University of Southern California Dissertations and Theses

A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members

A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members [capstone paper]

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A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members [capstone paper]

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Content Ba Con Café 1
A Targeted Culturally-Informed Approach for Caregiver Stress Among
Vietnamese Caregivers of Family Members
Executive Summary
Linda Nguyen, MSW
University of Southern California
Suzanne Dworak-Peck School of Social Work
DSW Program
Renee Smith-Maddox, Ph.D., Chair
August 2024

Ba Con Café 2
Table of Contents
ACKNOWLEDGMENTS 4
ABSTRACT 5
POSITIONALITY STATEMENT 6
PROBLEM OF PRACTICE AND LITERATURE REVIEW 8
WICKED PROBLEM 8
LITERATURE REVIEW 9
SOLUTION LANDSCAPE 11
PROBLEM OF PRACTICE 13
THEORETICAL FRAMEWORK 16
EDUCATION ON CAREGIVER STRESS 17
RESPECT FOR CULTURAL FACTORS AND UTILIZATION OF COMMUNITY RESOURCES 17
METHODOLOGY 18
DESIGN THINKING PROCESS AND DESIGN JUSTICE FRAMEWORK 18
ROLE OF THE DESIGN TEAM 22
MARKET ANALYSIS 23
PROJECT DESCRIPTION 24
PROTOTYPE DESCRIPTION 24
DESIGN CRITERIA 24
THEORY OF CHANGE 28
LOGIC MODEL 30
ETHICAL CONSIDERATIONS 31
LIKELIHOOD OF SUCCESS 31
IMPLEMENTATION PLAN 32
BUDGET & FUND DEVELOPMENT 33
MARKETING & BRANDING 35

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EVALUATION PLAN 35
MEASURING SOCIAL CHANGE AND IMPACT 35
DATA COLLECTION PLAN: 35
COMMUNICATION PLAN 36
CHALLENGES/LIMITATIONS 37
CONCLUSIONS AND IMPLICATIONS 38
LESSONS LEARNED 38
IMPLICATION FOR PRACTICE & FUTURE 38
ACTION PLAN 39
REFERENCES 42
APPENDICES 41

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Acknowledgments
I would first like to acknowledge the University of Southern California’s Suzanne
Dworak-Peck School of Social Work and the Doctor of Social Work (DSW) professors whose
guidance and support have allowed me to create this Capstone Project. Specifically, I want to
express my appreciation to Dr. Renee Smith-Maddox who believed in my aspirations to be a
change leader for the Vietnamese community in California and inspired me to think outside the
box to create this innovative social solution.
I would also like to thank my grandmother and mother who preserved our heritage in my
upbringing, which enabled me to connect with my community and motivated me to keep the
traditions, norms, and beliefs alive for future generations. Additionally, the life lessons that my
late younger sister, Dalina Nguyen, left behind have given me the courage to do what seemed
impossible: a daughter of a poor and single immigrant mother graduating with a doctorate.
This Capstone Project is also dedicated to all the family caregivers who selflessly
sacrifice their time, heart, and life to uphold the value of caring for their loved ones. You embody
resiliency, determination, and unconditional love. This project serves as a sign of hope for a
better future for the well-being of family caregivers and with hope, anything is possible.

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Abstract
Family caregiver stress is not only prevalent in the United States where it impacts 71% of
the 41.8 million family caregivers providing services to adults over the age of 50, but also has
significant consequences for the aging system and health care system, and the health and safety
of caregivers and their care recipients. The American Academy of Social Work and Social
Welfare has emphasized eradicating social isolation and loneliness (SI/L); research has found
SI/L to be a root cause of family caregiver stress. Effective evidenced-based interventions like
the Powerful Tool of Caregivers (PTC) and Stress-Busting Program for Family Caregivers have
promising outcomes of reduction of caregiver stress. However, the current research and solution
landscape have focused on the general caregiver population, which has created barriers and gaps
in services. For example, Vietnamese family caregivers are not utilizing these resources, have
reported poor comprehension of the resources, and are not always aware that the resources exist.
In response to these issues, this Capstone Project developed the Ba Con Café (BCC)
(Translation: parent, children, grandparent, grandchildren, and community Café). The BCC is a
culturally-informed approach for Vietnamese family caregivers caring for family members who
can independently live in the home and who only need assistance with daily living activities.
BCC provides prevention and self-care options for caregiver stress through education and
community support. BCC recognizes the effectiveness of current models to address caregiver
stress while being mindful of the unique challenges and belief systems that Vietnamese family
caregivers face. BCC seeks to bridge the gaps in support services and knowledge about caregiver
stress by creating culturally-informed solutions.
Keywords: caregiver stress, social isolation, loneliness, family resiliency, Vietnamese
caregivers, culturally responsive social supports.

Ba Con Café 6
Positionality Statement
As a graduate student in the Doctor of Social Work Program at the University of Southern
California (USC), I aim to increase access and quality of caregiver stress services by addressing
and eradicating barriers imposed by caregiving with a targeted solution for specific caregiver
subpopulations. I was raised by a single Vietnamese immigrant mother and grandmother in the
United States. I use my expertise in cultural factors and networking within the Vietnamese
community to create innovative solutions for Vietnamese family caregivers that are focused on
reducing social isolation and loneliness (SI/L) and, subsequently, caregiver stress. I acknowledge
the stigma within the Asian culture of seeking support. As a result of these long-held beliefs and
perceptions, many Vietnamese caregivers do not seek treatment and support or hide their access
to treatment due to guilt and shame; thus, they live with stress-related symptoms that accompany
caregiving. I seek to design a solution for reducing caregiver stress by engaging the Vietnamese
community, providing a nonjudgmental space where Vietnamese caregivers can get access to
evidence-based treatment, and educating them through a culturally sensitive and competent
approach. My interest stems from my personal experience as a caregiver for my grandmother and
my professional experience as a certified nursing assistant (CNA) in various settings. My
experiences have broadened my perspective on the gaps in services for informal and formal
caregivers. I have witnessed and endured increased and unmanaged stressors from the
professional responsibilities and societal and cultural expectations for a caregiver, including
SI/L, which exacerbates caregiver stress. I recognize the significance of the love and care of
caregivers for positive caregiving outcomes and understand the negative impact on well-being
when effective support services and caregiver stress that can reduce SI/L and caregiver stress are
not provided. I am equipped with the knowledge and experience to be an effective change agent

