Table 3.

Overview of the Activity Program

Session #	Week #	Type of contact	Session content
Phase 1 – Assessment of Caregiver, Dementia Patient and Environment
1	1	Home visit	• Provide overview of intervention goals and particular session goals • Provide caregiver with 36 hour day as a resource book and the Caregiver Notebook     - Discuss how Notebook will be used in each session and help caregiver find a place to keep the Notebook for easy access     - Provide basic information about caregiving, dementia, challenging behaviors, and value of structured and customized activities     - Refer to materials in Caregiver Notebook • Conduct clinical interview with caregiver (review daily routines, preferences and interests and pleasant event) • Observe caregiver-patient communication and management techniques • Begin assessment of dementia patient (MMSE, Allen's cognitive assessments) • Evaluate patient comportment • Have caregiver complete Pleasant Event Survey • Review main points made in session and obtain closure • Establish next meeting date
2	2	Home visit	• Provide overview of specific session goals • Review education materials and inquire if caregiver has questions • Review Pleasant Event Survey and information from clinical interview to begin to brainstorm and identify specific activities that may be of interest • Continue with Allen cognitive assessments with dementia patient (ALLLEN Placemat) • Introduce stress reduction technique (signal breadth) to help caregiver manager their stress and set a positive emotional tone for activity engagement • Observe/evaluate areas of home (lighting, safety) in which activity will be conducted • Review main points made in session and obtain closure • Establish next meeting date
Phase 2 – Introduction of Activity, Communication, Task breakdown and Environmental Simplification Techniques
3	3-4	Home visit	• Provide overview of sessions goals • Review assessment results with caregiver • Provide 3 written activity prescriptions and ask caregiver/dementia patient (if appropriate) to select first activity to focus on • Review first activity prescription and implement:     - Use role play to show caregiver how to set up activity or if possible demonstrate set up and activity with dementia patient     - Instruct in relevant strategies (communication, cueing, environmental and task simplification techniques)     - Introduce activity with dementia patient and have caregiver practice how to set up activity     - Practice reinforce and validate caregiver techniques and dementia patient participation • Provide specific practice schedule (e.g., when to introduce activity each day and number of times in day/week to use) and how to integrate within a structured daily routine • Review main points made in session and obtain closure • Establish next meeting date
4	5-6	Home visit	• Provide overview of session goals • Review progress in use of first activity prescription with caregiver and use activity record to record number of times activity was used and outcome • Reinforce use of specific strategies (communication, task simplification, cueing) • Problem solve with caregiver if unable to use activity prescription or if activity was not received well and modify activity prescription if necessary • Identify and introduce next activity prescription with caregiver and dementia patient if appropriate using procedures outlined above in previous session • Reinforce and validate caregiver techniques • Provide specific recommendations as to when to introduce activity and number of times • Review main points made in session and obtain closure • Establish next meeting date
5	7	Tele-contact*	• Review progress and reinforce strategy use • Review, practice communication, environment and task simplification techniques • Determine with caregiver what was effective and modify strategies if necessary • Problem solve with caregiver how to use activities and generalize strategies to other types of activities or newly emerging problems (e.g., behavioral manifestations) • Establish next contact date/time
6	8-9	Home visit	• Provide overview of session goals • Review progress in use of first and second activity prescription with caregiver and use activity record to record number of times each activity was used and outcomes • Reinforce use of specific strategies (communication, task simplification, cueing) • Problem solve with caregiver if unable to use activity prescriptions or if activity was not received well; modify activity prescriptions if necessary • Identify and introduce 3rd activity prescription with caregiver and dementia patient if appropriate using procedures outlined above in previous sessions • Reinforce and validate caregiver use of techniques • Provide specific recommendations as to when to introduce each activity and number of times day/week • Review main points made in session and obtain closure • Establish next meeting date
Phase 3 – Generalize Strategies
7	10	Tele-contact *	• Review progress with caregiver • Reinforce use of all activities and strategies • Problem solve with caregiver if unable to continue to use activities • Discuss how to use strategies such as relax rules, divergence, cueing etc) to address other daily care challenges (e.g., resistance to bathing) • Establish next contact date/time
8	11-12	Home visit	• Review progress • Reinforce use of activities • Generalize use of strategies (e.g., simplifying the environment) to other care activities • For each activity prescription, provide written instructions for how to change activity for future declines • Obtain study closure

Note.

^*If caregiver is having difficulty using activity prescriptions, then this will be a home visit and outline for session 6 will be followed.