The Senior Companion Program Plus (SCP Plus): A Psychoeducational Intervention for African American Dementia Caregivers
Phase: NA
Conditions: Family, Alzheimer Dementia
Sponsor: The University of Texas at Arlington

PROTOCOL COVER PAGE 
OFFICIAL TITLE OF THE STUDY: The Senior Companion Program Plus (SCP Plus): A 
Psychoeducational Intervention for African American Dementia Caregivers  
VERSION DATE: 07/11/2024 
NCT number: NCT03602391 
Principal Investigators:  
Dr. Noelle Fields and Dr. Ling Xu (MPI) 
School of Social Work, The University of Texas at Arlington 
Telephone: 817-272-3181 
Emails: noellefields@uta.edu ; lingxu@uta.edu 

Protocol 
The Senior Companion Program Plus 
Background 
Approximately 6.7 million Americans aged 65 years and older are currently impacted by 
Alzheimer disease and related dementias (ADRD) [1]. Given that age is a key risk factor for 
ADRD and the number of older Americans continues to grow, it is expected that cases of ADRD 
will also increase [1]. ADRD is a disease marked by profound disability and dependence that 
worsens over time. Informal family caregivers provide most of the care to persons with ADRD, 
and they are at greater risk for negative physical and psychosocial outcomes when compared to 
noncaregivers or other types of caregivers [2]. 
Several intervention strategies have been implemented and evaluated to alleviate stressors 
and other negative outcomes among dementia family caregiving. In particular, research 
suggests that psychoeducational interventions may positively impact caregiver well-being, 
including burden [3], perceived health [4], and mental health [5,6]. While most 
psychoeducational interventions use trained interventionists, [7,8] peer-led interventions have 
demonstrated considerable promise. For example, research suggests that peer-led interventions 
may enhance family caregivers’ social support and help with the management of chronic
conditions [9,10,11]. Additionally, the translation potential of peer-led programs is further 
enhanced because of the use of lay providers rather than trained interventionists.  
African American ADRD Caregivers 
Based on demographic projections, the African American older population will grow to nearly 
11% of the older adult population in the United States by 2050 [12]. Compared to White people, 
African Americans are about 2 times more likely to develop ADRD [1] and may live longer with 
ADRD than other races [13]. However, there exist a number of disparities in how ADRD is 
diagnosed and treated among African American older adults. For example, research suggests 
that missed diagnoses of ADRD occur more often among older African American adults than 
Whites [14].  
These disparities also affect African American ADRD family caregivers. Among this group, 
outcomes related to caregiver burden are mixed. For example, as reported by Brewster et al [15], 
a study presented by McLennon [16] indicated low scores on the Zarit Burden Scale [17] in 
African American ADRD family caregivers of persons with moderate to severe ADRD. 
However, the qualitative findings suggested that ADRD family caregivers experienced several 
challenges related to finances, safety concerns such as wandering, and providing physical care. 
Similarly, Brewster and colleagues [15] reported that in a mixed methods study of African 
American ADRD family caregivers conducted by Moss et al, participants scored relatively high 
on measures of quality of life but qualitatively reported stress and negative aspects related to 
caregiving [18]. Although psychosocial interventions for dementia caregivers have shown 
promise, more research on culturally relevant interventions for African American ADRD 
caregivers is needed.  

 
 
The Senior Companion Program 
The Senior Companion Program (SCP) is one of 3 core programs funded by AmeriCorps. 
The SCP focuses on lower income, older adult volunteers providing assistance and friendship to 
other older adults who need support with daily living tasks [19]. SCP volunteers must be “at least 
55 years of age or older and be capable of serving the frail elderly or adults who have one or 
more physical, emotional, or mental health limitations and are in need of assistance to achieve 
and maintain their highest level of independent living” [20]. Senior companions (SCs) serve as 
volunteers for 5 to 40 hours per week and receive modest hourly stipends [20]. SCs’ typical tasks 
include providing assistance with meal preparation, offering medication reminders, 
accompanying their care recipient (CR) to social activities and medical appointments, and 
providing respite to family caregivers [20]. 
 