Ba Con Café 7
as evidenced by my employment and community contributions. My area of expertise includes
working as a medical social worker for the older marginalized population living with HIV/AIDs,
as a licensed psychotherapy clinician for the Vietnamese population living in locked institutions
for mental diseases, as a social work manager for an adult protective services agency, and
currently as a clinical manager for the chronically homeless and justice-involved older adult
population living with comorbid diseases. Specifically, I assess, evaluate, and implement
programs, policies, and high-fidelity intervention models for mental health and stress-related
disorders. I am also an adjunct professor at the University of Kentucky in their Master of Social
Work (MSW) program and hold the title of Miss Vietnam of California 2024 where I am
working on building equity and inclusion for my community. As a young and passionate female
change leader, I am motivated to advocate for my community and deliver an effective,
culturally-sensitive, and evidenced-based intervention for caregiver stress among Vietnamese
family caregivers. Overall, I am motivated to incorporate my personal, academic, and
professional expertise to create a solution for and with the targeted population.

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Problem of Practice and Literature Review
Wicked Problem
The American Academy of Social Work and Social Welfare (Grand Challenges of Social
Work, n.d.) defines social isolation (SI) as the absence of social connection and consistent
relationships, and perceived loneliness (L) as the subjective feeling of social disconnection. The
Academy has prioritized eradicating SI/L as it is a prevalent root cause and predictor of many
social and public health concerns. SI/L is a complex and multifaceted wicked problem, which
can lead to adverse outcomes, including the focus of this Capstone Project, caregiver stress.
Family caregivers often suffer from caregiver stress in solitude as they must attend to the
day-to-day demands of family members with physical, mental, and cognitive limitations
(National Association of Chronic Disease Directors, 2018). Hawkley and Capitanio (2015)
emphasized that SI/L can lead to negative health outcomes of poor immunity, cardiovascular
disease, depression, anxiety, and substance addiction. Musich et al. (2023) highlighted protective
factors that strengthen an individual to overcome life stressors like caregiver demands and
caregiver stress, such as sense of purpose, social outlets, flexibility, and inner resolve; however,
family caregivers face barriers with limited social support and interactions with peers and
community members because of their caregiving responsibilities. For example, the AARP
(Horovitz, 2024) reported that 27% of caregivers surveyed had to reduce working hours and,
therefore, meaningful interactions at work to care for their loved ones. Additionally, 31.8% of
caregivers surveyed took a leave of absence and 15.5% had to stop working for a period of time
(Horovitz, 2024). The well-being of family caregivers who are the major coordinators of
everyday long-term care and who provide unpaid care to support the older adult population and
improve systems of service provision for aging populations is threatened. Given these alarming

Ba Con Café 9
statistics as well as harmful and even fatal predictions, SI/L and caregiver stress is a wicked
problem that requires appropriate interventions and should not be underestimated.
Literature Review
The American Psychological Association (2011) reported that 65.7 million Americans
serve as family caregivers for an ill or disabled relative. The Family Caregiver Alliance and 43.5
million caregivers who provided unpaid care to family members with an estimated economic
value of $470 billion in 2013 (Family Caregiver Alliance, 2006). Family caregivers spend time
on caregiving tasks such as housekeeping, food preparation, and medication management, and
also have family obligations, employment duties, and attendance to their own mental and
physical health. The challenges with balancing caregiving and life responsibilities has led to an
occurrence of caregiver stress. In a study examining compassion fatigue and compassion
satisfaction in 168 family caregivers, Lynch et al. (2018) found that 71% of their sample reported
high levels of caregiver stress (Lynch et al., 2018). The Mayo Clinic (Mayo Clinic Staff, n.d.)
identified that caregiver stress includes symptoms of fatigue, sleep disturbances, irritability, and
angry outbursts. In Johnson and Fertel’s (2023) study, prolonged and unmanaged caregiver stress
resulted in a 32.9% increase in mental health problems among participants (Johnson & Fertel,
2023). The AARP and National Alliance for Caregiving’s (2020) Caregiving in the United States
report indicated that caregivers are at risk for poor health; 21% of unpaid caregivers surveyed for
the report stated they had “fair or poor health” (p. 6), a 6% increase from 2015. Finally, chronic
stress, such as is experienced in unpaid caregiving, can increase caregivers’ risk for
cardiovascular disease, high blood pressure, and immune system problems (Mausbach et al.,
2019) . The outcomes of caregiver stress can also lead to impaired functions, such as poor
self-care and lack of engagement in mental health and medical needs. In a National Institutes of

