Scaling an Evidence-Based Program: The Case of the Tailored Activity Program

Abstract The Tailored Activity Program (TAP) is a proven program delivered primarily by occupational therapists addressing dementia-related clinical symptoms including caregiver well-being. Although used in 9 countries including the United States, scaling and widespread dissemination is challenging. We discuss key revisions to TAP to facilitate dissemination including matching assessments to those used in different practice settings, translation of materials into different languages, providing worksheets to help trainees adapt TAP to local contexts and a training/certification online experience using story board, an interactive media integrated onto the Blackboard learn management system, to provide on-demand training modules. The learning platform allows learners to engage with others, preview modules and share experiences. Revisions enable greater flexibility for program adaptation yet adherence to its core principles. With over 150 trainees, we use REAIM to evaluate effectiveness of modifications and to understand implications for its reach. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.


TRANSLATING BEHAVIORAL INTERVENTIONS: IT IS MORE THAN JUST LANGUAGE
Chair: Katherine Marx Co-Chair: Laura Gitlin In the United States, over 5 million people are living with Alzheimer's disease or a related dementia. Providing care are an estimated 16 million unpaid caregivers and millions of paid caregivers. Neuro-psychologic symptoms (NPS) such as agitation, aggression, depression, rejection of care, and apathy are almost universal in persons living with dementia (PLwD). Caring for NPS often leads to poor physical, mental and financial outcomes. There have been hundreds of nonpharmacologic interventions tested and found efficacious to help caregivers with NPS and daily care challenges. However, very few of these interventions have been widely adopted in different languages and settings. One promising intervention used in various countries is the Tailored Activity Program (TAP). TAP, delivered by occupational therapists, customizes activities to PLwD's current capabilities and prior roles and interests and instructs caregivers in their use. This session will examine TAP's reach and how it has been translated and adapted. First, Ms. Sokha Koeuth will present modifications needed to the program to facilitate widespread dissemination including placing training in the program online and virtual. The next two presentations will discuss adaptations to TAP in different countries and cultures; Dr. Marcia Novielli will present TAP-Brazil, and Dr. Jean Gajardo Jauregui will present TAP-Chile. Finally, Dr. Katherine Marx will examine the adaptations needed to place TAP into a long-term care setting with both family and paid caregivers. These papers highlight the cross-cultural adaptations that need to be considered in taking a program from research to different real world clinical and community-based settings. Behavioral Interventions for Older Adults Interest Group Sponsored Symposium.
Baltimore, Maryland,United States,3. Thomas Jefferson University,Ardmore,Pennsylvania,United States The Tailored Activity Program (TAP) is a proven program delivered primarily by occupational therapists addressing dementia-related clinical symptoms including caregiver well-being. Although used in 9 countries including the United States, scaling and widespread dissemination is challenging. We discuss key revisions to TAP to facilitate dissemination including matching assessments to those used in different practice settings, translation of materials into different languages, providing worksheets to help trainees adapt TAP to local contexts and a training/certification online experience using story board, an interactive media integrated onto the Blackboard learn management system, to provide on-demand training modules. The learning platform allows learners to engage with others, preview modules and share experiences. Revisions enable greater flexibility for program adaptation yet adherence to its core principles. With over 150 trainees, we use REAIM to evaluate effectiveness of modifications and to understand implications for its reach. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

CROSS-CULTURAL ADAPTATION OF THE TAILORED ACTIVITY PROGRAM FOR BRAZILIAN PORTUGUESE Marcia Novielli, University of Sao Paulo, Santos, Sao Paulo, Brazil
Brazil lacks an Occupational Therapy methodology of action, justifying the cross-cultural adaptation of TAP. Objectives were to adapt TAP reference materials to the Brazilian culture and evaluation of the applicability of the Portuguese version by perceptions of Occupational Therapists (OT) and family caregivers. The methodology used translation, back translation, evaluation of semantic, idiomatic, conceptual and cultural equivalences and pretest of materials for production in Portuguese. The OT applied the translated version and evaluated its applicability. Caregivers evaluated the social impact of the adapted program. The cross-cultural adaptation process adapted the entire materials program to Portuguese culture. The OT perception is a need to include one session to guide caregivers and to modify the cognitive assessment used. The caregivers pointed out that TAP helps them in understanding and caring for the elderly with dementia. The TAP-BR has been adapted to the Brazilian culture. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.  Santiago,Region Metropolitana,Chile,5. Drexel University,Philadelphia,Pennsylvania,United States Chile is currently implementing policies addressing dementia care with efforts to translate evidence-based programs towards culturally sensitive models of care. This study describes the cultural adaptation of the Tailored Activity Program (TAP). A complementary mixed-method design was performed following the 4-phase Dynamic Adaptation Process (DAP) model by Aarons et al, 2012. Ten dyads (family caregivers and people with dementia) completed a regular 8-session home-based TAP intervention during 2017-2018. Qualitative data was collected through interviews and observation with caregivers, and weekly follow-up and a focus group with provider occupational therapists. Quantitative data in pilot testing was obtained through assessments at baseline and after intervention. The TAP was well accepted by family caregivers, and sociocultural adaptations on content, context, target level, and training were identified. Significant reduction of frequency and severity of neuropsychiatric symptoms in individuals with dementia was found, and caregivers reported reduction of depressive symptoms, improved perceived well-being & self-confidence. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

UNDERSTANDING HEALTH CONCERNS OF OLDER ADULTS: HEALTH PERSONALITY, HEALTH ACTIVATION, AND WELL-BEING Chair: Peter Martin
Individuals display different levels of concern about their health. These overall concerns may be a result of health personality dispositions based on the five-factor model of personality. They include health neuroticism, health extraversion, health openness, health agreeableness, and health conscientiousness. Furthermore, whether older adults take active care of their health and how they view their overall physical and emotional well-being may depend on these health personality dispositions. This symposium sheds light on the association between health personality, resilience, activation, and well-being. The first presentation provides an overview of our health personality conceptual model and summarizes measurement properties of the Health Personality Assessment. The second presentation highlights demographic differences in health personality. Gender, age, marital status, and regional differences in health personality are reported. The third presentation links health personality with levels of health activation and resilience. Direct and indirect effects of health personality on resilience and health activation are presented. Finally, we highlight results about the relationship of health personality with physical and emotional well-being in later life. All five health personality dispositions directly related to physical and mental health. Our discussion emphasizes practical implications for health practitioners and outlines future research on health personality and outcomes.

HEALTH PERSONALITY AND WELL-BEING: AN OVERVIEW
Peter Martin, Joseph Kim, Rotem Arieli, and Nicholas Cone, Iowa State University, Ames, Iowa, United States It is well established that there are interindividual differences in many areas of well-being. Based on previous segmentation research and work connecting personality traits to health outcomes, we developed the health personality segmentation model. The health personality segmentation