REACH VA: Moving from Translation to System Implementation.
OBJECTIVE
Resources for Enhancing All Caregivers Health in the Department of Veterans Affairs (REACH VA) has been implemented in the VA system as a national program for caregivers.


METHODS
We describe the trajectory of REACH VA from national randomized clinical trial through translation to national implementation. The implementation is examined through the six stages of the Fixsen and Blasé implementation process model: exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Different drivers that move the implementation process forward are important at each stage, including staff selection, staff training, consultation and coaching, staff evaluation, administrative support, program evaluation/fidelity, and systems interventions.


RESULTS
Caregivers in the REACH VA 4 session intervention currently implemented in the VA had similar outcomes to longer REACH interventions, including Resources for Enhancing Alzheimer's Caregivers Health (REACH II). Caregivers experienced significant decreases in burden, depression, anxiety, number of troubling patient behaviors reported, caregiving frustrations, stress symptoms (feeling overwhelmed, feeling like crying, being frustrated as a result of caregiving, being lonely), and general stress. Effect sizes (Cohen's d) for these significant variables were between small and medium ranging from .24 to .46.


CONCLUSIONS
The implementation of REACH VA provides a road map for implementation of other behavioral interventions in health care delivery settings. Lessons learned include the importance of implementing a proven, needed intervention, support from both leadership and clinical staff, willingness to respond to staff and organization needs and modify the intervention while preserving its integrity, and fitting the intervention into ongoing routines and practices.
Veterans Affairs Medical Center Memphis and Departments of Preventive Medicine and Internal Medicine, University of Tennessee Health Science Center, Memphis, TN. linda.nichols@va.gov.
Linda O
LO
Nichols
Department of Preventive Medicine, University of Tennessee Health Science Center and Veterans Affairs Medical Center Memphis, Memphis, TN.
Jennifer
J
Martindale-Adams
Geriatrics Group of Memphis and Departments of Preventive Medicine and Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
Robert
R
Burns
Department of Preventive Medicine, University of Tennessee Health Science Center and Veterans Affairs Medical Center Memphis, Memphis, TN.
Jeffrey
J
Zuber
Department of Preventive Medicine, University of Tennessee Health Science Center and Veterans Affairs Medical Center Memphis, Memphis, TN.
Marshall J
MJ
Graney
D003866:Depressive Disorder / Q000534:rehabilitation*; D006801:Humans; D012944:Social Support; D014481:United States; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans / Q000523:psychology*
Caregiving-informal; Dementia; Organizational and institutional issues