Ba Con Café 10
Health report, Torgan (2016) found that 57% of caregivers reported they did not go to the doctor
because they put their care recipients’ needs first, 51% reported they did not have time to take
care of themselves, and 49% stated they were too tired to care for themselves. Caregiver stress
also negatively impairs interpersonal relationships, employment responsibilities, hinders
caregiving productivity, and increases the possibility of violence and abuse toward care
recipients. Orfila et al. (2018) conducted a meta-analysis that highlighted this life-threatening
outcome and safety concerns. Orfila et al. found that caregivers living in the same household
have a higher chance of engaging in elder mistreatment that stems from stress. The meta-analysis
also revealed that the use of supportive resources, such as respite care and support groups is low
among caregivers. A study of family caregivers revealed that only 25% of the sample who
experienced significant emotional difficulty and health-related concerns utilized caregiver
support resources (Wolff et al., 2016). The literature has showcased an emotional and physical
toll that family caregivers experience as they care for family members with complex needs while
balancing their own needs, and the ambivalence caregivers have around seeking support; thus,
minor changes in caregiver demands or life responsibilities can be catastrophic for both the
caregiver and the care recipient.
Solution Landscape
The solution landscape for the wicked problem of SI/L and caregiver stress among family
caregivers shows promising interventions. First, on a federal and state level, the largest funding
source for caregiver resources is the National Family Caregiver Support Program
(Administration for Community Living, 2023) which supports research, advocacy for policy
reform, and implementation of programs and services to target family caregivers and caregiver
stress. In FY 2015, more than $145M was granted to states and local governments to support

Ba Con Café 11
programs and services, such as respite care and adult day care programs as well as to produce
fact sheets on caregiving, counseling services, and support groups (Administration for
Community Living, 2023, “Funding History,” para. 1). Additionally, the Family and Medical
Leave Act (FMLA) provides 12 weeks of unpaid leave, which can be used to focus on caregiver
responsibilities while protecting one’s job (Park & Robinson, 2020). Likewise, caregiving
organizations, such as the National Asian Pacific Center on Aging in Los Angeles (n.d.) provide
written informational material in many languages and cover general caregiving and caregiver
stress topics, such as relaxation and soothing techniques, depression among caregivers, and
medication management for older adults. There are also evidenced-based interventions for
caregiver stress, such as the Powerful Tool for Caregiving (PTC; Rosney et al., 2017) for
caregiver stress. The PTC uses a virtual 4-week support group to create a space for caregivers to
learn about caregiver stress, express their experiences, and get support from people with the
same struggles; classes are currently offered in Spanish, Korean, and English. Furthermore, the
Stress-Busting Program (SBP; National Council on Aging, 2023), offers a virtual 9-week support
group with tailored stress management techniques such as meditation, mindfulness, imagery, and
aromatherapy to manage caregiver stress symptoms.
However, these promising solutions have also revealed gaps in knowledge and barriers to
services. For instance, Zebrak and Campione (2021) conducted a study to evaluate the
effectiveness of the National Family Caregiver Support Program, the nation’s largest resource for
family caregiving support. The National Family Caregiver Support Program (Administration for
Community Living, 2023) reported that in FY2014, “more than 700,000 caregivers received
services” through their program (“Data Show Extensive,” para. 1). Yet, this figure meagerly
represents less than 2% of the 41.8 million family caregivers in America. Zebrak and Campione

Ba Con Café 12
evaluated the program’s efficacy in the areas of educational services and respite care, finding that
caregiver burden among the 908 participants who were measured longitudinally decreased only
slightly as a result of respite care. However, any improvement, Zebrak and Campione noted,
signals the need for further resourcing for caregivers, especially in the area of respite care .
Additionally, given that the implementation of programs and services is done at the smaller
government level, the availability of caregiver interventions depends on the region and its
capacity to execute such programs, highlighting that these numbers can be more disturbing for
specialized groups.
The FMLA has created challenges for employed caregivers; only 60% of the workforce
are eligible for FMLA (Park & Robinson, 2020). Unpaid leave restrictions make it financially
difficult to take paid time off and fears of employer discrimination are high (Park & Robinson,
2020). Furthermore, caregiving organizations like the National Asian Pacific Center on Aging
(n.d.) in Los Angeles only provide informational material or fact sheets, leaving a question about
the efficacy of this intervention for addressing, mitigating, and eradicating caregiver stress. Both
PTC and SBP are evidenced-based tools that target caregiver stress for the general population.
Neither program takes into account the cultural factors and lived experiences that influence a
subpopulation’s risk factors and trajectory for caregiver stress. Ultimately, there remains a major
concern about caregiver support that includes questions about the availability of resources, ease
of access to services, and whether the programs are meeting the needs of the targeted population.
Problem of Practice
The literature and solution landscape for family caregivers and caregiver stress is
reflective of the general family caregiving population and is not specific to subpopulations, such
as Vietnamese family caregivers. Vietnamese family caregivers who provide caregiving for older

Ba Con Café 13
adults living independently in the home and who require assisted daily living care have unique
cultural factors and life experiences that impact their susceptibility to caregiver stress.
Vietnamese family caregivers experience unique barriers, needs, and concerns that call for a
targeted and effective solution. Family caregivers are not a monolithic group and in order for
solutions to be effective, targeted interventions that are designed with and for specific end users
are vital.
Vietnamese family caregivers’ lived experiences change their trajectory of SI/L, which is
a predictor of caregiver stress; therefore, caregiver burden is heightened in this population. Jang
et al. (2022) found that Vietnamese family caregivers feel powerless, lonely, and socially isolated
in Western society due to their status as foreigners who were refugees and immigrants. The
large-scale Vietnamese population’s migration to the United States after the fall of Saigon on
April 30, 1975, resulted in a loss of vital protective factors, such as their homogenous homeland,
relationships, shared beliefs, traditions, societal norms, language, and religion. Language is
essential for meaningful social connection. Thomas and McDonagh (2013) described language as
a process of sharing ideas, thoughts, and feelings. Vietnamese family caregivers are
disadvantaged in a nation where English is the primary language, as only 35% of foreign-born
Vietnamese are English proficient (Budiman, 2021). A lack of English language proficiency
coupled with an underrepresentation of Vietnamese-speaking providers, Vietnamese family
caregivers are challenged with building rapport and trust in systems that will help them seek
caregiver stress treatment (Chan, 2020). This challenge creates a barrier to comprehension and
accessibility to resources and interventions.
Multiple cultural factors impact Asian caregivers’ readiness for help-seeking (Chan,
2020). For example, there is a taboo on discussions of stigmatizing circumstances; these

