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Implementation Science in Caregiving: Best Practices

Authors:
Leisa Easom, PhD, RN
Executive Director, Rosalynn Carter Institute for Caregiving

Laura Bauer, MPA
Director of National Initiatives, Rosalynn Carter Institute for Caregiving

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  • Encourage coaching, cheerleading, and certification. As a purveyor, it is critical to become a coach for those caregiver interventions that lacked quality implementation materials, as well as a cheerleader for those programs that have created outstanding training and certification standards.  It is necessary to encourage an open dialogue around legal issues. Development of a licensure/certification process helps to ensure the program is delivered with fidelity. Indemnification is important as well so that risk is minimized and intellectual property is protected.

  • Assess fit and address technical assistance needs. In order to successfully implement an evidence-based caregiver program in a community-based setting, a series of questions must be addressed. How can we do it in the most cost-effective way possible? Whoís doing it? What is the training going to cost and what is the mode of delivery? Does our agency have personnel that can do this? Do we have the resources? Does it fit culturally? Does it meet an identified need in our community?

  • Value needed marketing/recruitment efforts. Common implementation issues exist across translational sites, although needs vary in their intensity.  Researchers (Gul & Ali, 2010; Nichols, et al, 2004; Thomas, 2002) have revealed that recruiting and retaining program participants is the most difficult piece of implementation. RCIís experience in implementing evidence-based programs validates that finding.  From a technical assistance point of view, a significant amount of resources have to be devoted to marketing. Sites need to be able to show that the program helps to achieve the organizationís mission and helps establish new partnerships in the community.

  • Plan ahead for sustainability. Another best practice issue is sustainability. In order for a program to be completely sustainable, it must have a line item in the agencyís budget. Many agencies lack expertise in this area. Identifying potential funding streams to embed a program into an agency should begin immediately, not after grant funding has been depleted and the program is at risk of discontinuation.

  • Manage the data appropriately. Program evaluation is another concern. Many community-based agencies lack expertise in properly obtaining data that will not only indicate whether or not their program produced the expected benefits to caregivers, but also the cost effectiveness of the program. Through technical assistance, agency staff can be taught to identify the proper tools to measure the outcomes they are expecting, but they must also be taught the correct protocols for collecting data both pre- and post-intervention. Depending upon the capacity of the agency, it may be necessary to contract out the statistical analysis of this data.  Data will help make the case for future funding as well.

As a purveyor of evidence-based caregiver programs, RCI continues to refine its training and technical assistance offerings to assist community agencies that have varying degrees of expertise in adopting evidence-based caregiver programs with fidelity. We have launched the RCI National Training Center of Excellence and offer training and certification as well as intensive technical assistance,  in three evidence-based programs: RCI REACH (Resources Enhancing Alzheimerís Caregiver Health); BRI Care Consultation (telephonic support for Alzheimerís) and Operation Family Caregiver (program for service member and veteran families).  For more information, contact the RCI at 229-931-1234 or www.rosalynncarter.org.

 

Leisa R. Easom, PhD, RN is the Executive Director of the Rosalynn Carter Institute for Caregiving (RCI) and Pope Eminent Scholar at Georgia Southwestern State University (GSW). The mission of the RCI is to establish local, state, national and international partnerships committed to building quality long-term, home and community-based services for caregivers in the promotion of caregiver health, skills, and resilience. Dr. Easom was a Professor of Nursing and served as the Chair in the GSW School of Nursing from 2007-2010. Prior to this, she served as the Program Coordinator of the RN-BSN program at Macon State College in Macon, Georgia. She has served as an adjunct professor for the Clinical Nurse Leader graduate program at the Medical College of Georgia. Dr. Easom has been a Registered Nurse for over 30 years and devoted much of her nursing practice to addressing the mental and physical health needs of the older adult population.

Laura Bauer is the Director of National Initiatives for the Rosalynn Carter Institute for Caregiving (RCI) at Georgia Southwestern State University (GSW) in Americus, Georgia. Co-author of the RCIís signature training program, Caring for You, Caring for Me Ė Education and Support for Family and Professional Caregivers, 2nd Edition; Laura has co-authored journal articles in Health & Social Work (2006) Educational Gerontology (2004), Generations (2010), and Aging Today (2012) and contributed chapters to Voices of Caregiving (LaChance Publishing, 2008) and Re-Creating Neighborhoods for Successful Aging (Health Professions Press, 2008).  Laura is a Certified Trainer in 5 evidence-based caregiving interventions: Savvy Caregiver, The Future is Now, RCI REACH, Care Consultation, and Operation Family Caregiver (Problem-Solving Training for Family Caregivers of Returning Service Members). She also teaches 3 courses in the RCIís Certificate in Caregiving Program at Georgia Southwestern.

References 
Gul, R. &  Ali, P. (2010). Clinical trials: The challenge of recruitment and participants Journal of Clinical Nursing, 19(1/2), 227-233.

Nichols, L., Martindale-Adams, J., Burns, R., Coon, D., Ory, M., Mahoney, D., &  Winter, L. (2004). Social marketing as a framework for recruitment: illustrations from the REACH study. Journal Of Aging & Health, 16(5), 157S-176s.

NIRN. (2012). The National Implementation Research Network. Retrieved from http://nirn.fpg.unc.edu/
RCI Caregiver Intervention Database. (RCI CID). (2012). The Rosalynn Carter Institute for Caregiving. Retrieved from http://www.rosalynncarter.org/caregiver_intervention_database/

Sackett D. , Rosenberg W. , Gray J., et al. (1996). Evidence based medicine: what it is and what it isnít: itís about integrating individual clinical expertise and the best external evidence. BMJ, 312, 71 Ė 72.

Thomas V. (2002). Conducting research with community agencies: Meeting recruitment and community challenges. Journal Of Marital And Family Therapy, 28(1), 9-14.

 

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