Risk Area 2: Keeping the Caregiver Physically Healthy

This chapter describes one of the five risk areas, namely, caregiver physical health. Outcomes in caregiver intervention research commonly have focused on the mental health or psychosocial consequences of caregiving. Caregiving can be a prolonged stressor, however, and caregivers may be at risk for conditions such as high blood pressure or other negative physical health symptoms. This chapter focuses on basic education regarding caregiver health by referring clinicians and caregivers to the Healthy Lifestyle Guide, located in the Appendix. When caregiver health issues are identified through the risk assessment, clinicians can reference this chapter as they create their Action Plans targeting improvement in caregiver physical health.

Risk Area 1: Home Safety

This chapter describes one of the five risk areas, namely, home safety. It aims to lead clinicians and caregivers through the process of ensuring personal safety for both the person with dementia and the caregiver. Clinicians are given a brief list of home safety items to check, arranged by area of the home, and referenced to an Appendix of this manual where a full Home Safety Checklist can be found. When safety problems are identified through the risk assessment, clinicians can incorporate items from these lists into their Action Plans in order to promote home safety. This chapter may be revisited throughout the REACH OUT protocol as new issues related to safety are identified.

Risk Area 5: Social Support

This chapter describes one of the five risk areas, namely, social support. The chapter is designed to address problems regarding social isolation and to help caregivers maintain contact with their social network. The goal of this chapter is to help caregivers receive the assistance they need with both caregiving and noncaregiving tasks from both formal (e.g., community services or agencies) and informal (e.g., family and friends) sources. When issues of isolation or low social support are identified in the risk appraisal, this chapter will be used to guide Action Plan development in order to provide caregivers with the resources and information they need to improve social support.

Filling in the Gaps

This chapter highlights and reiterates important clinical issues, REACH OUT materials, and roadblocks to success. It begins with a few clinical suggestions and a list of materials to bring to each session in order to help clinicians fill in the gaps and increase the likelihood of a successful REACH OUT intervention. This chapter also discusses common barriers faced over the course of the intervention as well as possible solutions. Clinicians will find this chapter helpful when faced with issues that commonly arise, such as dealing with off-topic discussions, caregiver limitations in hearing or vision, or low literacy levels.

Risk Appraisal and Action Plans

This chapter describes the first session and the basic components of the REACH OUT intervention. The first session focuses on risk appraisal, conducted using two standardized measures, which helps the clinician and caregiver jointly establish a hierarchy of needs and goals for treatment and organize them according to the five risk areas. The chapter then outlines, step-by-step, the core process of REACH OUT: the creation of formal Action Plans. The goal of this intervention is to engage the caregiver in joint problem solving with the objective of creating written Action Plans targeting specific caregiving problems (e.g., improving caregiver health, addressing hazards in the physical environment). The chapter ends with tips for the clinician to keep in mind when working with caregivers to develop Action Plans.

Risk Area 4: Managing Challenging Behaviors

This chapter describes one of the five risk areas, namely, managing challenging behaviors. The chapter begins with a description of the ABC Process of Behavior Management. Learning this process will help clinicians structure the development of individualized Action Plans and target behavior with the greatest likelihood of success. The chapter also includes instructions to format Challenging Behavior Action Plans as well as guidelines for presenting these Action Plans to the caregiver. The chapter ends with tips, reminders, and advice for clinicians on working with caregivers to reduce and manage challenging behaviors of the person with dementia.

Risk Area 3: Caregiver Emotional Well-Being

This chapter describes one of the five risk areas, namely, caregiver emotional well-being. Caregiving for a person with dementia often is associated with increased levels of depression, stress, anxiety, and anger. This chapter focuses on two strategies designed to improve caregiver emotional well-being: relaxation to reduce stress and increasing engagement in pleasant events. Clinicians are given instructions to teach caregivers the Signal Breath technique, a deep breathing skill to help increase alertness and reduce stress. The chapter also includes worksheets designed to be filled out with the caregiver in order to identify and plan pleasant events for both the caregiver and the person with dementia.

Development and Overview

This chapter describes the basic tenets of the REACH OUT protocol and how they came to be. It begins with an overview of the development of the REACH OUT protocol and details the program’s evolution over more than two decades. The chapter describes the five risk areas around which the REACH OUT program revolves: home safety, physical health, emotional well-being, behavior management, and social support. Following this, it provides a brief description of the tools available to the clinician as well as the intervention strategies utilized on a session-by-session basis. The chapter ends with a sample intervention schedule to help the clinician organize a potential timeline for treatment.