Ba Con Café 14
conversations are forbidden to protect the family’s reputation from shame and embarrassment
(Chan, 2020). Additionally, there are strict obligations of filial piety (Chan, 2020). As a result of
these beliefs, social norms, and traditions, struggling family caregivers remain isolated and
avoidant and possess decreased help-seeking behavior as they close the door to frontline workers
who provide supportive services. Furthermore, Vietnamese caregivers often present a rigid
perspective of caring for older adults at all costs, even to the point of jeopardizing the caregivers’
well-being. Hence, a dangerous and even fatal situation is created where cultural differences lead
to unspoken truths and more complicated barriers to interventions for caregiver stress arise.
Finally, stakeholder interviews conducted through this Capstone Project revealed that
Vietnamese family caregivers find great difficulty in navigating, understanding, and following
through with current family caregiver interventions. Vietnamese family caregivers noted a
complicated system by which to access the resources in their region, a lack of knowledge and
comprehension of available resources, a long waitlist for services, fear of stigma related to
accessing resources, and low motivation to engage in resources developed with Western customs
and practices. Ultimately, interview data emphasized that Vietnamese family caregivers who are
experiencing caregiver stress must navigate a convoluted system and process to get access to
help.
A successful solution for Vietnamese family caregivers caring for older adults who are
independently living in their homes but who need daily assisted living care needs to align with
caregivers’ unique barriers and culturally-specific needs. The solution needs to incorporate the
best practices in the field of caregiving to address SI/L and caregiver stress, including
community supportive resources, support groups, and evidence-based practices that have
empirical evidence to validate their efficacy. More so, the best guidelines in building a culturally

Ba Con Café 15
informed program highlight the importance of respecting cultural values and norms. Hence,
implementation of solutions in common cultural settings, such as cultural centers with
individuals who share the same cultural background, and the establishment of a network of
providers who are culturally informed is necessary for a welcoming and inclusive environment
with the goal of eradicating SI/L and caregiver stress.
Theoretical Framework
Family resilience theory (Walsh, 2003) posits that strengthening the family unit where
family connectedness is a vital protective factor can help its members and the overall unit
overcome setbacks, challenges, and future obstacles. This strengths-based approach highlights
the central role of the family unit in supporting members’ transitions through significant life
events and reaching positive adaptation or resilience (Walsh, 2003). Family resilience theory also
builds on the assumptions of viewing the family as a whole unit rather than focusing only on
family members (Falicov, 2005). Families provide social and economic resources for their
members, including financial support and caregiving. Finally, family resilience theory argues that
family cohesion is maintained through shared cultural values and goals, demonstrating that by
strengthening the family unit, all members of the family can rebound from adversity and reduce
risk factors (Falicov, 2005; Walsh, 2003).
Family resilience theory guides the formation and execution of Ba Con Cafe (BCC). The
identified solution recognizes that Vietnamese family caregivers and the older adults living in the
home are an interconnected family unit and when the core unit is strengthened, the family can
overcome hardships, such as increasing demands of caregiving caregiver stress, and SI/L. Family
plays an integral role in all aspects of life in Asian households; therefore, family resilience theory
is relevant for a targeted solution for this specific population. For example, milestones that

Ba Con Café 16
include marriage, dating, career, education, and even death require intensive family involvement
in the Vietnamese community. When the Vietnamese family unit is working collaboratively and
effectively, the unit is strengthened and can overcome setbacks and challenges such as grief, loss,
depression, illnesses and, subsequently, SI/L and family caregiver stress. The fundamentals of
family resilience theory are categorized into two parts to guide BCC to increase Vietnamese
families’ resiliency to overcome future challenges: (a) education on caregiver stress, and (b)
respect for cultural factors and utilization of community resources.
Education on Caregiver Stress
BCC provides a comprehensive learning experience through Vietnamese facilitators who
are culturally competent as they understand the target population’s perspective and their cultural
background and experiences (Danso, 2018). The topic of caregiver stress will be discussed with
relevant data and studies and the topic will be applied to the unique challenges and beliefs
systems of Vietnamese family caregivers, such as language barriers and mistrust in the Western
treatment system (Noe-Baustamante et al., 2022). BCC highlights the use of education to
increase awareness on the possible negative effects of caregiver stress for Vietnamese family
caregivers as a means of prevention and intervention before symptoms and functioning worsen.
These efforts will enhance knowledge of caregivers’ stress, improve attitudes toward community
support, and improve the well-being of Vietnamese family caregivers to continue to provide care
for family members.
Respect for Cultural Factors and Utilization of Community Resources
Family resilience theory (Falicov, 2005; Walsh, 2003) explains the unavoidable conflict
in life that can cause instability in the family and emphasizes that strengthening the family
through common goals and values can help the family and its members overcome adversities.

Ba Con Café 17
BCC respects family and cultural values, including filial piety, honoring the household name by
preventing shame and dishonor, and prioritizing the family (Choi et al., 2008). BCC also
acknowledges the cultural clashes between Vietnamese family caregivers who must uphold the
demands of their American life while balancing the obligations and commitments to their deeply
rooted heritage (Choi et al., 2008). BCC utilizes respect to invite an open conversation about the
strengths and challenges of these long-held cultural traditions, beliefs, values, and norms and to
provide a network of valuable caregiving resources that meet Vietnamese family caregivers’
unique needs.
Methodology
Design Thinking Process and Design Justice Framework
The Capstone Project followed the design thinking principles proposed by the Interaction
Design Foundation (n.d.) and upheld the Design Justice Network’s (2018) principles for design
processes. The design thinking process prioritized the voices, needs, and concerns of the
normally excluded group of Vietnamese family caregivers. Through a nonlinear and interactive
process of stakeholder interviews, stakeholder analysis, design labs, and utilization of a feedback
loop, Vietnamese family caregivers created BCC to eradicate SI/L and caregiver stress.
Empathize
Empathy allows human-centered designers to see the world of Vietnamese family
caregivers through their perspective, including what they feel, what they think, and what they
experience (Dam & Siang, n.d.). To gain this understanding for the needs and concerns of the
end users rather than assuming, the design process prioritized an immersion into Vietnamese
family caregivers’ environment. Through a series of 15 interviews with key stakeholders,
including Vietnamese family caregivers, Vietnamese older care recipients, senior center

