The PI and collaborators trained a psychology PhD student to serve as an interventionist and provide the TAP. In preparation for Session 1 with the caregiver, the interventionist delivering the TAP meets with the facility’s rehabilitation team (and in particular, the SCI interdisciplinary team collaborators and consultants on the grant) to identify the primary difficulties anticipated for the individual with SCI after discharge. The interventionist takes notes on the particular needs and bring these notes to Session 1 with the caregiver. Before discharge, the interventionist implements Session 1, a 1-hour meeting with each caregiver in the intervention group only. The primary focus of Session 1 is to orient the caregiver to the TAP and prepare the caregiver for discharge home. The interventionist provides the caregiver the guidebook and orientation to it, encouraging the caregiver to use it as a resource (caregivers in the control group receive a copy of the caregiving guidebook after the final data collection). The interventionist asks what concerns the caregiver has caring for the individual with SCI after discharge, taking notes on the caregiver’s responses. The interventionist shares with the caregiver the difficulties that the rehabilitation team had anticipated the individual with SCI will experience after discharge. The interventionist provides support and helps the caregiver problem solve caregiving related to these issues.

The interventionist administers four 1-hour telehealth clinic-to-home sessions with the SCI caregiver at 1, 2, 4, and 6 weeks after hospital discharge. One of the rehabilitation centers already had in place secure and encrypted telehealth technology that allows an interventionist on-site to meet virtually with a caregiver at home via personal computers or mobile devices. For caregivers who do not have a personal computer, mobile device, or adequate internet connection, a telephone-based approach is used. The individual with SCI may or may not be in the same room as the caregiver during these sessions, depending on the wishes of the caregiver. These sessions involve the same general format. The interventionist brings his or her notes from the previous sessions and from the rehabilitation team’s input. The interventionist reviews the content of these notes with the caregiver, checking in to see whether the problems are still present and to what extent. The interventionist engages in supportive problem solving and refers the caregiver to the guidebook sections relevant to the issues, walking the caregiver through those sections. Because of this format, the TAP is specifically designed for interventionists to tailor its use in future studies or administrations not only according to possible facility differences in what may be necessary for the intervention but also for differences in caregiver responsibilities and needs within a single facility. The entire structure of the TAP is centered around the caregiver’s most pressing needs. The interventionist takes notes on the continued problems and strategies for resolving them.

After enrollment and immediately before discharge (as well as before Session 1 for the TAP group), demographic and baseline data are collected from the individual with SCI and caregiver separately by a study coordinator. A study coordinator reads items aloud from an assessment packet (unless a participant explicitly requests a paper-and-pencil format) to the individual with SCI and caregiver, noting participants’ responses. The caregiver packet includes validated measures of caregivers’ quality of informal care provided, depression, relationship satisfaction, burden, caregiving self-efficacy, health status, and positive affect/well-being. The packet for the individual with SCI includes validated measures of functional status, perceptions of quality of informal care received, depression, relationship satisfaction, self-perceived burden, health status, and positive affect/well-being. In rare cases, after Data Collection 1 has been conducted, where the patient’s discharge is moved to a later date, data collection may be readministered to ensure data accuracy.

At 2 and 4 months, a study coordinator collects follow-up data from the individual with SCI and caregiver over the phone using the same validated measures as during the first data collection. A graphic depicting the study timeline can be seen in Figure 1.

The Exemplary Care Scale is administered for both patient and caregiver and is an 11-item self-report questionnaire that assesses the extent to which caregivers engage or do not engage in activities that help care recipients maintain dignity and respect [24]. Parallel caregiver and care recipient versions are available with equivalent measurement properties.

The Spinal Cord Independence Measure Version III is completed by the patient and is a 19-item self-report questionnaire that assesses functioning of individuals with SCI in 3 domains: self-care, respiration and sphincter management, and mobility. Higher scores indicate greater patient functioning [25].

The Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) is completed for both the patient and caregiver. The 20-item CESD-R [26] is the revised version of the original CESD [27], and higher total scores reflect higher depression symptomology.

The Self-Perceived Burden Scale is completed by the patient and assesses care recipients’ feelings of dependence and guilt regarding their caregiver’s difficulties [28]. The Self-Perceived Burden Scale contains 10 items, and higher scores indicate higher self-perception of being a burden.

The Zarit Burden Interview [29] is completed by the caregiver and is a 22-item, self-report measure of caregiver burden with items referring to the caregiver and patient relationship and evaluating the caregiver’s health condition, psychological well-being, finances, and social life. Higher total scores indicate greater burden.

The Revised Scale for Caregiving Self-Efficacy [30] is completed by the caregiver and measures 3 domains of caregiving self-efficacy: obtaining respite, responding to disruptive patient behaviors, and controlling upsetting thoughts.

Both the patient and caregiver complete the 12-item Short Form (SF-12). The SF-12 is one of the most widely used assessments of HRQoL in individuals with neurological conditions and their caregivers [31]. The SF-12 has 8 dimensions: physical function, role-physical, bodily pain, general health, energy/vitality, social function, role-emotional, and mental health. Higher scores indicate better HRQoL.

The Positive Affect and Well-Being Short Form [32] is completed by both the patient and caregiver and is a 10-item version of the National Institutes of Health Patient-Reported Outcomes Measurement Information System that has been tailored and optimized for the SCI population. Higher scores reflect greater positive affect and well-being.