PROJECT SUMMARY The daily task of "caring for those that have borne the battle" falls not only to health care professionals, but also to the well over 20,000 informal caregivers who provide critical in-home care for Veterans with serious chronic conditions. The VA Central Office Caregiver Support Program (CSP), which has worked closely with us to develop this proposal, is tasked with developing programs that support caregiving activities and caregiver health and, by extension, Veteran well-being. Building Better Caregivers (BBC) is an online, evidence-based program designed to boost caregiver skills and self-efficacy. The CSP began its national dissemination throughout the VA in January 2013. Early data indicate wide variation in caregiver enrollment across VA facilities (0 to >40 dyads/facility), indicating a need for implementation evaluation and improvement. We conducted preliminary interviews using the PARIHS framework of implementation sciences to build knowledge and develop data collection instruments that would distinguish implementation characteristics of high enrollment sites. These data strongly suggest that this national experiment in implementation of caregiver support will yield valuable lessons on how best to disseminate this important program. This proposal will generate the pilot data necessary to plan a comprehensive implementation evaluation and to design and test an intervention to boost BBC implementation in a subsequent Service Directed Project (SDP). The proposal will proceed with three specific aims: Aim 1: Identify national & regional characteristics of successful rollout of caregiver support program We will conduct semi-structured interviews with 5 national and 5 regional leaders regarding implementation characteristics considered important to BBC rollout success. Questions will derive from the revised PARIHS constructs of evidence, context, facilitation, and implementation success. We will apply qualitative analytic approaches to transcripts to identify key implementation characteristics at national and regional levels. Aim 2: Identify facility characteristics associated with high caregiver enrollment We will survey and interview VA staff and caregivers at local VA facilities-two with high and two low BBC enrollment. We will recruit staff involved in the BBC rollout (20 total, 5/facility) and caregivers who have and have not enrolled in the BBC (9 total, 2-3/facility). We will perform surveys and semi-structured interviews (also using PARIHS-derived questions) that probe regarding implementation topics. We will summarize survey findings with descriptive statistics and apply qualitative analytic approaches to interviews to identify implementation characteristics likely specific to high enrollment facilities. Aim 3: With partners, integrate findings, make recommendations, & plan targets for future evaluation This Aim will culminate in a full-day development meeting of the evaluation team, Advisory Group, and other project partners. Meeting discussion will generate a collaborative report that (a) integrates proposal findings, (b) recommends implementation characteristics amenable to immediate refinement, (c) describes draft implementation interventions and characteristics that require comprehensive targeting, and (d) designs the future SDP, all of which comprise the deliverables of the proposal. In sum, this proposal will identify key characteristics of successful implementation of the BBC program. Upon its completion, we and our project partners will be able to target some implementation characteristics for immediate refinement and others for further study and implementation intervention in a subsequent SDP. This collaborative, step-wise approach will inform, galvanize, and spread national dissemination of a signature VA program for Veteran caregivers.

Project Narrative Patients with posttraumatic stress disorder (PTSD), traumatic brain injury, and other serious chronic conditions have better outcomes when their family and other informal caregivers are involved in their treatment and can perform caregiving effectively. Veterans want them involved-for example, 76% of Veterans with PTSD want greater family involvement in their care. The VA Central Office Caregiver Support Program (CSP) is tasked with supporting caregivers of Veterans. They commissioned the development of an online caregiver training and social support program called Building Better Caregivers and began its national rollout throughout the VA January 2013. But this rollout has only been moderately successful. The proposed project will provide necessary pilot data for a larger evaluation to better understand how to extend the program's reach and impact. If the VA can determine how best to disseminate effective training and support to large numbers of caregivers nationally, tens of thousands of Veterans may reap the rewards.