The personal, social, and health impacts of caregiving have been well documented in recent years (Ory, Hoffman, Yee, Tennstedt

The personal, social, and health impacts of caregiving have been well documented in recent years (Ory, Hoffman, Yee, Tennstedt, & Schulz, 1999; Schulz & Beach, 1999; Schulz, 2000; Schulz, O’Brien, Bookwala, & Fleissner, 1995). These findings in turn have generated intervention studies aimed at addressing the burden, distress, and health-related morbidity associated with caregiving. The majority of intervention studies have focused on caregivers of persons with progressively dementing illnesses such as Alzheimer’s disease (AD). Using a wide variety of intervention approaches, researchers have been able to achieve small to moderate decreases in burden and depression and, in a few cases, impressive clinically meaningful outcomes (Schulz, 2000; Schulz et al., under review). Similar results have been reported for the intervention literature overall. A recent meta-analysis of the caregiver intervention literature reports that interventions produced significant improvement of .14 to .41 standard deviation units, on average, for caregiver burden, depression, and subjective well-being (Sorensen, Pinquart, & Duberstein, in press). However, these conclusions need to be qualified by a host of methodological problems that still characterize much of this literature. First, sample sizes are often too small to detect even large effects (Cooke et al., 2001), and minority populations are not well represented in intervention trials. Second, randomized controlled trial methods have been used infrequently and are often implemented incompletely. Third, interventions are not well described, and treatment implementation data are infrequently collected or reported (Burgio et al., 2001). Finally, the proportion of studies reporting clinically significant outcomes for important public health indicators is relatively small (Schulz et al., under review). REACH I addressed several of these shortcomings by implementing six different randomized clinical trials at six different sites using identical measurement intervals and common outcome measures. Studies included relatively large sample sizes (N =1222 total) with significant numbers of African American and Hispanic caregivers. Interventions were carefully described and implemented. Meta-analysis was used to examine pooled parameter estimates of 9 active compared to 6 control group conditions of REACH at 6-months on burden and depressive symptoms in family caregivers (Gitlin et al., submitted). Associations of caregiver relationship, gender, education, racial/ethnic identity and treatment outcomes were examined. For burden, active interventions were superior to control conditions. Also, active interventions were superior to control conditions for women but not for men, and for caregivers with < high school education but not for those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami’s combined family therapy and computer technology intervention. Also, active interventions were superior to control conditions for caregivers who were Hispanic, non-spouses or of lower education. Analyses based on a conceptual framework developed by REACH investigators showed that interventions using hands-on training modalities such as role play, modeling, demonstration and practice were most effective in reducing depressive symptomatology (Czaja et al., submitted; Belle et al., submitted). Finally, the data suggest that caregivers are receptive to and benefit from new technology (the CTIS system) that facilitates communication and information access. Overall, these findings suggest that interventions need to be responsive to important variations in need among caregivers and should therefore have some degree of tailoring to the individual, and that there are specific components and delivery methods likely to enhance the effectiveness of an intervention.