The Senior Companion Program Plus 
Despite the benefits of the services provided by the SCP, many ADRD caregivers still report 
significant stress,  as the SCP does not currently include a unique service to address caregiver 
stress/burden for ADRD caregivers [21]. Augmenting the SCP with ADRD specific training is 
ideal as it extends the typical services of the SCP by providing psychoeducation to address 
the stress and burden that ADRD family caregivers continue to experience. 
 
Study Purpose 
The Senior Companion Program Plus (SCP Plus) is the proposed intervention adapted from 
the work of Morano and King [22]. However, the SCP Plus differs from that work by 
training lay providers (ie, SCs) rather than clinical experts to deliver the intervention to 
increase its accessibility and translational potential. In the pilot study of the SCP Plus [23,24], 
the research team held focus groups with African American SCs to refine the work of 
Morano and King [22] and to adapt their intervention for use with the SCP. The SCP Plus 
trains SCs as lay provider “interventionists” to deliver a 9-week, in-home psychoeducational 
intervention with African American ADRD caregivers. The SCP Plus includes 9 educational 
modules that cover topics focused on education, safety, strategies for challenging behaviors, 
communication, coping, finding purpose/meaning in caregiving, and community-based services 
(for an overview of each module, see Fields et al [23]). 
 
The SCP Plus includes 12 hours of training for the SCs that take place over a 2-day period 
and reviews the essential components of the intervention. Following this training, SCs 
deliver 1 module of SCP Plus to the African American dementia caregivers during a weekly, 
60-minute meeting in the caregivers’ or CRs’ homes over a 3-month period (for a total of 9 
hours). Based on the success of a pilot study of the SCP Plus [23,24], the proposed project 
will expand the program to 3 states to conduct a randomized evaluation of efficacy. 
For this proposed study, the revised sociocultural stress and coping model [25,26] provides 
the conceptual framework to examine caregiver burden along with how cultural values 
affect the coping style, social support, and well-being of ADRD caregivers. Specifically, the 
aims and hypotheses of the proposed study are listed below: 
 
• Aim 1: We will examine the specific effects of the Senior Companion Program 
Plus (SCP Plus) to increase knowledge about Alzheimer disease, reduce caregiver 

 
 
burden and stress, and increase caregiver well-being after the SCP Plus 
intervention. 
• Hypothesis 1: Participants will indicate clinically significant and statistically 
significant (P<.05) reductions in caregiver burden/stress and increased caregiver 
well-being at 3 months and at a 6-month postintervention interval. 
• Aim 2: We will examine the specific effects of the SCP Plus to improve caregiver 
coping skills. 
• Hypothesis 2: Participants will indicate statistically significant (P<.05) 
improvements in coping skills associated with dementia caregiving. 
• Aim 3: We will analyze the specific effects of the SCP Plus to increase caregiver 
satisfaction with social support (eg, received support, satisfaction with support, 
social support network, and negative interactions). 
• Hypothesis 3: Participants will indicate statistically significant (P<.05) increases 
social support. 
• Aim 4: We will explore and interpret the statistical results obtained in the first 
quantitative phase to help explain why participants who scored in the lower and 
upper quartiles on caregiver burden/stress were impacted or not by the usefulness of 
the intervention. 
 
