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about us
Built upon the findings of REACH I, REACH II was funded in 2001 to design and test a single multi-component intervention among family caregivers of persons with Alzheimer's Disease or related disorders. The overall objectives of REACH II are to 1) identify and reduce modifiable risk factors among diverse family caregivers of patients with Alzheimer's Disease or a related disorder, 2) enhance the quality of care of the care recipients, and 3) enhance the well-being of the caregivers. This competing renewal will build on existing infrastructure and results obtained from its parent multi-site feasibility study, REACH I. REACH I explored the effectiveness of different interventions to reduce burden and distress of family caregivers in six participating sites. Detailed analyses of these data suggest specific components of the REACH I interventions may be efficacious in improving caregiver outcomes.
The REACH II intervention seeks to increase caregiver knowledge, skills, and well being while enhancing support to the caregiver. The intervention will consist of 10 home visits by trained staff plus 5 pre-planned contacts with trained staff through an innovative computer/telephone technology system over a six- month period. The technology will also provide access to formal services, family, and other caregivers. The intervention process will involve administering a risk appraisal following the baseline battery, prioritizing the risk areas, and then using a stepped intervention approach that addresses risk in multiple domains.
The study design is a multi-site, two group randomized clinical trial, comparing the active intervention to an information only control. Unlike REACH I, which implemented a variety of active interventions at 6 different sites, this study will implement the same two interventions at each of five participating sites: Birmingham, Memphis, Miami, Palo Alto, and Philadelphia. Across the five sites we expect to enter 600 (120 per site) caregiver-care recipient dyads with a goal of 510 completing the protocol. The 15% missing data rate at six months is based on data from REACH I (5% attrition, 10% missed visits). Differential attrition among race/ethnic groups was not found in REACH I and is not expected in the proposed study. The dyads will be randomized into two equal sized groups, a multi-component core intervention group or a standardized information-only control group. Equal numbers of African Americans/Blacks, Hispanics/Latinos, and Caucasians/Whites will be assigned to the two groups at each site. Thus, each site will enter 120 dyads (40 African Americans/Blacks, 40 Hispanics/Latinos, and 40 Caucasians/Whites) with the goal of completing the six-month assessment.
The study will be conducted in two study Phases. Phase 1 will involve intervention refinement and staff training in how to conduct the new intervention protocol; in Phase 2, the randomized clinical trial will be conducted. A uniform battery of predictor and outcome measures will be collected at baseline and six months. Cost-effectiveness and clinical significance of the intervention will also be evaluated.
To summarize, this study promises to:
- Test a potent multi-component intervention.
- Assess the intervention's impact on ethnically diverse populations.
- Provide new measurements for assessing the quality of care provided by caregivers and tools for identifying caregivers at risk for adverse outcomes.
- Evaluate the cost effectiveness and public health significance of the intervention.
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