New York University Caregiver Intervention

Primary Practice

Counseling and Support Group Intervention led by Professionals

Description

The NYUCI includes six sessions of individual and family counseling, support group participation, and additional counseling by telephone for the primary caregiver and family members. Each caregiver receives all components of the intervention, and is provided with ad hoc phone/email support for an indefinite period of time. A detailed intake assessment and interview, as well as periodic follow-ups, guide the counseling.

The first component consists of two individual and four family counseling sessions that include relatives suggested by the caregiver (in the original NYUCI, the person with dementia was not included, although in some implementations this is no longer the case). The content of these sessions is determined by a needs assessment of each caregiver and other participating family members (e.g., learning techniques for management of behavioral issues, and promoting communication among family members). Counselors also provided education about AD and community resources. The second component of the intervention is participation in a support group to provide the caregiver with continuous emotional support and education.

The third component of the program is “ad hoc” counseling—the continuous availability of counselors to caregivers and families to help them deal with crises and with the changing nature and severity of their relatives’ symptoms over the course of the disease. The emergence of new psychiatric and behavioral symptoms, or difficulties with ADLs, often precipitated ad hoc calls from caregivers. Ad hoc counseling makes it possible for caregivers and families to determine the amount of contact they have with the counselors beyond the scheduled structured sessions.

Target Population

Caregivers of individuals with dementia

Goals/Objectives

NYUCI was designed to improve caregiving skills, mobilize the support of naturally existing family networks, and provide counseling as needed over the entire course of caring for a spouse with dementia.

Evidence of Outcomes

Evidence-Based Practice
A longitudinal randomized control study was implement starting 1987 and lasted 9.5 years. During that time 206 caregivers received the intervention and reported a decrease in caregiver depression, a decrease in negative caregiver appraisals of behavior problems in the person with dementia, and delays in nursing home placement of the person with dementia. Patients whose spouses received the intervention experienced a 28.3% reduction in the rate of nursing home placement.

A second study was conducted in the US, England and Australia and had 154 caregivers; half of them randomly received the NYUCI. Similar positive outcomes were also reported by participants of this study. Community translations of the intervention in Minnesota, Vermont and Medicaid Managed Care in NYC have served more than 100 caregivers and new community sites around the country are currently enrolling additional caregivers. In the original NYUCI, each counselor was responsible for more than 50 families. An independent evaluation of the first community translation in Minnesota, which began in 2007, estimated that the direct service costs per caregiver would be between $850 and $1430 with an average cost of $1,226.

Additional Information

Description of NYU Caregiver Counseling and Support Intervention from Rosalynn Carter Institute for Caregiving: http://www.rosalynncarter.org/caregiver_intervention_database/dimentia/nyu_caregiver_counseling_and_support_intervention/

References

Mittelman, M., Ferris, S., Shulman, E., Steinberg, G., Ambinder, A., Mackell, J., & Cohen, J. (1995). A comprehensive support program: Effect on depression in spouse-caregivers of AD patients. The Gerontologist, 35, 792-802.

Mittelman, M.S., Ferris, S.H., Shulman, E., Steinberg, G. & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer disease. Journal of the American Medical Association, 276, 1725-1731.

Mittelman, M.S., (2002). Family caregiving for people with Alzheimer’s disease: Results of the NYU spouse caregiver intervention study. Generations, 26(1).

Mittelman, M.S. (2003). Psychosocial intervention for dementia caregivers: What can it accomplish? International Psychogeriatrics, 15, Suppl. 1, 243-249.

Mittelman, M.S., Roth, D.L., Haley, W.E. & Zarit, S.H. (2004). Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer’s disease: Results of a randomized trial. Journals of Gerontology, Psychological Sciences, 59B(1), P27-P34.

Mittelman, M.S., Roth, D.L., Coon D.W. and Haley, W.E. (2004). Sustained benefit of supportive intervention for depressive symptoms in Alzheimer’s caregivers. American Journal of Psychiatry, 161(5), 850-856.

Jang,Y., Clay, O.J., Roth, D.L., Haley, W.E. &. Mittelman, M.S. (2004). Neuroticism and longitudinal change in caregiver depression: Impact of a spouse-caregiver intervention program. The Gerontologist, 44, 311-317.

Roth, D.R., Mittelman, M.S., Clay, O.J., Madan, A., Haley, W.E. (2005). Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer’s disease. Psychology and Aging, 20(4), 634-644.