Methods 
 
Study Design 
The proposed study is a randomized control trial that will assess the effects of SCP Plus on 
African American dementia caregiver stress and burden, coping skills, and social support. An 
explanatory sequential mixed methods design [27] will be utilized, involving first collecting 
quantitative data and then analyzing the data to identify subsamples of participants who 
reported the greatest and least change in caregiver stress/burden. Of the individuals in the 
SCP group with the highest quartile (n=14,  25%) and lowest quartile (n=14, 25%) of change, 
we will conduct follow-up qualitative interviews to capture the details of their situation and 
present a more comprehensive analysis that leverages the strengths of both methods. We 
propose a 3-year study. The study will take place in collaboration with SCP at sites in 
Texas, Louisiana, and Arkansas with approximately 114 SC-caregiver dyads. Half of the 
sample will receive services as usual (SAU) without the SCP Plus intervention. The control 
group will be randomly selected after baseline screening of all family caregivers, and all 
measures will be collected blind to group condition. To further prevent selection bias, 
statistical techniques such as mixed factorial analysis of covariance (ANCOVA) will be 
conducted to adjust for covariate imbalance during data analysis. 
 
Participants and Setting  
Power analyses performed with G*Power software (version 3.1.9) indicated that a total of 114 
participants are required to address our primary research objective using a mixed factorial 
ANOVA of our primary study outcome, caregiver burden. This sample size estimate was 
based on a small effect size (f =.12) and a 2-tailed alpha of .05 and beta of .20. This effect 
size estimate was generated from our pilot data, which indicated a mean change in caregiver 
burden of 2.82. 
 

 
 
Study participants will be the SC-caregiver dyads that include the SCs (n=114) recruited 
from the state-wide agencies with SCP as well as the African American caregvers (n=114) 
for older adults with ADRD who are currently enrolled in a Senior Companion Program in 
Texas, Arkansas, and Louisiana. Each dyad consists of 1 SC matched with 1 caregiver. To 
be eligible for this study, SCs must be (1) currently participating in the SCP and (2) 
currently providing respite services to the caregivers. As per the requirements of the SCP, 
SCs must be “55 years of age or older, be determined by a physical examination to be 
capable of serving the frail elderly, and be able to provide such service without detriment to 
either themselves or the clients served” [20]. For caregivers that receive services from the 
SCs, they must be (1) self-identified as African American, (2) 21 years of age and older, (3) 
providing unpaid care for an older adult with ADRD, and (4) cognitively intact as measured 
by the 6-item screener [28]. The CRs with ADRD must have a physician diagnosis of 
ADRD and live at home in the community. Caregivers who are involved in another 
caregiver psychosocial intervention study or have an acute illness that would prevent them 
from participating for at least 6 months will not be eligible.  
 
Study Procedures 
Randomization 
The SCP directors at each site will first help identify the potential SC-caregiver dyads who meet 
the inclusion criteria. The identified potential participants will then be randomly selected, and the 
research team will contact them afterward. Participant dyads who are interested in participating 
will be guided through the informed consent process, administered a baseline survey via phone, 
and randomized to one of two groups: (1) the SCP Plus group that will receive the intervention 
plus SAU and (2) the control group that only receives SAU as part of the SC Program. SAU 
include providing respite care for the family caregiver and personal care and light 
housekeeping/meal preparation for the person with dementia.  
 
Data Collection 
Quantitative data will be collected at preintervention, postintervention, and at the 6-month 
postintervention follow-up. The research team will then analyze the quantitative data in 3 time 
points to assess the effectiveness of the intervention and identify caregivers who reported the 
greatest and least change in caregiver stress/burden. Individuals in the highest and lowest 
quartiles of change in stress/burden will be recruited for follow-up interviews to understand 
their results in more depth through a qualitative study analysis.  
 
SAU Program 
For SAU, SCs volunteer with frail, low-income older adults approximately 20 hours a week. 
SCs’ tasks include helping older adults with ADRD by accompanying them to health care 
professional appointments, accompanying them t o  recreation/social activity/senior centers, 
providing assistance with ambulation and mobility, dressing, grooming, and feeding, reading, 
writing letters/forms, light cleaning, light meal preparation, monitoring for safety, peer 
support/companionship, and general caregiver respite. As part of the SCP, all SCs receive 40 
hours of training from their agency, which includes topics such as program and agency 
policies, code of conduct, and a criminal background check.  
 

