Judging outcomes in psychosocial interventions for dementia caregivers: The problem of treatment implementation

Purpose: In published dementia caregiver intervention research, there is wi despread failure to measure the level at which treatment was implemented as intended, thereby introducing threats to internal and external validity. T he purpose of this article is to discuss the importance of inducing and ass essing treatment implementation (TI) strategies in caregiving trials and to propose Lichstein's TI model as a potential guide. Design and Methods: The efforts of a large cooperative research study of caregiving interventions, Resources for Enhancing Alzheimer's Caregiver Health (REACH), illustrates induction and assessment of the three components of TI: delivery, receipt, and enactment. Results: The approaches taken in REACH vary with the interve ntion protocols and include using treatment manuals, training and certifica tion of interventionists, and continuous monitoring of actual implementatio n. Implications: Investigation and description of treatment process variabl es allows researchers to understand which aspects of the intervention are r esponsible for therapeutic change, potentially resulting in development of more efficacious and efficient interventions.