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Implementation of the REACH model of dementia caregiver support in American Indian and Alaska Native communities

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

The Resources for Enhancing Alzheimer’s Caregivers Health in the VA (REACH VA) dementia caregiving intervention has been implemented in the VA, in community agencies, and internationally. As identified in the 2013 and 2015 National Plan to Address Alzheimer’s Disease, REACH is being made available to American Indian and Alaska Native communities. Implementation activities are carried out by local Public Health Nursing programs operated by Indian Health Service and Tribal Health programs, and Administration for Community Living/Administration on Aging funded Tribal Aging program staff already working in each community. The implementation is described using the Fixsen and Blasé implementation process model. Cultural, community, health system, and tribe-specific adaptations occur during the six implementation stages of exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Adaptations are made by local staff delivering the program. Implementation challenges in serving AI/AN dementia caregivers include the need to adapt the program to fit the unique communities and the cultural perceptions of dementia and caregiving. Lessons learned highlight the importance of using a clinically successful intervention, the need for support and buy-in from leadership and staff, the fit of the intervention into ongoing routines and practices, the critical role of modifications based on caregiver, staff, and organization needs and feedback, the need for a simple and easily learned intervention, and the critical importance of community receptivity to the services offered.

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Acknowledgements

We would like to thank Marshall Graney, PhD, Memphis VA Medical Center and University of Tennessee Health Science Center for his insightful comments.

The content is solely the responsibility of the authors and does not necessarily represent the views of the Administration for Community Living/Administration on Aging, the Department of Veterans Affairs, Indian Health Service, the University of Tennessee Health Sciences University, the United States government or any Tribal organization.

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, University of Tennessee Health Science Center and Co-Director Caregiver Center, Veterans Affairs Medical Center Memphis, Memphis, USA

    Jennifer Martindale-Adams Ed.D

  2. Division of Nursing Services, Office of Clinical and Preventive Services, Indian Health Service, Rockville, USA

    Tina Tah MBA, BSN, RN

  3. Nashville Area Indian Health Service and Learning and Diffusion Group, CMS Innovation Center, Nashville, USA

    Bruce Finke MD

  4. Office for American Indian, Alaska Natives and Native Hawaiian Programs, Administration for Community Living, Administration on Aging, Washington, USA

    Cynthia LaCounte

  5. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA

    Barbara J. Higgins MA

  6. Caregiver Center, Veterans Affairs Medical Center Memphis and Departments of Preventive Medicine and Internal Medicine, University of Tennessee Health Science Center, 1030 Jefferson Avenue (11h), Memphis, TN, 38104, USA

    Linda O. Nichols Ph.D

Authors
  1. Jennifer Martindale-Adams Ed.D
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  2. Tina Tah MBA, BSN, RN
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  3. Bruce Finke MD
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  4. Cynthia LaCounte
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  5. Barbara J. Higgins MA
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  6. Linda O. Nichols Ph.D
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Corresponding author

Correspondence to Linda O. Nichols Ph.D.

Ethics declarations

Animal welfare

This article does not contain any studies with animals performed by any of the authors.

Funding

This study was supported by the Rx Foundation (no grant number), with additional support from the University of Tennessee Health Sciences University and the Memphis Veterans Affairs Medical Center.

Conflict of interest

The authors declare that they have no conflict of interest.

Data

The findings reported have not been previously published and the manuscript is not being simultaneously submitted elsewhere. There has been no previous reporting of data. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Human rights

The University of Tennessee Health Science Center was the institutional review board of record. The project was judged to be exempt and in accord with 45 CFR 46.116(d), informed consent was waived. The application was determined by IRB to comply with proper consideration for the rights and welfare of human subjects and the regulatory requirements for the protection of human subjects. The implementation of the REACH program reported in this manuscript was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, in that the health, well-being and rights of individuals participating in the intervention were promoted and safeguarded. Privacy and confidentiality were protected with no personally identifiable information being provided to the authors.

Additional information

Implications

Practice: To implement an intervention successfully, even if staff and organizations are engaged, the community must recognize and identify the problem as a concern.

Policy: Sharing of successful caregiving programs across federal and local agencies is an efficient and effective way to serve caregivers, reduce start-up time, and maximize resources, but programs should be targeted to address local community and cultural factors by the individuals implementing the programs.

Research: Future research conducted in partnership with Tribes and local communities is needed to evaluate ways to increase community awareness of dementia and caregiving and different models of providing support to AI/AN caregivers.

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Martindale-Adams, J., Tah, T., Finke, B. et al. Implementation of the REACH model of dementia caregiver support in American Indian and Alaska Native communities. Behav. Med. Pract. Policy Res. 7, 427–434 (2017). https://doi.org/10.1007/s13142-017-0505-1

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  • DOI: https://doi.org/10.1007/s13142-017-0505-1

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