 
 
SCP Plus  
SCs randomly assigned to the SCP Plus will receive the 12-hour training. Two members of 
the research team will conduct all the SCP Plus training in person at each site. The training 
protocol was developed to affirm and build on the SCs’ existing knowledge and skills related to 
ADRD caregiving [23]. The SCP Plus training is delivered in-person, in a group format that 
includes both didactic approaches and role play experiences. The SCP Plus training will last 2 
days (6 hours per day). To ensure treatment fidelity related to the training, manuals and 
protocols for the training were created before the onset of this study. The training material 
will be audio recorded and reviewed by the research team using a checklist to quantify 
adherence to the training program.  
 
SCP Plus is based on a dementia caregiver program [22] and adapted by Fields and 
colleagues [23,24]. ADRD caregivers whose SCs are randomly assigned to the intervention 
group will receive the SCP Plus intervention. The SCP Plus intervention will be delivered 
face to face by the S C  who is a part of the SC-caregiver dyad. The intervention involves 9 
in-home psychoeducational sessions over a 3-month period with 1 session per week. 
Every week for 9 weeks, the SC-caregiver dyad will meet for 1 hour in the home of the CR 
(ie, person with dementia). This allows the SC to maintain their duties while still 
participating in the SCP Plus program. This also allows the ADRD caregiver to receive 
intervention in the home setting of the person with dementia. Each week, the SC will deliver 
1 module from the SCP Plus. “Icebreaker” questions are included at the beginning of each 
module in an effort to answer any questions that the ADRD may have from the previous 
module and to facilitate a time for informal, supportive communication between the SC and 
the ADRD caregiver. At the end of each module, the SC will ask the ADRD caregiver to 
reflect on the content of the module, which will be written down in the form of brief notes 
by the SC. The inclusion of incentives (ie, retail gift cards) will be used to reduce caregiver 
attrition.  
 
Measurements 
The outcome evaluation will include measures of caregivers’ stress and burden, knowledge 
of ADRD, coping skills, social support and activity, caregiver appraisal, caregiver physical 
health, and cultural justifications for caregiving. Standardized measures will be used to 
assess these outcome variables. The study by Xu and colleagues [29] contains an illustration of 
how these measures are mapped onto the conceptual model for this study. 
 
Sociodemographic characteristics of the caregiver and their CRs will be collected at baseline, 
such as age, gender, education, length of caregiving relationship, self-rated health [30], and 
number of hours spent in caregiving, etc. Information about CRs’ activities of daily living (ADL) 
and instrumental activities of daily living (IADL) that require help from caregivers will also be 
collected [31]. The Global Deterioration Scale [32] will be used to measure the severity of 
dementia of the person with ADRD. The frequency and duration of weekly contact with the 
SC will also be collected from the agency timesheets. 
 
Dementia Caregiver burden and stress will be measured by the Zarit Burden Interview (ZBI) 
[17]. The ZBI was developed to measure burden among caregivers of persons with dementia 
living in the community [33]. The ZBI has 22 items measured with a 5-point Likert scale ranging 

 
 
from (never) to 4 (nearly always). Total sum scores range from 0 to 88, with higher scores 
indicating higher levels of distress. Studies have shown that ZBI has good validity and reliability 
among various minority dementia caregivers [34], particularly African American caregivers [35].  
 
Knowledge of ADRD will be measured by the Knowledge of Dementia (KAD) scale [36]. KAD 
consists of 4 subscales concerning the (1) epidemiology and etiology of ADRD, (2) perceived 
effectiveness of different and currently available treatments, (3) beliefs regarding the perceived 
threat of ADRD for oneself, and (4) how respondents learned about the disease. KAD has shown 
good reliability and validity in assessing attitudes and beliefs regarding ADRD among dementia 
caregivers of diffierent ethnic minorities [37]. 
 
