alabama department of senior services irene collins, commissioner

Center for Mental Health and Aging

Alabama Department of Senior ServicesAlabama Department of Senior ServicesIrene Collins, CommissionerIrene Collins, Commissioner

Bettina Schmid, State Project DirectorBettina Schmid, State Project Director

The University of AlabamaThe University of AlabamaCenter for Mental Health and AgingCenter for Mental Health and Aging

Louis D. Burgio, Director/Co-PILouis D. Burgio, Director/Co-PITracy Wharton, Project ManagerTracy Wharton, Project Manager

and the REACH investigatorsand the REACH investigators

The Alabama The Alabama REACHREACH Demonstration Project Demonstration Project

2004 - 20072004 - 2007


The Alabama REACH Demonstration Project

2004 - 2007

In 2004, The University of Alabama partnered with the Alabama Department of Senior Services and received an Alzheimer’s Disease Demonstration Grant to States (ADDGS) award (thru AoA) which included the following goal:

Implement a 3-year program to improve direct services available to family caregivers by incorporating REACH-like evidence-based, in-home social and behavioral interventions which promote skill building.


The Alabama REACH Demonstration Project

2004 - 2007

The Center’s tasks were to provide material, training, and consultation for the case worker interventionists in each of the 4 Area Agencies on Aging (AAA) participating in the project, and manage/analyze data.


How was REACH II translated?

We provided training in the intervention and procedures, along with the caregiver and therapist Notebooks, to the case managers and Directors during a 2-day workshop at the Center.

We continued to train new AAA case workers due to turnover.

Hotline: 2 half-days per week Project Manager/ PI were available for consultation.

Monthly Conference Calls with Center (Dr. Burgio & Project Manager), ADSS staff (including the Commissioner), and most importantly, caseworkers.


REACH II Alabama REACH Demonstration Project:

Practical elements of REACH II were selected to bring a useful intervention into everyday practice to improve the lives of Alzheimer’s patients and their caregivers. The focus was on feasibility, translating findings from the NIH clinical trial to a real world setting.

Initially a Risk Assessment was conducted to produce tailored interventions.

Interventions include:

1. Education about AD, Caregiving, & Stress

2. Health and Safety Home Safety Check Health Passport

3. Behavioral Management Behavioral Prescriptions

4. Signal Breath Relaxation (stress management) (excluded social support and use of technology)


Direct Services to Families Living with Alzheimer’s Disease

4 hour-long home visits to families over 3-4 months to introduce treatment components

1st Home Visit: Initial visit includes Risk Assessment

2nd Home Visit: ~ 3 weeks later

3rd Home Visit: ~ 4 weeks later

4th Home Visit: ~ 4 weeks later (final home visit)

Therapeutic phone calls (3) between home visits


Direct Services to Families Living with Alzheimer’s Disease (cont.)

Project Assessment

Alabama Risk Assessment (21 items)

ADSS Client Enrollment form (Demographics)Caregiver burden (Zarit 12-item)Caregiver health (Item)Care recipient memory, behavior, & mood (Items)Caregiver Satisfaction Survey (23 items)Focus group with case managers

Why do assessment? What do we gain from all those numbers?


This intervention is now being applied in Shelby County, AL, thanks to a grant from the RCI

and Johnson & Johnson.


Let’s take a short break, then we’ll talk about details.


Forms(examples are available at www.cmha.ua.edu)

Tracking sheet Risk Assessment CG Questionnaire

CG Notebook Case Worker Training Manual


Education about Education about AD, Caregiving, & StressAD, Caregiving, & Stress

Progression of the disease Research about caregiving & stress The importance of self-care

Exercise: (role play) What are some objections that CGs have to self-care? What are some responses to those objections?

*This is often the 1st time anyone has asked about the CG.


Health & SafetyHealth & Safety

Home Safety Check & Risk AssessmentExercise: role playing walk-thrus

Comments, thoughts, suggestions about this exercise?

Following up on suggestions


Stress TechniquesStress Techniques

Signal Breath

ExerciseComments, thoughts, suggestions

about this exercise?


Caregiver Self-CareCaregiver Self-Care

Health Passport Discussion of plans for the CR if CG

is unable to continue Tracking the Passport


Behavioral PrescriptionsBehavioral Prescriptions

“Prescription” ABC’s Finding the right choice for the family Giving it a chance to work Teaching about applying the

technique to other problems


Behavioral Prescriptions

Eating Personal hygiene Communication Repetitive

questions Losing or

misplacing things

Talking loudly or rapidly

Anxiety or worry Verbal aggression Sadness or

depression Wandering


Let’s take another short break, then talk about some challenging

issues for interventionists.


Asking tough questionsAsking tough questions

Why ask? When to ask. How to ask (the wording is important!). Preserving your role, getting the

information, and valuing the working relationship.


Boundaries & Termination IssuesBoundaries & Termination Issues

Your role Small communities and dual

relationships Leaving the clients Support down the road Grief work


Feedback from previous interventionistsFeedback from previous interventionists

Support from advisors/experts very helpful and protective.

Tracking forms were helpful to keep track of caseloads and progress.

Connection to other interventionists was good.


Thank you for your time and attention.

Dr. Burgio & the rest of the staff at the CMHA look forward to working with you in the future!

1 (205) 348-7158www.cmha.ua.edu

Dr. Burgio: [email protected] Wharton: [email protected]

alabama department of senior services irene collins, commissioner

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