Ba Con Café 18
representatives, home care agencies, social services social workers and case managers, and
cultural center representatives, questions were asked and common themes were gathered.
Questions included the following:
● Do you ever feel overwhelmed with caring for your loved ones?
● Do you find when you are overwhelmed, you are irritable, depressed, lose sleep and
appetite, and have difficulty concentrating?
● Do you know what caregiver stress is?
● What do you do to cope?
● What resources do you use to cope?
● Have you received adult day care, home health care, respite care, support groups,
counseling, used caregiving stress relaxation techniques, or read facts on caregiving
stress?
● Are you interested in these resources?
● What are your barriers to utilizing these resources?
● What resources do you need?
Hence, the voices and experiences of this marginalized population were incorporated through
every step of the design process (Costanza-Chock, 2020). Next, key takeaways were identified
and trends were analyzed through the stakeholder analysis. First, the majority of the interviewees
could identify symptoms of caregiver stress but did not acknowledge that they had caregiver
stress. Next, many interviewees had limited interest in or knowledge of community resources for
caregiver stress. Last, an emphasis was made on sacrificing their personal care for their family
care and life obligations, such as financially providing for their children. In contrast, engaging
with extreme users allowed for outliers that provided insight on the gaps which could offer a
potential social solution. For example, a Vietnamese family caregiver reported no interest in
caregiving resources as their time was consumed; this caregiver had an all-or-nothing thought
process. This caregiver’s perspective highlights that current resources are not appealing and
challenges assumptions that by creating effective solutions end users will be motivated to
participate.

Ba Con Café 19
Define
A concise description of the design problem was formulated through multiple iterations
of a problem statement. The problem was articulated through completing stakeholder interviews
and an analysis as well as a literature review of peer review articles, evidence-based research,
and leading organizations in caregiving stress, including Family Caregiver Alliance, National
Alliance for Caregiving, AARP, and the National Council on Aging. The statement focused
broadly on the challenges and barriers for Vietnamese family caregiver stress as stated by the end
user’s point of view. More so, discussion with experts in the field and individuals with lived
experiences facilitated the understanding of the problem. Every step of the statement focused on
the user, their needs, and their insight to follow the design justice principles (Costanza-Chock,
2020). The process allows for possible innovative solutions to be what the user wants.
Ideate
The design team supported the prototype-driven, innovative design, and human-focused
process to create several ideas. These ideas occurred during brainstorming sessions where
outside-of-box thinking was encouraged. Attendees creatively discussed virtual classes on
caregiver stress, in-person meals to learn about caregiver stress, and collaboration with various
stakeholders including senior day care programs and adult protective services. An emphasis was
made on practical methods and tools, such as utilizing existing solutions with proven efficacy,
like PTC and SBP. Additionally, the end goal of design thinking was highlighted, emphasizing
that the solution should be desirable, feasible, and viable as the focus was on what the end users
wanted in a solution, the ability to create the solution, and whether financial resources would be
available to implement the solution.

Ba Con Café 20
Prototype
Low, mid, and high prototypes were created, tested, and iterated. To start brainstorming
the idea of BCC, multiple iterations of a low-fidelity visual storyboard (see Appendix I) was
created that was inspired by the real-life stories and real-life people in the 15 stakeholder
interviews. The visual storyboard tells the story of Thu, a Vietnamese family caregiver. She
struggles with life balance while taking care of her mother and starts to experience symptoms of
caregiver stress. She found difficulties navigating available resources due to language barriers as
well as stigma about reaching out for help. Through the local Vietnamese newspapers and news,
Thu was able to easily locate BCC. She took her mother to enjoy a cultural dish and then
attended a support group while her mother attended enrichment activities with bilingual staff.
Thu found at BCC a community and safe space to overcome challenges in caregiving and to keep
providing quality care to her mother.
Next, a mid-fidelity prototype (see Appendix J) was created that shows the flow and
functionality of the design that is not static and is a working model that allows for user
interaction. The mid-fidelity prototype displays the functionality and experience the user will
have. These prototypes were presented to the design team and capstone chair to elicit feedback
and improvement in the prototype to support community feedback and improvement
(Costanza-Chock, 2020). The mid-fidelity prototype can be used with end users and stakeholders
for testing purposes, such as utilization of design labs. The mid-fidelity prototype goes into detail
about the mission and values of the project, and topics that will be addressed in each step, and
has a tangible prototype called a Zen meditation (see Appendix L).

Ba Con Café 21
Test
Design labs were implemented to test the effectiveness of the prototype where benchmarks
guided by the end users were used to inform the design process. A virtual class in a design lab
was tested using the high-fidelity prototype (see Appendix K). There were five invited
participants who were all Vietnamese family caregivers of older adults independently living in
the home and who required assisted daily living care. Only four participants arrived and stayed
throughout the entire 60-minute class. At the end of the module, a plan to capture output was
done through a speed networking (Gray, 2012) opportunity. Each pair of participants were
invited into a breakout room with each facilitator to record their answers on the experience in the
virtual space. The feedback loop, assessed through a post module questionnaire (see Appendix C
will determine if the project is meeting its desired outcomes and design criteria and will include
six questions. The end users guided and informed the evaluation process (Costanza-Chock,
2020).
● Were there challenges faced to access services?
● Do you feel like you can safely share your voice and learn in a non-judgemental way?
● Has your understanding of caregiver stress increased?
● Do you feel like you have a support network through BCC?
● Have you learned or utilized community resources for family caregivers?
● Are you experiencing a reduction in caregiver stress symptoms or improvement in
functioning?
Role of the Design Team
The BCC design team includes Dr. Beth Walker, a caregiver specialist and social worker
who holds a doctorate of social work. Dr. Walker has insight into the environmental and social
challenges of the targeted population as well as the value of community support. The team also
includes Dr. Christopher Hernandez, a psychologist and CEO of multiple behavioral health
nonprofit organizations in Santa Clara County who is an expert in maintaining the fidelity of
evidence-based models and incorporating the best practices in the field. Buddhist Temple

