Working with individuals living with dementia and their family caregivers requires a special kind of dedication. We are glad to be part of the team bringing services and support to people affected by dementia in the state of Florida.

At this time, this intervention is only offered through referral by Dr. Rosemary Laird at the MDC at AdventHealth Orlando.

If you are interested in participating in the FL-REACH intervention, please contact Dr. Laird's office or Dr. Wharton for more information.

Funding for this program is provided by a grant from the Ed & Ethel Moore Alzheimer's Research initiative of the Florida Department of Elder Affairs (2019-2021; PI: Wharton)


Health Impact

The state of Florida spends an estimated $20 billion per year on care and treatment of individuals with Alzheimer’s disease. With more than 500,000 patients residing in the state, that equals nearly 10% of the total US cases. Our healthcare system could never support the majority of this population in long-term care, and consequently relies heavily on the family caregivers of these individuals to provide the bulk of ongoing care in community based settings. According to the Department of Elder Affairs Purple Ribbon Task Force (Department of Elder Affairs, 2013), informal caregivers save the state significant money by fulfilling the Florida State Plan on Aging Objective 2.7: preventing premature facility placement, and by taking the burden off of the healthcare and funding systems (Department of Elder Affairs, 2013). According to the report, 75% of informal caregivers felt that early education and training should be a high priority for the state; 22% of these caregivers reported having no additional help in their duties, and the report concludes that difficult behaviors and limited knowledge about Alzheimer’s disease and other dementias were among the most significant challenges that they faced. Alzheimer’s is a disease where it is known that there is risk of future events that may be fairly predictable. Early intervention for training and contingency planning could ensure that caregivers have effective supports in place. Home based support and maintenance in the community “is considerably less expensive than a transfer to a hospital or institution” (Department of Elder Affairs, 2013, p.42).

This project is focused on the diverse individuals and their caregivers who receive a diagnosis of Alzheimer’s disease or another type of dementia from the Advent Health-Orlando Memory Disorder Clinic (MDC), and is targeted at the novel context of the specialty outpatient clinic where they receive ongoing care. Using validated instruments, this study will demonstrate that a six week intervention can build on relationships and create a foundation for future intervention by providing common language and conceptualization that caregivers can apply to engage in future resources and supports.

Previous research has demonstrated that skills-based learning can transfer- meaning that families who are able to adopt problem-solving strategies early on should be able to apply those same skills later when more complex challenges arise (Burgio et al., 2009; Hepburn, Lewis, Tornatore, Sherman, & Bremer, 2007; Schulz et al., 2003). If we can provide patients and families with these high impact aspects of care coordination and intervention early enough in the disease progression, we can build foundational skills and knowledge which can provide the groundwork for future care by teaching language to describe and manage disease related symptoms, skills to problem solve meaning and need related to developing behavioral expressions, and awareness and willingness to engage with community and clinic based resources that are not standard mechanisms of care, such as legal and financial services, community-based support groups, art or music groups, or family support networks.


Burgio, L., Collins, I., Schmid, B., Wharton, T., McCallum, D., & Decoster, J. (2009). Translating the REACH caregiver intervention for use by area agency on aging personnel: the REACH OUT program. The Gerontologist, 49(1), 103–16.

Department of Elder Affairs. (2013). Department of Elder Affairs Purple Ribbon Task Force 2013 Final Report and Recommendations, State Plan on Alzheimer’s Disease and Related Forms of Dementia. Tallahassee, FL.

Hepburn, K., Lewis, M., Tornatore, J., Sherman, C. W., & Bremer, K. L. (2007). The Savvy Caregiver program: the demonstrated effectiveness of a transportable dementia caregiver psychoeducation program. Journal of Gerontological Nursing, 33(3), 30–36.

Schulz, R., Belle, S. H., Czaja, S. J., Gitlin, L. N., Wisniewski, S. R., & Ory, M. G. (2003). Introduction to the special section on Resources for Enhancing Alzheimer’s Caregiver Health (REACH). Psychology and Aging, 18(3), 357–360.

