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Takeaway: Over time, the estimated 14 million-plus family members and friends who provide in-home care for Veterans can feel burdened, burned out, and isolated. Working with VA partners, HSR and QUERI investigators helped drive Caregivers FIRST, a caregiver training and support intervention, from development to a single-site trial and onward to VA-wide adoption. Today, Caregivers FIRST has provided training and implementation toolkits to more than 1,500 VA employees nationwide and has reached more than 5,500 family and friend caregivers of Veterans.
Caregivers FIRST has been shown to provide benefits that include:
An estimated 14 million-plus family members and friends provide in-home care for Veterans. [1] While this informal care might reduce health system costs and enable Veterans to live at home longer, it can leave caregivers feeling burdened, burned out, and isolated.[2]
To mitigate some of the negative consequences of caregiving and enhance the quality of care that caregivers provide, Courtney Van Houtven, PhD, formerly of the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), and her team developed “Caregivers Finding Important Resources, Support, and Training” (Caregivers FIRST; previously “iHI FIVES”), a program for caregivers that includes four group classes plus optional training topics. Caregivers FIRST helps caregivers connect with each other and with resources to enhance their confidence and support. It teaches coping methods, health system navigation, and hands-on skills for caretakers of Veterans of any age or diagnosis.
“Caregivers FIRST was one of our most successful programs that we ever ran at Hines VA. Our caregivers absolutely loved it.”—Jillian Inserra, former Caregiver Support Program VISN lead, Caregivers FIRST pilot site.
Following a four-year randomized clinical trial at the Durham VA Medical Center that engaged VA’s Office of Caregiver Support, Geriatrics and Extended Care staff, and social workers and showed the effectiveness of caregiving training, Dr. Van Houtven and her team submitted Caregivers FIRST to VA’s Diffusion of Excellence Shark Tank. The resulting 2016 effectiveness implementation trial led by Function QUERI examined the effectiveness of specific implementation strategies for Caregivers FIRST in eight VA sites. The trial also assessed the adaptability of Caregivers FIRST and its impact on Veteran independence and caregiver function (e.g., caregiver burden, depressive symptoms).
In 2021, the proven effectiveness of Caregivers FIRST led the Office of Caregiver Support to name the program as part of minimum clinical practice standards. National rollout ensued, with dissemination of the Caregivers FIRST toolkit to all 142 VA Caregiver Support Program sites.
To learn more about Caregivers FIRST, check out the HSR Cyberseminar “Research to the Real World: Insights from Implementation of a Caregiver Support Training Program.”
Today, Caregivers FIRST has provided training and implementation toolkits to more than 1,500 VA employees across all sites nationwide and has reached more than 5,500 family and friend caregivers of Veterans. Caregivers FIRST has successfully achieved widespread adoption and sustainment with delivery as part of usual clinical care and support from VA program offices. Now officially under the Caregiver Support Program, Caregivers FIRST continues to share best practices and key information while it enables sites to collaborate with and learn from each other.
VA Caregiver Support Program
[1] https://www.rand.org/pubs/research_reports/RRA3212-1.html