Ba Con Café 22
501(c)(3) operates a Senior Nutrition Program through Santa Clara County and has held a pivotal
role in providing the physical safe space to implement BCC. Additionally, religious leaders at
various temples have provided education and guidance on using cultural and familiar spaces to
invite participants. Finally, Miss Vietnam 501(c)(3) has been at various brainstorming sessions
and design thinking labs to provide input as a major Vietnamese influencer in the Vietnamese
community and has offered the Miss Vietnam 501(c)(3) platform to market BCC. Each member
played a role in the design thinking process, ensuring that the solution was innovative, ethical,
and developed with the end users in mind.
Market Analysis
There are multiple grant opportunities to target the well-being of caregivers as the
number of older adult demographics expands. For instance, Calgrows offers grants for novel
caregiver programs in the state of California of up to $1 million. Moreso, BCC will be
implemented in Santa Clara County, which is the county with the second largest population of
Vietnamese people in the United States with a census of 140,000 in 2019 (County of Santa Clara,
2019). The county is home to a centralized area of Vietnamese business ideas and religious sites,
providing opportunities for partnership with physical locations to implement BCC. The strong
sense of community enhances the scalability and reach of BCC to targeted end users.
Project Description
Prototype Description
The Capstone Project, BCC, seeks to create a community and physical safe space to
learn, express, and address caregiver stress through evidence-based support groups and a
culturally responsive curriculum that respects Vietnamese family caregivers’ traditions, values,
and belief systems while breaking down the stigma of seeking help. BCC seeks to provide

Ba Con Café 23
caregivers with knowledge, awareness, and a support network through a 5-week program of
social support groups (see Appendix K), stress management techniques (see Appendix L), and a
resource tool kit (see Appendix M) that includes a directory of Vietnamese health care providers,
respite care, and adult day care programs to ultimately empower family caregivers, strengthen
family units, and prevent and treat caregiver stress.
Design Criteria
The goal of BCC is to increase awareness of caregiver stress, decrease caregiver stress
through improved meaningful social networking and stress management techniques, and increase
utilization and knowledge of caregiver stress community resources. BCC’s objectives will be
achieved through the following design criteria (see Appendix A):
1. The design must have low barriers to access: The 5-week social support groups will
be implemented at Buddhist Temple 501(c)(3), a Buddhist temple in San Jose, that
hosts the Senior Nutrition Program (SNP) every Friday, Saturday and Sunday from
10:00 a.m. to 12:00 p.m. While older family members are enjoying their meals and care
with SNP staff in attendance, Vietnamese family caregivers will increase their
knowledge and awareness of caregiver stress signs and symptoms and negative
outcomes as well as expand their expertise in stress management strategies to combat
caregiver stress in these specialized support groups.
2. The design must provide a safe space for Vietnamese family caregivers: The
facilitators within the facilitator-led groups are responsible for setting the parameters,
rules, and culture of support groups to ensure that the Capstone Project meets the stated
objectives and creates an inclusive and safe environment (Benson et al., 2020).
Specifically, facilitators will create a safe space, where there is a nonjudgmental and

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open group discussion, by reviewing ground rules at the beginning of each session and
monitoring the group discussion. Group members will follow the best practices in
ground rules as outlined by Smutny’s (n.d.) Respective Communication Guideline,
which is based on the acronym RESPECT: take Responsibility for one’s own
experience and perspective, use Empathetic listening, be Sensitive to different
communication styles, Ponder before you speak, Examine your assumptions and
perceptions, maintain Confidentiality, and Trust that greater truths come from
diversity (para. 5). Studies have resulted in a positive relationship between caregiver
stress and using online health forums to seek emotional support (Tanis et al., 2011). As
these caregivers struggle with social connectedness and loneliness, support groups can
make them feel less isolated and alone in what they are experiencing and provide
opportunities for engagement while addressing caregiver stress through a targeted
curriculum. Class settings will have a maximum of 12 students as the Anxiety &
Depression Association of America (n.d.) found that this number of participants
facilitates meaningful, rich, and in-depth discussion through participatory scenarios and
role-plays.
3. The design must target education on caregiver stress and the unique barriers and
needs of Vietnamese family caregivers: Vietnamese family caregivers will increase
their knowledge and awareness of caregiver stress signs and symptoms and negative
outcomes as well as expand their expertise in stress management strategies to combat
caregiver stress. The 5-week social support groups will incorporate the unique beliefs,
traditions, needs, and barriers of the Vietnamese population through every topic and
group discussion.

