Evaluation of REACH-TX: A Community-Based Approach to the REACH II Intervention.

ABSTRACT

BACKGROUND AND OBJECTIVES: Family caregiving interventions have been proven efficacious at reducing dementia caregiver's stress and burden, yet translation of evidence-based interventions into community-based support service programs requires modification to the original intervention protocol. In collaboration with community partners, the REACH-TX program was developed based on the REACH II (Resources for Enhancing Alzheimer's Caregiver Health) intervention. REACH-TX maintains the integrity of the multicomponent skill-based REACH II intervention but requires significantly fewer therapeutic contacts between the family caregiver and the dementia care specialist. This study presents an evaluation of REACH-TX implemented by the Alzheimer's Association North Central Texas Chapter. RESEARCH DESIGN AND METHODS: REACH-TX was provided to 1,522 caregivers between November 2011 and December 2017. The number of therapeutic contacts scheduled for caregivers was determined by the Risk Appraisal Measure (RAM) and ranged from 1 to 23. The rate of follow-up data on outcome measures collected was 59.0% (n = 898). All five domains of the REACH II quality-of-life measure (burden, depression, social support, self-care, and problem behaviors) were assessed at baseline and at 6 months. Caregivers (n = 53) participating in the program more than once allowed us to investigate the long-term impact of the first exposure to REACH-TX and the value of repeating the program. Generalized linear models were used to assess changes in quality of life after adjusting for covariates. RESULTS: Caregivers who completed the program showed significant improvements from baseline to 6 months on all five domains of quality of life, as evidenced by the follow-up data. Furthermore, caregivers who enrolled a second time in REACH-TX showed significant improvement in burden and social support scores. DISCUSSION AND IMPLICATIONS This evaluation of REACH-TX suggests that REACH II evidence-based intervention can be translated into a valuable and sustainable community-based service for family caregivers. Additional translational research is needed to overcome the challenges of conducting standardized outcome assessments of caregiving services.