Evidence-Based Practices and the Rosalynn Carter Institute

Implementing EBPs on a large scale and making them easily accessible to family caregivers is challenging work. The mission of the Rosalynn Carter Institute ion Caregiving (RCI) is to build quality home and community-based supports for family caregivers. Increasing the use of evidence-based interventions (EBPs) is an important part of this work. We define evidence-based to mean that an intervention has undergone sufficient scientific evaluation to have demonstrated its ability to achieve outcomes of importance to family caregivers and has been thoroughly described in a peer-reviewed scientific journal. The "gold standard" of evaluation is the randomized, controlled trial (RCT), and an increasing number of interventions for family caregivers have been tested in this manner. Why Evidence-Based Programs? The Institute of Medicine defines quality health care as: "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (Lohr, 1990). Evidence-based interventions, by meeting both these standards, provide a solid foundation on which to build quality supports for family caregivers. While continued research is needed to answer questions about how well EBPs work in diverse settings and the durability of their effects, Covinsky and Johnston (2006) summed up the feelings of many who see the urgent need for improved caregiver supports. In an editorial accompanying publication of REACH II (Resources for Enhancing Alzheimer's Caregiver Health II) and NYUCI (New York University Caregiver Intervention) clinical trials results (two evidence-based programs for Alzheimer's caregivers) they concluded: "Despite these uncertainties, we shouldn't let the perfect be the enemy of the good. If these interventions were drugs, it is hard to believe that they would not be on the fast track to approval. The magnitude of benefit and quality of evidence supporting these interventions considerably exceed those of currently approved pharmacological therapies" (p.780). Because EBPs represent the state-of-the-art of professional knowledge and practice, their widespread adoption represents a significant opportunity to improve the overall quality of assistance provided to family caregivers. Background In 2006 and 2007, the National Institutes of Health, the U.S. Department of Health and Human Services, and the Veterans Administration brought together caregiving researchers in a workshop entitled 'the Science and Practice of Informal Caregiving." These researchers conducted a review of interventions for informal caregivers, with a focus on interventions tested in RCTs. The review identified 60 RCT studies, of which 46 showed significant positive outcomes. The group concluded that many negative aspects of caregiving could be improved by implementing already existing interventions (Amsellem, Harris, and Sieverding, 2007). They recommended that a database be maintained and developed as a resource for the field and that vigorous efforts to disseminate information about effective interventions be undertaken as well (Amsellem, Harris, and Sieverding, 2007). Following this conference, RCI worked with members of the group to transfer the database to RCI for further development and began planning the "First National Summit on Evidence Based Practice in Caregiving." This summit took place in October 2007 in Americus, Georgia. Participants included nearly 300 caregiving researchers, as well as agency and program leaders, caregiving advocates, and policy makers from 42 states. After two days of presentations and discussion, the group concluded that the majority of effective interventions for caregivers were not being implemented through the aging network, the National Family Caregivers Program, or through Medicaid, Medicare, or private health insurance. As a result, family caregivers were significantly underserved. …