Inside the black box: Modeling "Life Writing" for lifelong health and well being.

We articulate the lifespan theory of change by which an attachment-focused integrative reminiscence intervention, "Life Writing", is expected to interrupt the continuing problem of insecure attachment in adults and reverse associated reduced health and well-being outcomes. Based on preliminary studies and previous research, Life Writing is expected to foster earned-secure attachment in adults who work through subjective memories of unresolved attachment trauma. Roughly two decades of research on integrative reminiscence interventions like Life Writing show their consistent and wide-ranging positive impact. However, the bulk of this research demonstrates that such programs work, without also clarifying how they work, leaving unanswered questions as to how change occurs and how benefits might continue to accrue to participants through the lifespan. This represents what are known as "black box" effects. A program and evaluation planning tool, The Netway, was used to 1) identify hypothesized links between program inputs, activities, outputs, outcomes, and long-term impacts; 2) to clarify the underlying assumptions related to the program's success; and 3) to consider the appropriate contexts for the program. The logic model presented here articulates the hypothesized causal pathway from insecure to earned-secure attachment, in preparation for rigorous empirical tests of the program's lifespan theory of change.

Attachment-focused integrative reminiscence with older African Americans: a randomized controlled intervention study.

OBJECTIVES: Prior integrative reminiscence interventions have had a limited focus on attachment themes. The attachment-focused integrative reminiscence (AFIR) intervention differs from these in its central emphasis on attachment themes. The wide range of health benefits resulting from integrative reminiscence may be due in part to reminiscing about, mourning, and integrating unresolved attachment experiences. METHOD: Participants were randomized into treatment and wait-list control conditions, completed a pre-test, met for eight consecutive weekly two-hour sessions of largely attachment-focused reminiscence, then completed post-tests immediately following the intervention and again six months later. RESULTS: Results show treatment effects for depression (p = .01 and .05 at eight weeks and six months), perceived stress (p = .01 and .04), and emergency room (ER) visits at six months (p = .04), with the intervention group showing lower depression and stress and fewer ER visits. CONCLUSION: Integrative reminiscence interventions are cost effective, have rapid impact, and carry a certain appeal to older adults. Augmenting such interventions with a focus on attachment experiences may reduce perceived stress, an important health risk factor. Wider application of AFIRs may further reduce health disparities among US older adults.

An intensely sympathetic awareness: experiential similarity and cultural norms as means for gaining older African Americans' trust of scientific research.

Well-known trust-building methods are routinely used to recruit and retain older African Americans into scientific research studies, yet the quandary over how to overcome this group's hesitance to participate in research remains. We present two innovative and testable methods for resolving the dilemma around increasing older African Americans' participation in scientific research studies. Certain specific and meaningful experiential similarities between the primary researcher and the participants, as well as clear recognition of the elders' worth and dignity, improved older African Americans' willingness to adhere to a rigorous research design. Steps taken in an intervention study produced a potentially replicable strategy for achieving strong results in recruitment, retention and engagement of this population over three waves of assessment. Sixty-two (n=62) older African Americans were randomized to treatment and control conditions of a reminiscence intervention. Sensitivity to an African American cultural form of respect for elders (recognition of worth and dignity), and intersections between the lived experience of the researcher and participants helped dispel this population's well-documented distrust of scientific research. Results suggest that intentional efforts to honor the worth and dignity of elders through high level hospitality and highlighting meaningful experiential similarities between the researcher and the participants can improve recruitment and retention results. Experiential similarities, in particular, may prove more useful to recruitment and retention than structural similarities such as age, race, or gender, which may not in themselves result in the trust experiential similarities elicit.

A Community-Based Participatory Critique of Social Isolation Intervention Research for Community-Dwelling Older Adults.