The FL-REACH Project Intervention Components

Esta intervención está disponible tanto en inglés en español.

This Intervention is available in both English and Spanish.

The FL-REACH intervention is a 6-session intervention designed to facilitate transition to care following delivery of a memory disorders diagnosis by a MDC team. Families often acknowledge shifting responsibilities and adaptation to new roles following delivery of a dementia diagnosis. Thus, the FL REACH intervention is designed as the first step of a broader stepped caregiver intervention program.

Practical elements of the REACH interventions have been selected for The FL REACH Translation Project in order to bring useful interventions into everyday practice to improve the lives of individuals living with dementia and their caregivers. Length of the intervention and chosen aspects from the original REACH studies were identified through ongoing dialogue between the research team and clinical leadership at the MDC. We aimed for inclusion of impactful practices that could be delivered efficiently in a reasonable amount of time in the outpatient clinical context. The primary approach in selection of components was to include broad areas of the original intervention, while shortening the length of time and intensity with which training is focused- for example, moving from teaching 4 possible stress reduction techniques to teaching one technique that was well-received in all previous trials, and prioritizing needs of the family to identify 1-2 behavioral prescriptions, rather than completing 4-6 behavioral prescriptions as is done in the original intervention.


This translation of the REACH II intervention is based on the RESST principle:

Build Rapport with the family.

Empower them to make decisions, ask questions & be the best advocate.

Safety issues come first; problem solve things before they happen and have a plan.

Skills-building is an ongoing process and gives the family options.

Team the family up- with community resources, with extended family & friends, and with their medical team.


Overview

Interventionists will have both face-to-face and telephone interventions with family or informal caregivers of individuals living with dementia: 4 visits and 2 therapeutic phone calls over a period of 6-8 weeks (allowing for some flexibility in scheduling); intake paperwork and assessments are done prior to the Week 1 meeting.

  • Prior to first meeting: Intake paperwork and assessments (at the clinic)
  • – Week 1: face to face meeting at the clinic; Initial visit includes Risk Assessment
  • – Week 2: face to face meeting at the clinic
  • – Week 3: phone check-in and review of progress
  • – Week 4: face to face meeting at the clinic
  • – Week 5: phone check-in and review of progress
  • – Week 6: face to face meeting at the clinic; final visit includes final assessments.
  • – Approximately 6 months later: follow-up assessment at the clinic, as possible.


At this time, this intervention is only offered through referral by Dr. Rosemary Laird at the MDC at AdventHealth Orlando.

If you are interested in participating in the FL-REACH intervention, please contact Dr. Laird's office or Dr. Wharton for more information.

Personnel Involved in the FL-REACH Project

Principal Investigators:

Tracy Wharton, PhD, MSc, MEd, MSW, LCSW
University of Central Florida
508-280-8715
Tracy.Wharton@ucf.edu

Daniel Paulson, PhD, Clinical Psychologist
University of Central Florida
407-823-3578
Daniel.Paulson2@ucf.edu
https://sciences.ucf.edu/psychology/older/ 
https://www.liveoakbehavioralhealth.com/ 

Rosemary Laird, MD, MHSA
Advent Health-Orlando

Personnel:

Team Members, Project Planning, and Supervision on-site:

Judy Clark, MSW, LCSW
Advent Health-Orlando
 
Gayle Shepherd, RN
Advent Health-Orlando

Project Coordination:

Nicolas James, M.S., Psychology Doctoral student
University of Central Florida
Nicholas.James@ucf.edu

Interventionist

Juan Herrera Ramirez, MSW
Juan.HerreraRamirez@ucf.edu

Project Design and Planning Support

Felicia Bender, BSW, UCF alum
Angie Moliere, BS, UCF alum
Lorriann Brooks, BS, UCF alum