Coping skills will be measured by the Brief COPE subscales and religiosity coping. The Brief 
Cope questionnaire consists of 28 items measuring the ways/strategies caregivers have been 
coping with the stress in their life with a 4-point scale ranging from 1 (“I have not been doing 
this at all”) to 4 (“I have been doing this a lot”). The Brief COPE scale has shown good validity 
and reliability in caregivers of persons with dementia [38]. Religiosity coping will be examined 
with the short form of the Brief Religious Coping (RCOPE) scale to measure the positive and 
negative aspects of religious coping [39]. All items are measured on a 4-point scale ranging from 
0 (“a great deal”) to 3 (“not at all”). This measure has shown good validity and internal 
consistency among racially and ethnically diverse populations of ADRD caregivers [34], 
including African American participants [40].  
 
Social support will be measured with 13 items from four domains: (1) received support [41,42], 
(2) satisfaction with support [42,43], (3) social support network [44], and (5) negative 
interactions [42]. Social support networks will be measured by a modified Lubben Social 
Network Scale [44] that uses 3 items on a 6-point scale (none, 1, 2, 3 or 4, 5 to 8, and 9 or more). 
All other items have a 4-point scale that ranges from 0 (never) to 3 (very often) [45]. Social 
support measures have been proven to be valid and reliable with ethnic minority dementia 
caregivers [40], including African American dementia caregivers [40]. 
 
Caregiver appraisal will be measured with two components: (1) appraisal of problem behaviors 
and (2) appraisal of benefits. For appraisal of problem behaviors, a modified version of the 
Revised Memory and Behavior Problems Checklist (RMBPC) [46] will be used to ask caregivers 
whether CRs’ problems occurred during the past week (yes or no). If the answer is yes, 
caregivers will then be asked to rate how much the problem “bothered or upset” them on a 5-
point Likert scale ranging from 0 (not at all) to 4 (extremely). RMBPC has shown in the 
literature to be a valid and reliable measure for different ethnic minority caregivers [47], 
especially African American caregivers [48]. For appraisals of benefits from caregiving, the 
Positive Aspects of Caregiving (PAC) scale will be assessed [49]. The PAC has 9 statements 
about the caregiver’s mental affective state in relation to the caregiving experience. Each 
statement begins with “Providing help to the care recipient has…” followed with specific items 
(eg, made me feel useful, enabled me to appreciate life more). Each statement is rated on a 5-
point Likert scale ranging from 1 (disagree a lot) to 5 (agree a lot). Studies show that the PAC is 
a valid and reliable measure for different ethnic minority dementia caregivers [34] and especially 
useful for African American dementia caregivers [50]. 
 

 
 
Caregiver well-being will be measured by the 12-Item Short-Form Health Survey (SF-12) [51] 
and the 16-item short version of the Caregiver Well-Being Scale (CWBS-ShortVersion). The SF-
12 is a frequently used screening device used to measure physical and mental health outcomes. It 
asks participants about their health, how they feel, and how well they are able to complete their 
usual daily activities. It has shown to be a valid and reliable measure with African American 
older adults [52]. The CWBS-Short Version was developed to help family caregivers, clinicians, 
and researchers to identify areas of caregiver strength and areas in which additional support is 
needed. All 16 items will be measured by a 5-point scale ranging from 1 (rarely) to 5 (usually). 
The CWBS-Short Version has good content and construct validity regardless of the ethnicity of 
the caregivers [53]. 
 
Cultural justifications for caregiving will be measured by the Cultural Justifications for 
Caregiving Scale (CJCS) [54]. CJCS consists of 10 items designed to assess caregivers’ cultural 
reasons and expectations in providing care. Each item is measured using a 4-point Likert scale 
ranging from 1 (strongly disagree) to 4 (strongly agree). Summed scores range from 10 to 40, 
with higher scores indicating stronger cultural reasons for giving care. Study results have shown 
good reliability and validity score of this scale with African American caregivers [55].  
 
