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SESSION-BY-SESSION DETAILS

Although Figure 3.2 indicates the components and associated activities to be accomplished in an intervention, it does not specify what happens and when and in what sequence or order. On the basis of a task analysis, and with pilot testing (e.g., Phases I and II), specific delivery characteristics can be further identified and refined. For example, the location of the intervention (e.g., office, home, clinic, community center), the dose and intensity of the intervention, how the intervention will be delivered (via technology, telephone, in groups, face-to-face), and by whom are some of the specific decisions that have to settled upon. All of these specific delivery considerations are explored in depth in Chapter 5.

Prior to any test of an intervention or its components, a protocol of what will be evaluated needs to be documented. One must specify the sequence of steps and activities that will occur. We recommend creating what can be referred to as a “session-by-session content chart” to help delineate what will happen in the intervention in such a way that it can be replicated by interventionists. Table 3.2 provides an example of a session-by-session description of the GBGB intervention. This table can be modified on the basis of pilot testing in Phases I and II before entering a definitive efficacy trial and serves as a working document for refining the content and flow of an intervention.

This session-by-session content chart is useful for individual and/or group formats. The applicability to technology-delivered interventions varies according to the role of the technology. For example, if an investigator was examining the usefulness of a technology-based reminder system that alerts a patient about medication- and glucose-monitoring schedules, a session-by-session content chart would have limited utility. If, however, the technology is being used to facilitate the delivery of an intervention (e.g., an Internet-based skill-building program, videoconferencing), a session-by-session content chart would have utility and in fact be important to treatment fidelity. For example, in the videophone caregiver intervention study (Czaja, Loewenstein, Schulz, Nair, & Perdomo, 2013), videophone technology was used to deliver an evidence-based intervention program that involved individual skill- building sessions led by a trained interventionist and facilitated caregiver support groups. To help ensure treatment fidelity and internal validity, detailed session-by-session protocols were developed for the individual skill-building sessions as illustrated in Table 3.3.

TABLE 3.2 Example of a Session-by-Session Content Chart of the Get Busy Get Better Intervention

Session

Location

Intervention Activities

Materials Needed

Screening

On-site senior center or via telephone

  • ? Assess for depression symptoms and eligibility for participation
  • ? Use Patient Health Questionnaire-9 (PHQ- 9) > 5 score as cutoff for participation
  • ? Referral form
  • ? Script explaining intervention

Session 1 (within 1 week of referral)

Home or senior center

  • ? Rapport building
  • ? Care management assessment
  • ? Review depressive symptoms
  • ? Introduce relationship between behavior and mood
  • ? Introduce and practice deep breathing
  • ? Referral and linkage to primary physician, if necessary
  • ? Clinical interview
  • ? Stress reduction handout

Sessions 2-3 (2nd and 3rd weeks from referral)

Home

  • ? On the basis of care management assessment, identify problem and potential resolution
  • ? Help make linkages with appropriate services, if necessary
  • ? Review ways to talk to one's doctor about symptoms
  • ? Review connection between behavior and mood
  • ? Complete forms together
  • ? Review deep-breathing technique
  • ? Documentation binder
  • ? Resource materials
  • ? Depression education materials

Sessions 4-5 (4th and 5th weeks from referral)

Home

  • ? Review care management plan
  • ? Review mood and activity forms and complete together daily activity recording and mood-rating forms
  • ? Identify list of pleasant events and meaningful activities of importance to person
  • ? Use problem solving to identify one activity that would make the person feel better
  • ? Break activity/task into small manageable steps
  • ? Rate likelihood of completing steps in week
  • ? Review deep breathing/ introduce stress reduction technique (counting; music)
  • ? Documentation binder
  • ? Behavioral activation rating forms

TABLE 3.2 Example of a Session-by-Session Content Chart of the Get Busy Get Better Intervention (Continued)

Session

Location

Intervention Activities

Materials Needed

Sessions 6-8 (every other week)

Home or telephone depending upon participant need and progress as measured by PHQ-9 and activation forms

  • ? Review depressive symptoms and condition
  • ? Review progress on all goals
  • ? Continue with second and third activity planning and tracking selecting new goals to attain
  • ? Validate accomplishments and support goal attainment
  • ? Documentation binder
  • ? PHQ-9

Sessions 9-10 (every other week

Home

  • ? Review depressive symptoms and conditions
  • ? Review all accomplishments
  • ? Encourage person to maintain gains and seek to attain new goals
  • ? Obtain closure

? Documentation binder

TABLE 3.3 A Sample of a Session-by-Session Protocol Developed for the Videocare Project

VIDEOCARE Phone Session # 2

Today's session will focus on common problem behaviors of dementia disorders. During the first part of our meeting, I will review common problem behaviors that have been identified by some caregivers in the past and practical suggestions for dealing with these problem behaviors. The second part of our meeting will be devoted to an open discussion to learn more about how some of these problem behaviors relate to your current situation. Please, feel free to take notes and share your own experience regarding today's topics.

 
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