The acronym of the program, REACH, does not correspond to a word with any meaning in Spanish. Based on careful considerations from several focus groups consisting of dementia caregivers, promotoras, and care managers, we renamed REACH I (the small group program) CALMA (Cuidadores Acompañándose y Luchando para Mejorar y Seguir Adelante, which translates to “caregivers giving each other company and striving to get better and move forward”), and we renamed the REACH II program (based on in-home visits and provision of extensive information about caregiving and cognitive impairment) CUIDAR (Cuidadores Unidos Inspirados en Dar Amor y buscar Respuestas, which translates to “united caregivers to give love and seek answers”). Although the new names are not direct or literal translations, the acronyms are meaningful to the target group and conceptually appropriate.

Training workshops for promotoras orient them to the SCRC services and teach them about key aspects related to dementia caregiving. The original length of the training was 10 hours (five 2-hour sessions), but we later condensed it into 5 hours due to logistical issues. Topics covered introduction to the two REACH models, eligibility criteria, and administrative protocols/procedures (e.g., referral protocols); additional services available in the San Diego area for older adults and caregivers; elder abuse and mandated reporting laws; Alzheimer’s disease, dementia, and related cultural beliefs (e.g., Alzheimer’s disease being equal to normal aging); skills to reduce caregiver stress; and plans for monthly promotora meetings and regular in-services. Lastly, we gave promotoras reading materials in both English and Spanish on topics related to Alzheimer’s disease and associated dementias, caregiving facts and statistics, and common signs of depression and anxiety.

The purpose of the 2-day training workshop for care managers was to train the two bilingual/bicultural master’s degree-level care managers hired by the SCRC to deliver the REACH interventions. On the first day, Dr. Gallagher-Thompson and Dr. Cardenas trained them in how to deliver the CUIDAR home-based caregiver intervention (corresponding to REACH II). They highlighted adherence to the original treatment protocol by including topics such as the following:

We redesigned the CALMA small group program to include four group sessions to be offered by a trained care manager with assistance from a promotora. The care managers acted as lead group facilitators responsible for teaching the skills and exercises covered in the session. The promotoras assisted the care managers in various ways, such as walking around the classroom to assist individual caregivers with the exercises and materials (especially for caregivers with literacy issues or needing help writing their responses). We also offered three between-session telephone calls. Care managers would check in with caregivers on how things were going as they were implementing suggested changes and practicing their assigned exercises at home. The four CALMA group sessions encompass the key components from REACH I: managing stress with relaxation exercises; increasing pleasurable activities (i.e., behavioral activation); cognitive restructuring; assertiveness training to help manage anger and frustration; and getting the help one needs. We eliminated certain components from the original protocol because other SCRC services readily offered them. The format of the sessions closely followed the original REACH I procedures. For example, each session started with a review of the previous class material and home practice assignments and ended with an introduction of a new relaxation exercise. Additionally, to ensure program fidelity, we required care managers to audio-record the sessions, which a consultant later reviewed and rated, and both care managers and promotoras had opportunities to ask questions and receive feedback from weekly supervision meetings.

The CUIDAR home-based program was redesigned to include four individual home sessions offered by a care manager and three telephone calls in between home sessions (a shortened version of the original REACH II protocol). We tailored each session to the individual caregiver’s needs by determining which modules included in the Caregiver’s Guide were most relevant and important.

The decision as to which content areas would be covered was based on review of baseline assessment information and consultation with Dr. Gallagher-Thompson, who met by teleconference biweekly with the care managers for the first year of program implementation. Following the original REACH II model, each session took place with the individual caregiver in his or her home and lasted up to 2 hours. The telephone calls provided an opportunity for the care managers to check in and give feedback to the caregivers on the specific skills that were being taught.

Care managers could choose among the following modules:

We implemented several measures to maintain fidelity to the original REACH interventions. Consultants again carefully reviewed final materials, and the care managers were required to attend training sessions (described earlier) to learn the steps to deliver the interventions correctly. For both programs, care managers were required to audio-record their sessions for fidelity checks. These were done by Veronica Cardenas, who is a bilingual/bicultural Spanish speaking psychologist who worked on the original REACH projects in northern CA with Dr. Gallagher-Thompson. Feedback was provided to the care managers in a timely manner so that the interventions would be delivered as planned.

We further modified the programs following the initial launch. At first, the four sessions in both programs were to be offered every other week (per consultants’ recommendations) as a way to extend the length of contact with caregivers and allow more time for materials to be absorbed and applied to caregivers’ situations. The SCRC quickly discovered, however, that a significant number of caregivers were not returning or were missing from sessions. As a result, the four sessions were offered in consecutive weeks—a modification that significantly improved participant retention and satisfaction with the program.