Qualitative Questions 
The second qualitative phase will explore and interpret the statistical results obtained in the 
first quantitative phase. The interview protocol will include a semi-structured interview 
guide to explore domains of difference (e.g., perceptions of treatment, level of engagement, 
intervention processes).  
 
Data Analysis 
Quantitative Data Analysis 
After data are collected and imputed into statistical software, data quality will be carefully 
reviewed and then checked both automatically and manually. These review processes include 
checking the coding of observations, responses, and out-of-range values in SPSS software (IBM 
Corp), adding variable and value labels where appropriate, checking completeness or any errors 
of data entry, double-checking any errors in statistical analyses, and correcting errors made 
during transcriptions. In addition, data will be reviewed for risk of disclosure of research 
participants’ identities, for sensitive data, and for private information to ensure confidentiality. 
Since all the key concepts in the proposed study are measured with standard scales, 
reliability tests for each scale and test-retest reliability across the 3 surveys will be 
conducted. Sum scores will be calculated for each of the standard scales. 
 
Any missing data that are random in nature, such as those due to random mistakes in data 
collection and entry, and are not related to research staff or patient noncompliance, will be 
submitted to maximum likelihood estimation procedures to estimate those missing values. 
Maximum likelihood estimation for random missing data is a common and accepted 
procedure for missing data estimation [56,57]. 
 
We will apply an intent-to-treat analytic approach to the study data. For study outcomes, 
multiple imputation (using maximum likelihood estimations referred to above) will be 
applied. Fisher exact tests, Pearson chi-square tests, and independent sample t tests will be 

 
 
computed to test for group differences that may be attributable to caregiver variables such 
as gender, age, ethnicity, clinical site, length of caregiving relationship, and number of hours 
spent in caregiving. If the groups significantly differ on any of these variables, the variable 
will be incorporated into the following analyses as a covariate, thereby controlling for 
potential influences that the covariate may have on the dependent variables. As noted in the 
statistical literature, large power gains can be achieved by including correlated stationary 
covariates in ANCOVA, ordinary least squares regression, and Cox proportional hazards 
regression [58]. Moreover, in the event that at the culmination of this study, our sample sizes 
are unequal in the treatment groups and our outcome data are nonnormal, we will follow 
through with appropriate statistical corrections where necessary. 
 
Mixed factorial ANCOVAs will be computed to compare the SCP Plus and SAU over time 
on caregiver burden (ZBI), beliefs about dementia (KAD), coping (Brief COPE), social 
support, caregiver appraisal, well-being (CWBS- Short Version), and cultural expectations 
(CJCS). The covariates will be any significant variable yielded from the univariate analyses, 
and the dependent variable will be the scores at pretest, posttest, and 6-month follow-up. 
Moreover, 95% CIs will be computed for each adjusted mean difference. The study alpha will 
be set at .05, with no adjustments for multiple comparisons due to the preliminary nature of 
this study and the increased risk of type 2 errors as a result of alpha adjustment [59]. 
  
Qualitative Data Analysis 
Qualitative interviews will be recorded digitally, transcribed, and analyzed using 
conventional content analysis [60]. A constant comparative approach [61] will be used to 
explore similarities and differences in participants who did and did not benefit from the SCP 
Plus. Multiple strategies will be utilized to address rigor and credibility including peer 
debriefing and an audit trail.  
 
Ethics Approval 
The study protocol was approved by the Institutional Review Board of the University of Texas at 
Arlington (2017-0431 on 9/30/2018). It will be conducted in accordance with the Declaration of 
Helsinki. 
 
Results 
This study was funded on September 15, 2018, by the National Institutes of Health 
(1R15AG058182-01A1). Data collection began on May 16, 2019, and ended on March 31, 2023. 
The study completion date will be June 30, 2023.  
 
