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HSR Partnered Research Leads to QUERI Scale-Up and Spread: Implementing a Caregiving Training Support Program

In the U.S., there are approximately 53 million friends or family caregivers who provide in-home help. Of those, approximately 5.5 million are caregivers for Veterans. While this informal care may reduce health system costs and increase Veteran days at home, it can lead to unintended consequences with caregivers experiencing strain, burden, burnout, and depression. Education and support can decrease caregiver burden and depressive symptoms, yet less than 10% of caregivers report getting the training they need. Addressing this gap is a priority for the VA Caregiver Support Program.

To help address the VA priority of supporting Veteran whole health, their caregivers, and survivors, Courtney Van Houtven, PhD, an investigator with the HSR Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), and her team developed and implemented Caregivers FIRST. Designed to build caregiver skills and support and improve satisfaction with care, Caregivers FIRST is a caregiver skills group training program that helps caregivers connect with each other and to other resources to help them feel more confident and supported in their caregiving role. Caregivers FIRST includes four classes and optional training topics that help caregivers learn and practice coping, support-seeking, and hands-on skills. Caregivers FIRST is unique in that it is applicable to any diagnosis a Veteran may have (i.e., it is not condition-specific), is offered at a potential tipping point when caregivers may need support, and is of national relevance.

The Caregivers FIRST journey, from research discovery to national real-world dissemination.

The HSR-funded four-year randomized clinical trial (RCT) engaged diverse partners throughout VA, including the VA Caregiver Support Program, Geriatrics and Extended Care staff, and social workers, from the beginning and throughout the trial. Results from the trial conducted at the Durham VA Medical Center demonstrated that Caregivers FIRST increased overall caregiver satisfaction with VA care and filled an important gap in caregiver group trainings.

To enhance the fit of Caregivers FIRST for implementation across diverse VA sites, Dr. Van Houtven and her team worked with the VA Caregiver Support Program to design and execute a QUERI-funded hybrid type III effectiveness implementation trial to evaluate the implementation of Caregivers FIRST in eight VA sites and understand its impact on Veteran independence (Veteran days spent at home) and caregiver function (caregiver burden, depressive symptoms).

The success of the QUERI-funded trial led to the VA Caregiver Support Program selecting Caregivers FIRST for national rollout and included dissemination of the Caregivers FIRST Toolkit as part of the minimum clinical practice standards to all 142 Caregiver Support Program sites. To support further scale-up, spread, and sustainment of Caregivers FIRST, Dr. Van Houtven and her team submitted Caregivers FIRST to the Diffusion of Excellence Shark Tank, proposing a QUERI hybrid type III effectiveness implementation trial to examine the effectiveness of specific implementation strategies. QUERI is currently funding this effort as part of the Function QUERI Program Center. In 2021 and 2022, Caregivers FIRST was selected as a semifinalist in the Diffusion of Excellence Shark Tank and was also featured in the Diffusion Marketplace.

To date, Caregivers FIRST has provided training and implementation toolkits to more than1,300 VA employees across all sites nationwide, reaching more than 4,600 family or friend caregivers of Veterans. The Caregivers FIRST Diffusion Network is helping to share best practices, disseminate key information, and enable sites to collaborate and learn from each other.