Ba Con Café 25
4. The design must include evidence-based practices of PTC and SBP to address
family caregiver stress: Each session will run for 90 minutes with a facilitator who has
been trained by a master trainer for the PTC program, followed by a 30-minute
enhanced education, discussion, and stress management skill practice that targets the
end users. These skills are outlined in the SBP; BCC has tailored and modified the
skills for the Vietnamese family caregiver population. For example, mindfulness
meditation was enhanced to guided storytelling through Zen meditation, where
storytelling is a cultural custom practiced by Vietnamese people. Maintaining the
fidelity of the PTC program, a master trainer-to-facilitator model will be used; a master
trainer will complete the master training for the PTC program and then train their
facilitators with the same program that is used by end users. Sousa et al. (2021) found
that a master trainer-to-facilitator model facilitation allows for mastery and oversight as
repetition occurs through the program curriculum as well as with master trainer on site.
5. User Feedback Loop: At the end of each session, participants will complete a post
module questionnaire (see Appendix C) and complete the APA Caregiver
Self-Assessment (see Appendix D; Epstein-Lubow et al., 2010), which provides a score
between 0 and 18 to monitor caregiver stress reduction and caregiver resource
knowledge. The program manager of BCC will collect data on the key metrics and
determine if the benchmarks meet their target through an evaluation process (see
Appendix E). For instance, at the end of each class, the program manager will gather
data on benchmarks to analyze the effectiveness of BCC, including the number of
participants for the week, the number of referrals for the week, and the number of
returning participants.

Ba Con Café 26
6. Review of User Feedback Loop: BCC’s team, which includes the master trainer,
facilitator, program manager, and stakeholders (funders, donors, subject matter experts)
will evaluate the participant responses by identifying common trends, adherence to
design criteria, and key metric target progress.
7. Action Planning: BCC’s team will identify specific, measurable, actionable,
responsive, and timely goals to address poor performing key metrics. The program
changes and deadline will be outlined through an action plan where the ongoing user
feedback loop will monitor progress.
8. Ongoing Monitoring & Evaluation: BCC’s team will have weekly meetings to
continue monitoring, evaluating, and brainstorming to ensure the accountability of the
action plan, adherence to key metrics and design criteria, and continuous improvement
and expansion opportunities.
Theory of Change
BCC will change the solution landscape for interventions to combat family caregiver
stress and create an effective and innovative solution by strengthening the family unit and
empowering Vietnamese family caregivers through education and community integration. The
family unit will be the center of this proposed solution, which enables families to overcome
adversities like caregiver stress as BCC is guided by family resilience theory (Falicov, 2005;
Walsh, 2003). It integrates the best evidence-based practices of PTC and SBP, uses guidelines
offered by the Family Caregiver Alliance and the Collaborative Community Based Approach,
respectively, and enhances the current landscape by ensuring that the unique barriers, needs, and
concerns of the targeted population are met. By addressing caregiver stress with targeted

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solutions through the perspective of Vietnamese family caregivers, BCC has the potential to
eradicate family caregiver stress and be a preventative and treatment model for caregiver stress.
The goal of BCC is to increase awareness of caregiver stress, decrease caregiver stress
through improved meaningful social networking and stress management techniques, and increase
utilization and knowledge of caregiver stress community resources. BCC will accomplish this
through a 5-week program of social support groups that encompass five, 120-minute in-person
sessions consisting of a 90-minute group session and a 30-minute enhanced education session at
Buddhist Temple 501(c)(3) in San Jose, California. While older adults are eating at the Senior
Nutrition Program (SNP) that operates Friday, Saturday and Sunday from 10:00 a.m. to 12:00
p.m., Vietnamese family caregivers will have the opportunity to join BCC. A
Vietnamese-speaking master trainer trained in PTC will train support group facilitators who can
lead the 90-minute classes. Class settings will have a maximum of 12 students to facilitate
meaningful, rich, and in-depth discussions through participatory scenarios and role-plays. The
five topics covered will include increasing awareness and knowledge of caregiver stress,
reducing caregiver stress, emotional management, improving self-confidence, and increasing
community resource knowledge. BCC will innovatively address gaps in knowledge and barriers
to services by following the 90-minute session with a 30-minute session that applies the
evidence-based material to cultural factors and lived experiences of Vietnamese family
caregivers and seeks to understand their needs for an effective caregiver stress solution. This
30-minute session will elaborate on the given topic with discussion and incorporation of stress
management techniques from the SBP.
Overall, BCC leverages the best practices and existing structures, such as cultural centers
and community centers to scale its innovative solution where the design criteria and program

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objectives will be monitored, analyzed, and evaluated through assessment tools and benchmarks.
BCC offers a safe and inclusive space with respect and appreciation for cultural norms through
cultural factors and lived experiences to motivate end users to come to the table. Activities will
include education seminars, support group work, and an interactive experience engaging in stress
management techniques and a resource tool kit. The impact will be a change to the landscape of
the current solutions, including the voices of Vietnamese family caregivers and taking a feasible
and practical step forward to eradicate the wicked problem of SI/L and decrease caregiver
burden.
Logic Model
BCC uses its logic model (see Appendix B) to provide a map of necessary inputs,
activities, outputs, outcomes, and impact. To implement BCC, inputs include human capital
(master trainer, group facilitators, program manager who will serve as the recruiter, event
coordinator, data collection analyst, church leaders, and volunteers), raw material (module
outlines, assessment handouts, worksheets on stress management techniques, training material,
office material, transportation to site, and a physical space for BCC), technology (computers,
large TV screen, cellphones, and printer) and fundraising material to attract in-kind and monetary
donations. Activities will include education, community social support, stress management
techniques, and a resource toolkit to support Vietnamese family caregivers who experience or are
at risk of caregiver stress, as well as assessment tools and benchmark data collection to monitor,
analyze, and evaluate that BCC is a responsive intervention. Desired short-term outcomes
include increased knowledge on caregiver stress and community resources and acknowledging
that BCC is a safe and inclusive space for learning and engaging in help-seeking behaviors. As
the master trainer, group facilitators, and volunteers implement improved practices through the