The study participants are SC-caregiver dyads. Due to COVID-19 social distancing 
requirements, data collections were halted in March 2020, 12 months into the planned 27-month 
recruitment period. The final sample size for the proposed study consisted of 20 dyads at base 
line, and only 11 CGs completed the posttest and follow-up test. There were no missing data, so 
imputation was not necessary. 
 
For the SCs in the 3 sites (N= 20), all of them were female with a median age of 71 (range 58-
80) years. More than one-third were either widowed or divorced (n = 8, 40%). In terms of 
educational status, half (n = 10, 50%) of the SCs were high school graduates or below. All SCs 

 
 
reported attending a religious service at least once per month. The participating SCs had taken 
care of their current CR with ADRD for a median of 4.5 (range 1-15) years and provided a 
median of 30 (range 6-40) hours weekly for their CRs. The majority (n = 17, 85%) of the SCs 
felt very confident or confident in providing care to their clients with ADRD. Half (n = 10) of 
them reported difficulty in paying for their basic needs (ie, financial strain). In general, the SCs 
had moderate levels of self-rated health (median 3). They helped their CRs with ADL (median 
2.5, range 0-6) and IADL (median 7.5, range 4-8). 
 
For the caregiver participants, the 20 CGs were a median age of 60.5 (41-80) years. The majority 
were female (n = 17, 85%), married (n = 11, 55%), and lived with their CR (n = 16, 80%) for a 
median of 3 (range 0-48) years. The majority (n = 15, 75%) of the CGs worked outside of home, 
45% (n = 9) were employed full time, and 35% (n = 7) of had to reduce working hours to take 
care of the CRs. The CGs reported that spirituality was important (median 3.5, range 1-4). They 
also regularly attended religious services (median 3, range 1-5) and often prayed or mediated 
(median 5, range 1-5). The majority (n = 13, 65%) of the CGs were children of the CRs. They 
had been taking care of their CRs for a median of 5 (range 1-26) years and provided a median of 
12 (range 2-24) hours of care daily. The majority of CGs used formal services “several times a 
week” (n = 16, 80%) and were “satisfied” or “strongly satisfied” (n = 18, 90%) with the services 
received. The CGs had moderate self-rated health (median 3, range 1-5). They reported their 
CRs’ general health as low (median 1.5, range 1-4) and their memory issues as a median of 25 
(range 10-49). 
 
Next are the key measurements in the pre- and post-tests for senior companions. Knowledge of 
AD/dementia (KAD) (z = −2.97, p = 0.003) and preparedness of caregiving (z = −2.81, p = 
0.005) were significantly improved for senior companion participants in the intervention group. 
What follows are the key measurements for CGs in pre-, post-, and follow-up tests in Texas and 
Arkansas. Baton Rouge did not complete the intervention due to the SCP programming being 
suspended during the COVID-19 pandemic. Caregiver burden decreased over time (F(2,10) = 
20.47, p < 0.001) especially between pre- and post- tests as well as between pre- and follow-up 
surveys. KAD (χ2(2) = 8.72, p = 0.01), satisfaction with social support (χ2(2) = 6.33, p = 0.04), 
coping skills F(2,12) = 4.10, p = 0.04), and PAC (χ2(2) = 11.39, p = 0.006) also increased 
significantly after the intervention. CJC were marginally significantly improved after SCP Plus 
intervention. 
 
Statistical comparisons were also conducted among key measurements of caregivers between the 
control group and the SCP plus group in Texas and Arkansas. Four key measurements showed 
significant changes for caregivers in the SCP Plus group. Specifically, caregivers in the SCP Plus 
group reported a significant decrease in caregiving burden (F(2,6) = 17.65, p = 0.003), especially 
between pre- and follow-up tests, as well as increase in KAD (χ2(2) = 6.53, p = 0.04), 
satisfaction with social support (χ2(2) = 6.53, p = 0.04), and PAC (χ2(2) = 6.53, p = 0.04), 
especially between pre- and post-tests as well as between pre- and follow-up tests. Coping skills 
of caregivers differed after the program, a finding that approached significance (F(2,6) = 
4.44, p = 0.07). Caregivers in the control group did not reveal any significant changes on any of 
the key measurements. 
 

