QUERI – Quality Enhancement Research Initiative

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Sustaining STAR-VA: Partnered Evaluation of Veteran, Implementation and Facility Factors Contributing to Positive Sustained Outcomes to Inform Ongoing Program Implementation

Western New York, Boston, MA, and Providence, RI


The Staff Training in Assisted Living Residences (STAR) intervention was originally developed for training direct care workers in assisted living residences to improve the care of older adults with dementia by successfully managing the challenging behaviors commonly exhibited by these residents. STAR-VA adapted this intervention to be a Veteran-centered, interdisciplinary, behavioral approach for managing the behavioral symptoms of dementia (BSD) in VA Community Living Centers (CLCs). Between 2013 and 2016, this intervention was implemented in 66 CLC sites. Veterans enrolled in STAR-VA demonstrate significantly decreased frequency and severity of targeted challenging behaviors, symptoms of depression, anxiety, and agitation. CLC staff also report increased confidence in their ability to understand and manage behavioral symptoms. However, VA has not yet been able to evaluate the longitudinal and systemic impact of STAR-VA for Veterans and staff, nor contributors to its sustainability.

Collaborative evaluation is necessary to demonstrate the longitudinal impact of STAR-VA on CLC Veteran and site-level outcomes – and to determine factors associated with sustained implementation and positive outcomes in order to support program sustainment and expansion. The QUERI Sustaining STAR-VA Partnered Evaluation of Veteran, implementation and Facility Factors Contributing to Positive Sustained Outcomes aims to identify:

  • Prevalence of behavioral symptoms of dementia (BSD) in Veterans residing in Community Living Centers;
  • Characteristics associated with changes in BSD;
  • STAR-VA implementation best practices, as well as barriers and facilitators;
  • High- and low-performing Community Living Centers; and
  • Optimal sustainment intervention and evaluation strategies.

Anticipated Impacts:

Findings from this project will guide development of an outcome-driven, tailored intervention designed to increase the ability to sustain implementation of STAR-VA to advance the VHA priority to improve access to evidence-based care and provide Veteran-centered care for Veterans with dementia who reside in Community Living Centers.

Principal Investigator: Kim Curyto, PhD, Center for Integrated Healthcare (CIH); contact at kimberly.curyto@va.gov.

Operations Partner(s):

The Offices of Mental Health and Suicide Prevention (OMHSP) and Geriatrics and Extended Care (GEC) are the partners for this project. The evaluation of STAR-VA implementation also involves substantial support from Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) and GEC Data and Analyses Center (GECDAC).