Richard Schulz, PhD Professor of Psychiatry Director, University Center for Social and Urban Research University of Pittsburgh

Transcription

1 Richard Schulz, PhD Professor of Psychiatry Director, University Center for Social and Urban Research University of Pittsburgh

2 Go to Presentations If you have questions, please contact Dr. Richard Schulz at

3 How are interventions developed? How are they evaluated? How effective are they? Key elements of a good interventions. Recommendations for effective interventions.

4 How are interventions developed? How are they evaluated? How effective are they? Key elements of a good interventions. Recommendations for effective interventions.

5 Observation Needs Assessment Descriptive/Observational Studies Theoretical Models I n t e r v e n t i o n

6 Stress Health Process Care Recipient: Disability, Problem Behaviors, Physical and Social Environment Appraisal of Demands and Adaptive Capacities Perceived Stress Intervention Components Pharmacologic Treatment, Environmental Changes Social Support Education Skills Training Emotional/Behavioral Response Self Care, Preventive Health Practices Morbidity/Mortality Communication

7 Basic education knowledge re caregiving and disease Skill training Information and referral Voice mail/support/advice/behavioral distraction Environmental alterations Behavioral management Stress management Psychoeducational/coping Technology Psychotherapy Empathic Listening

8

9 How are interventions developed? How are they evaluated? How effective are they? Key elements of a good interventions. Recommendations for effective interventions.

10 CONSORT guidelines for randomized trials eligibility criteria, recruitment methods, participant flow from screening through end of study, randomization and masking procedures, intervention goals and methods, specification of primary and secondary outcomes, and statistical methods (Moher et al., 2001) TREND guidelines for non randomized trials (Des Jarlais, 2004) ITAX: intervention taxonomy guidelines (Schulz et al, in progress)

11 How are interventions developed? How are they evaluated? How effective are they? Key elements of a good interventions. Recommendations for effective interventions.

12

13 NYU Caregiver Intervention

14 NYU Caregiver Intervention

15 REACH II

16 REACH II

17 How are interventions developed? How are they evaluated? How effective are they? Key elements of good interventions. Recommendations for effective interventions.

18 Delivery Characteristics: Content: Mode Strategies Materials Location Mechanisms Schedule Scripting Cultural sensitivity Special considerations Adaptability Staffing and training of interventionists Monitoring implementation

19 Dimension Definition Specific Examples Mode Method of contact face to face between interventionist telephone and target individual, group internet/computer Materials Location Materials used to help deliver the intervention Site where intervention is delivered manuals/workbooks pamphlets, information sheets checklists videotapes/audiotapes, CDs/DVDs assistive devices client s home classroom healthcare provider s office hospital/clinic/operating room work site, community center nursing home, group residence facility

20 Schedule Scripting Frequency and duration of sessions Level of detail guiding interaction between interventionist and client/subject overall duration of intervention number of sessions minutes of contact per session distribution of sessions over time exact script/protocol provided specific language provided with elaboration allowed/not allowed goals/tasks specified but no further scripting general guidelines provided

21 Cultural sensitivity Special considerations Extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of target population are incorporated in the design, delivery and evaluation of intervention materials Extent to which materials and intervention adapted to special characteristics of target population race/ethnicity age, gender matching of interventionist with client intervention staff recruited from client community interventionists trained to be knowledgeable of cultural views and values of clients design of treatment strategies based on client/ community input intervention materials and delivery in language preferred by client materials written for specific reading or health literacy level visual supplements, augmentative communication devices for hearing impaired verbal supplements and visual enhancements for vision impaired

22 Staffing and training of interventionists Adaptability Qualifications of individuals selected to be interventionists and training they receive Extent to which intervention can be modified. What can be modified? Why or on what basis modifications are made. When in the course of the study modifications are made. required disciplinary/professional expertise for interventionists licensing/certification requirements type and quantity of training provided proficiency tests administered What: number/schedule/duration of sessions location of treatment, mode of delivery content/target of treatment, dosage Why: client assessment client progress, clinical judgment spontaneous request, secular event checklist/lab test results, performance outcomes When: intake, baseline, specified intervals

23 Treatment Implementation Treatment Delivery: Documentation of interventionist compliance to intended treatment and modifications (treatment delivery). Treatment Receipt: Extent to which processes are implemented by client and/or goals are met. Treatment Enactment: Extent to which knowledge and skills acquired during treatment are applied in real world settings outside of treatment. number and duration of sessions, content delivered Knowledge, skills, motivation, self-efficacy, social support/ integration, changes in pathophysiology assessed in client Direct observation, self-report, observer report of client

24 Types of treatment content Dimension Definition Specific Examples Treatment content strategies Specific strategies aimed at improving client outcomes providing feedback to client through tracking and monitoring provision of information behavioral incentives/ reinforcements didactic instruction skill building techniques problem solving techniques stress management techniques facilitate social support biologic interventions (surgery, medications, radiation) structure /process modifications (e.g., staffing, scheduling, communications)

25 Mechanisms of action Key processes, goals, or mediators of desired treatment outcomes ability to assess risks/goals knowledge behavioral skills problem solving skills motivation self-efficacy social support social engagement environmental motivation change in policies/ regulations change in pathophysiology of client

26 How are interventions developed? How are they evaluated? How effective are they? Key elements of a good interventions. Recommendations for effective interventions.

27 Michigan Dementia Coalition: Marci Cameron, Lorie Massuch, & Donna Wishart

28 Do you know what outcomes are important and how to achieve them? Is there a reasonable link between intervention and outcome? Does the connection make sense?

29 Assess caregiver needs, resources, strengths, and goals. How do you currently assess caregivers and can they be adapted to include needed information? What tools will you use? Does assessment take into account individual/cultural differences? (See Family Caregiver Alliance: Toolkit to Assess Needs of Family Caregiver). Are staff available to do assessments? How do you transition from assessment to treatment?

30 To what extent do you elicit specific interests, needs and goals? How do you resolve client s expressed needs with professionally assessed needs? What is the match between needs assessment and treatment delivery options? How flexible are treatment options?

31 Ok to mix and match. Should you be offering other interventions for clients along with what you currently offer? If offerings are expanded, what is the impact on staffing and resources? If we you don t have the resources to offer other interventions, or if your mission does precludes certain offerings, can you partner with other organizations or individuals to ensure multi component interventions for mutual clients? How do coordinate offerings?

32 Possible targets in caregiver interventions Caregiver Care recipient Other family members Physical environment (see Schulz et al., 2009, Rehabilitation Psychology)

33 Limited resources (money, staff, and time) for fewer clients or few resources for many clients? Staffing implications? Implications for client? (need to provide respite to encourage enable client to attend sessions). How do you get client to commit to intense intervention?

34 Evaluate staff ability to deliver intervention Obtain client feedback Tweak intervention

35 Are interventionists delivering treatment as intended? What seems to be working and what isn t working? Are clients compliant?

36 No matter how well you plan and prepare, something will surprise you.

37 Go to Presentations If you have questions, please contact Dr. Richard Schulz at