 
 
The qualitative analysis led to the emergence of three themes, which contextualize and further 
support the abovementioned quantitative results: (1) learning new skills about caregiving; (2) 
gaining knowledge about ADRD; and (3) benefits for the dyad. These three themes are expanded 
upon below with representative quotes. 
 
The first theme was related to caregivers learning new skills as part of the SCP Plus. Skills 
included CGs’ changing their approach to supporting activities of daily living. For example, one 
caregiver shared: 
 
“Well…[name of a senior companion] had a good suggestion for me that was perfect. …because 
Mom would have all these clothes all in her room and she was still pretty much dressing herself 
and [name of a senior companions] told me to start to kind of remove some of those clothes, but 
to start putting her outfits together, pants and shirt, you know, and then, you know, put it all 
together and that’ll make it easier for her [care recipient] to continue to dress herself. And so, 
yes, I learned that from her. I learned too some little things, especially when she was moving 
towards her dementia things… I say they like to ‘fiddle with things.’ So I learned some little 
traits to have her to do to occupy her fingers and that would would settle her down. So I learned 
some of those things as well.” (Caregiver, Dallas) 
 
Similarly, another caregiver shared: 
“It turned around a lot of things that I was doing that I found out I was doing incorrectly as far as 
taking care of Mom. For instance. Uh, trying to make her remember things when she couldn’t, 
and I learned in the I learned in the program that that was not the thing to do. It was more or less 
to allow her to remember it the way that she remembered it and not try to force her to remember 
something that she couldn’t. And so. But I yeah, that was just one of the things that stood out 
with me. So there were several things that that I that it helped me with that I changed in taking 
care of her that helped out a whole lot. I mean a whole lot it. It was a a lifesaver. The program 
was a lifesaver.” (Caregiver, Dallas) 
 
Additionally, one caregiver reported changing their approach to handling challenging behaviors 
of the person with ADRD: 
“A lot of things cleared up and a lot of things learned. How to handle a person with dementia, 
Alzheimer’s. You know, sometimes it takes for you to walk through their delusions for them to 
get to a better place, like even with that.” (Caregiver, Baton Rouge) 
 
A second theme was related to education, particularly related to knowledge about ADRD. For 
example, one caregiver shared: 
“Ohh man ohh it to be honest with you it was very eye opening about a lot of misconceptions 
about dementia and and honestly not just the misconceptions, but just some things that’s just not 
known., I mean it, it was so much in that that you learn about. Dementia. Alzheimer’s that you 
either ever knew. If it wasn’t that you never knew the the myth and the misconception of it” 
(Caregiver, Baton Rouge) 
 
Another caregiver shared that they learned about other symptoms of ADRD. She shared, “You 
know, we we’re talking about Sundowning. And stuff like that. At night, you know, she [care 
recipient] was changed completely, completely changed. And I said yeah, that that that happens 

 
 
with me. I told her [Senior Companion] since she completely changes at night.” (Caregiver, 
Baton Rouge) 
 
The final theme was related to the caregivers’’ perspective that the SCP Plus had benefits for the 
dyad. For example, one caregiver shared: 
“I do feel like when we did that [SCP Plus], that it helped us both…I want to say it helped us 
better bond, to talk, to deal with grandmother…It helped us both to be able to talk to somebody 
else…that made a difference…It made a difference for her and I to be on the same page at the 
same time talking about Grandmother.” 
(Caregiver, Little Rock) 
 
Similarly, a caregiver shared that “she (the Senior Companion) learned very much from the 
training”. (Caregiver, Baton Rouge) 
 
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