Caregiver Services and Supports Innovations Hub (the "Hub)Submission Form Survey

Thank you for your interest in submitting to the Caregiver Services and Supports Innovations Hub. The Hub is an online clearinghouse that facilitates the sharing of innovative* and evidence-informed* programs, services and interventions for Aging Network providers. Please complete the questions below to submit.

Submitters will be notified if their submission is accepted and may be contacted for additional information. Contact USAging’s caregiving team at caregiving@usaging.org with any questions.

*See ACL definition in Question 6

Identifying Information

1.Contact Information(Required.)

Name:

Title:

Organization:

City:

State:

Email Address:

Phone Number:

2.Title of caregiver program, service or intervention:(Required.)

3.Has the program been implemented for at least 6 months?(Required.)

Yes

If no, please describe

6.Which of the following best describes your program, service or intervention?(Required.)

Evidence-informed practice (as defined by the Administration for Community Living):
Found to be effective through evaluation (but not using experimental or quasi-experimental design) or adapted from an evidence-based practice (without exact fidelity to the model)
Inclusive of guidance to carry out essential activities (e.g., protocol, checklist)
Translated at least once before in one or more site(s)

Innovative practice (as defined by the Administration for Community Living):
May be effective (some outcome data available), but not yet evaluated using experimental or quasi-experimental design (e.g., using control group and random assignment)
Not yet inclusive of guidance to reproduce practice
Not yet translated in a different site or population

Other (please describe below)

7.What type of geographic region does this program, service or intervention serve? Select all that apply.(Required.)

8.What are the primary populations that this program, service or intervention serve? Select all that apply.(Required.)

Family caregivers (age 18 and older) providing support to older adults aged 60 and older

Family caregivers (age 18 and older) providing supports to adults of any age with Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction

Older relative caregivers (age 55 and older) caring for children other than their own, who are not more than 18 years of age

Older relative caregivers (age 55 and older) of adults (which may include children of the older relative caregiver) age 18-59 with disabilities

Family caregivers of individuals with early onset dementia

Other (please describe below)

10.Please briefly describe the role each selected partner plays in program implementation, delivery, referrals or evaluation.(Required.)

11.What is your program's source(s) of funding? Select all that apply.(Required.)

Other (please describe below)

Submission Questions

12.Please provide a summary description of the caregiver program, service or intervention and key accomplishments to date in your description (in at least 250 words).(Required.)

13.Please describe the innovative features of this caregiving program.(Required.)

14.Please describe any outputs and outcomes the program has achieved to date.

Outputs may include number of participants served, number of sessions or contacts delivered, or products/materials developed.
Outcomes may include participant satisfaction, changes in caregiver knowledge, skills, confidence, burden or other tracked indicators aligned with program goals.
If output and outcome data are still being collected, please describe what data are available so far and what you plan to measure.

(Required.)

15.What is the total cost of the program?(Required.)

16.What staffing is needed to support the program?(Required.)

17.Has this program, service or intervention received an innovations award (e.g., Family Caregiver Alliance Innovations in Alzheimer’s Caregiving award, ARCH Innovative and Exemplary Respite Services award, USAging Aging Innovations & Achievement award)? If yes, please describe and provide links.(Required.)

18.Has this program, service or intervention received an innovations award (e.g., Family Caregiver Alliance Innovations in Alzheimer's Caregiving award, ARCH Innovative and Exemplary Respite Services award, USAging Aging Innovations & Achievement award)? If yes, please describe and provide links.(Required.)

19.Please describe any lessons learned and/or challenges faced while implementing this program, service or intervention, along with strategies used to address them (in at least 250 words).(Required.)

20.Please describe and provide available links for materials and resources that could help other organizations replicate this program. This may include toolkits, technology, data collection instruments or training materials.(Required.)

21.Please note whether these materials are publicly available.(Required.)

22.How did you learn about the Caregiver Services and Supports Innovations Hub?(Required.)

23.Please share the contact information for the individual who others may contact if they wish to learn more about the program, service or intervention.(Required.)

Name

Email address

* PCTI combines the principles of:
Person-centered supportive service delivery, which considers everyone's experiences, needs, strengths, preferences, and goals. Trauma-informed approaches to care in which all individuals and levels of an organization or system have a basic realization about trauma and understand its impacts on individuals, families, groups, organizations, and communities (Person-Centered, Trauma-Informed Service | ACL Administration for Community Living).

Thank you for your submission! We will be in contact if your program is selected to be featured in the Caregiver Services and Supports Innovations Hub.