Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination

Abstract

Background and Objectives A minority of family caregivers receive training, with implications for their own and their recipient’s outcomes. Federal policy has supported implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers’ acceptance of an evidence-based training program in preparation for system-wide dissemination. Research Design and Methods This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers’ reaction and learning and interview questions elicited caregivers’ reports about the value of the program for them. Results Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit. Discussion and Implications Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.

Implementation intensification to disseminate a skills-based caregiver training program: protocol for a type III effectiveness-implementation hybrid trial

“…Caregivers Finding Important Resources, Support, and Training (FIRST) is an evidence-based group skills training for friends or family members of Veterans and is designed to be delivered by existing clinical staff. Core and adaptable components of the Caregivers FIRST intervention were developed in prior work and refined over time using caregiver, provider, and operational partner input [ 15 , 16 , 20 , 21 ], making its design user-centered. VA medical centers implementing Caregivers FIRST must deliver the core components which include four sessions that address caregiver coping, support seeking, hands-on, and health system navigation skills [ 15 , 21 ].…”

“…Implementation support was guided by the Replicating Effective Programs (REP) framework and included five facilitated calls with each site, a two-day site visit, and technical assistance [ 15 ]. Based on the demand for caregiver training and high program satisfaction from caregivers [ 16 ], CSP announced Caregivers FIRST for national dissemination as a ‘strong practice’ program, meaning facilities could elect to begin offering in fiscal year 2021 [ 18 ] and then a mandated ‘minimum standard’ program, where all sites must begin offering in fiscal year 2022.…”