This article examines the dialogue that occurred within the structure of a Research-to-Practice Consensus Workshop that critiqued academic research priorities regarding social isolation among community-dwelling older adults and identified practice-based suggestions for a social isolation research agenda. The investigators adapted the scientific consensus workshop model to include expert practitioners and researchers in a discussion of the current state and future directions of social isolation intervention research. The group's critique resulted in several key recommendations for future research including the need for a social isolation measure with specific capacity to identify isolated older adults during a community crisis. This study demonstrates that the Research-to-Practice Consensus Workshop model can be used successfully to identify priority areas for research that have implications for community practice, construct an evidence base more relevant for community application, strengthen existing community-researcher partnerships, and build agency and practitioner capacity to take part in community-based participatory research.

The importance of family relationships with nursing facility staff for family caregiver burden and depression.

We explore the association between family caregiver depression and the quality of staff-family relationships, and we test burden as a mediator of this relationship. Using structural equation modeling, we used data from a representative sample of 932 family members from 20 nursing homes in Central New York to examine the association between staff-family relationship quality and family caregiver depression. We then tested family caregiver burden as a mediator of the relationship between staff-family relationship quality and family caregiver depression. Staff-family relationship quality, specifically perceived conflict with staff, is significantly associated with family caregiver depression. Further, caregiver burden mediates this relationship. Interventions to improve staff-family relationships may impact family caregiver depression by reducing the stress that family caregivers experience.

The CITRA pilot studies program: mentoring translational research.

PURPOSE: We developed an innovative pilot studies program to foster partnerships between university researchers and agencies serving older people in New York City. The development of researchers willing to collaborate with frontline service agencies and service agencies ready to partner with researchers is critical for translating scientific research into evidence-based practice that benefits community-dwelling older adults. DESIGN AND METHODS: We adapted the traditional academic pilot studies model to include key features of community-based participatory research. RESULTS: In partnership with a network of 265 senior centers and service agencies, we built a multistep program to recruit and educate scientific investigators and agencies in the principles of community-based research and to fund research partnerships that fulfilled essential elements of research translation from university to community: scientific rigor, sensitivity to community needs, and applicability to frontline practice. We also developed an educational and monitoring infrastructure to support projects. IMPLICATIONS: Pilot studies programs developing community-based participatory research require an infrastructure that can supplement individual pilot investigator efforts with centralized resources to ensure proper implementation and dissemination of the research. The financial and time investment required to maintain programs such as those at the Cornell Institute for Translational Research on Aging, or CITRA, may be a barrier to establishing similar programs.

The CITRA research-practice consensus-workshop model: exploring a new method of research translation in aging.

PURPOSE: On the basis of the experience of an extensive community-based research partnership in New York City, we developed an innovative process for bridging the gap between aging-related research and practice, using a consensus-workshop model. DESIGN AND METHODS: We adapted the traditional scientific consensus-workshop model to include translation of the research into nontechnical language and the involvement of practitioners in the process. We then applied the model to the specific issue of falls prevention among community-dwelling older adults. RESULTS: The dialogue and interaction among researchers and practitioners provided new insights beyond a traditional research review. Practitioners offered astute guidance for future research based on their day-to-day field experience. IMPLICATIONS: The recommendations that emerged from the workshop demonstrated the value of close interaction between the aging-related research and practice communities. The consensus-conference model has significant potential to establish a bridge between the worlds of research and practice in a variety of settings.

Predictors of successful relationships in a peer support program for Alzheimer's caregivers.

This study explores the role of similarity in the success of peer support relationships in an intervention program for dementia caregivers. Hypothesized predictors of successful matches included structural similarity between partners (e.g., in age, education), appraisal similarity (e.g., in satisfaction with support for caregiving), and psychological similarity (e.g., in psychological well-being). Contrary to expectations, no relationship between these types of similarity and the success of the match were found, but effects were found for dissimilar pairs on several characteristics. The findings suggest: 1) that what really makes a difference for successful peer support is sharing the stressful but also rewarding experience of caregiving; and 2) that program planners do not need to develop extensive matching criteria.