (VA) healthcare system. Unpaid family and friends (“family caregivers”) who assist adults with caregiving needs report insufficient training to perform their role [1, 2]. There is recognition that family caregivers are an essential part of long-term care services and supports [13, 14]. The National Academies recommends that Veterans Affairs (VA) health system along with Centers for Medicare and Medicaid Services proactively identify and support family caregivers’ needs [9]. Effective interventions for caregivers are rarely implemented beyond local areas due to lack of funding supporting implementation beyond time-limited research studies and need to balance site-specific adaptation with fidelity to original program models [18, 19]

Methods

Results

Discussion

Conclusion