Scaling Caregiver Health and Wellbeing Coaching: A Mixed Methods Evaluation of Implementation and Sustainment in the Veterans Health Administration.

BACKGROUND AND OBJECTIVES: Effective and sustainable support for family caregivers is a growing priority, yet practical guidance for scaling promising coaching interventions into routine practice is limited. The objective of this evaluation was to identify organizational determinants, barriers, facilitators, and adaptations affecting national implementation of the Caregiver Health and Wellbeing Coaching (CHWC) program in the Veterans Health Administration. RESEARCH DESIGN AND METHODS: An explanatory, sequential mixed‑methods design included surveys of CHWC staff (n = 53) and qualitative interviews (n = 14), guided by the updated Consolidated Framework for Implementation Research, its Outcomes Addendum, and the Framework for Reporting Adaptations and Modifications‑Enhanced. RESULTS: Successful implementation-defined as program launch and delivery to at least one caregiver at each site-and successful sustainment-defined as ongoing or expanding delivery to new and returning caregivers-were associated with thorough planning, leadership engagement, and flexible delivery. Barriers included staff turnover, complex documentation, and challenges recruiting caregivers. Facilitators and process improvements were rapidly integrated into program operations. DISCUSSION AND IMPLICATIONS: Findings can inform strategies to scale caregiver support programs that underpin sustainable aging and long-term care systems.