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The Gerontologist 41:481-489 (2001)
© 2001 The Gerontological Society of America

Judging Outcomes in Psychosocial Interventions for Dementia Caregivers: The Problem of Treatment Implementation

Louis Burgio, Mary Corcoran, PhD, OTR/La,b, Kenneth L. Lichstein, PhDc, Linda Nichols, PhDd, Sara Czaja, PhDe, Dolores Gallagher-Thompson, PhDf, Michelle Bourgeois, PhDg, Alan Stevens, PhDa, Marcia Ory, PhDh, Richard Schulz, PhDi and for the REACH Investigators

a Applied Gerontology Program, The University of Alabama, Tuscaloosa
b Department of Health Care Services, George Washington University, Washington, DC
c Department of Psychology, University of Memphis, TN
d Veterans Affairs Medical Center, Memphis, TN, and Stanford University Medical School, Palo Alto, CA
e Center on Adult Development and Aging, University of Miami, FL
f Veterans Affairs Medical Center, Palo Alto, CA
g Department of Communication Disorders, Florida State University, Tallahassee, FL
h Behavioral and Social Science Program, National Institute on Aging, National Institutes of Health, Washington, DC
i University Center for Social and Urban Research, University of Pittsburgh, PA

Correspondence: Louis Burgio, Mary Corcoran, PhD, OTR/L, Applied Gerontology Program, The University of Alabama, 210 Osband Hall, Box 870315, Tuscaloosa, AL 35487-0315. E-mail: Lburgio{at}sw.ua.edu.

Decision Editor: Laurence G. Branch, PhD

Purpose: In published dementia caregiver intervention research, there is widespread failure to measure the level at which treatment was implemented as intended, thereby introducing threats to internal and external validity. The purpose of this article is to discuss the importance of inducing and assessing treatment implementation (TI) strategies in caregiving trials and to propose Lichstein's TI model as a potential guide. Design and Methods: The efforts of a large cooperative research study of caregiving interventions, Resources for Enhancing Alzheimer's Caregiver Health (REACH), illustrates induction and assessment of the three components of TI: delivery, receipt, and enactment. Results: The approaches taken in REACH vary with the intervention protocols and include using treatment manuals, training and certification of interventionists, and continuous monitoring of actual imple-mentation. Implications: Investigation and description of treatment process variables allows researchers to understand which aspects of the intervention are responsible for therapeutic change, potentially resulting in development of more efficacious and efficient interventions.

Key Words: Treatment implementation • Alzheimer's caregiving • Interventions




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