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user feedback loop, evaluation process, and action planning, they will become subject experts.
Desired long-term outcomes include an increased rate of participation return, reduction in
caregiver stress, and increased use of community resources.
Ethical Considerations
Throughout the design process, the designers of BCC have worked collaboratively with
Vietnamese family caregivers to identify gaps in knowledge and barriers to services and have
empowered caregivers to speak about the cultural factors and lived experiences that have
uniquely influenced the trajectory of caregiver stress for their community. Designers have
prioritized caregivers’ vision of a safe and inclusive space to comfortably speak about these
stigmatizing issues of caregiver stress and help-seeking behaviors throughout the design process.
There is respect and acknowledgment by designers—who are facilitators and not experts, as the
end users are the experts—to hold onto their traditional norms, beliefs, and practices while
working toward a non exploitative solution. More so, an ethical emphasis is prioritized to
maintain the safety of the end users from being harmed by BCC by identifying designer
assumptions, challenging designer assumptions, and keeping the voices of the end users
throughout the Capstone Project design process to ensure end users are comfortable using the
solutions created. The prioritization of a nonjudgmental environment is achieved by group
facilitators who set the ground rules under RESPECT (Smutny, n.d.). Ongoing monitoring and
evaluation ensures that ethical concerns are addressed.
Likelihood of Success
The likelihood of success for BCC is high due to several factors. BCC will be
implemented in Santa Clara County, which has the second largest population of Vietnamese
people in the United States. The strong sense of community enhances the scalability and reach of

Ba Con Café 30
BCC to targeted end users. Community efforts through networking can identify hard-to-reach
populations, such as unmotivated Vietnamese family caregivers to get access to caregiver
resources. Additionally, the designers of BCC have a footprint in the community with Miss
Vietnam California 2024 where they can use the networking, academic, and professional
experience, reputation, and platform to attract these end users as well.
Implementation Plan
Using the EPIS framework of Exploration, Preparation, Implementation, and Sustainment
(Moullin et al., 2019), the four well-defined phases strategically outline the steps for a seamless
implementation of BCC.
In the Exploration Phase, the stakeholder interviews were conducted with end users and
stakeholders, such as Vietnamese family caregivers, care home agencies, medical providers,
older adults who are cared for by family caregivers, and frontline workers to understand the
needs and concerns of the target population and caregiver stress services. Additionally, the best
practices from caregiver support organizations and evidence-based tools of PTC and SBP were
identified as the most suitable fit to incorporate into the Capstone Project.
In the Preparation Phase, assumptions, challenges, and potential barriers were identified,
and a detailed plan to address these factors was developed. For example, the outer context of
preparation, such as potential funding sources, was a barrier due to limited resources and
deadlines for grant proposals. Hence, to expedite the launch and meet the start-up expenses
expectations, an existing 501(c)3 under Miss Vietnam 501(c)(3). has agreed to take on the
project and use its platform to market, fund, and attract end users. Moreover, Buddhist Temple
501(c)(3) has provided a physical space for BCC at their cultural site that already invites 300
Vietnamese people each Friday, Saturday and Sunday from 10:00 a.m. to 12:00 p.m. at their

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SNP. Furthermore, the inner context of preparation such as creating a culture in the organization
that fosters an inclusive and nonjudgmental space that values the belief systems of the end users
needed to be addressed.
In the Implementation Phase, BCC and the 5-week social support groups will be
initiated. Using the respective program benchmarks (number of participants for the week,
number of referrals for the week, and number of returning participants) and assessment tools
(APA Caregiver Self-Assessment, which provides a score between 0 to 18 to monitor caregiver
stress reduction and increase caregiver stress awareness and knowledge) in the evaluation
process, the implementers can determine if the preparation phase was effective or ineffective in
addressing major issues.
In the Sustainment Phase, there is stable funding and ongoing monitoring for quality
assurance. There will be more partnerships with Vietnamese businesses and donors to increase
the scalability of BCC.
Budget & Fund Development
In the first year, BCC will acquire its start-up funding (see Appendix F) through multiple
sources. First, the CalGrows program under the California Department of Aging (n.d.) seeks to
improve the skills and retention of direct caregivers by providing $89 million for novel
approaches for caregivers. Currently 76 organizations have received funding for programs that
train and retain a variety of caregivers, including unpaid caregivers of older adults and
individuals with disabilities (California Department of Aging, n.d.). CalGrows awards up to $1
million to support pilots ready to be Proof-of-Concept. Second, BCC will operate under a
501(c)3; its nonprofit status will allow BCC to be a reputable entity that will seek funding
through grants like CalGrows. Additionally, its status as a 501(c)3 will also enable BCC to raise

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money through donations and fundraisers. Currently, BCC has garnered interest from the Miss
Vietnam 501(c)(3) organization that empowers women to be change leaders and agents in the
Vietnamese community. Miss Vietnam 501(c)(3) is providing the initial startup costs for BBC,
such as the cost of course material, marketing, and technology equipment. More so, Buddhist
Temple 501(c)(3) has partnered with BCC to implement the 5-week social support group on their
physical cultural site. Buddhist Temple 501(c)(3) will also provide student volunteers who can
operate as marketers, recruiters, and facilitators. Additionally, other vital stakeholders, including
local Vietnamese medical doctors, mental health providers, and adult day care programs have
expressed interest in sending referrals to the program.
BCC will need a $100,000 initial investment during the first 12 months (see Appendix
G). Expenses will include the salaries of two part-time employees who will serve as the master
trainer and facilitator at $20/hour, a full-time program manager who will serve as the recruiter,
event coordinator, and data collection analyst at $20/hour. Additionally, the cost of the PTC
master trainer course is valued at $250. The Vietnamese-speaking master trainer will complete
the virtual curriculum to train facilitators who will lead the PTC curriculum. The cost of
marketing material is valued at $500, the cost of technology equipment for running social media
platforms and the courses will be an in-kind donation from Miss Vietnam USA, fundraiser
material will cost $1000, consultants will cost $10,000, and the cost of rent and utilities will be
another in-kind donation from Buddhist Temple 501(c)(3). The diversified funding strategy
through grants like CalGrows, monetary donations, in-kind donations, and fundraisers ensures
robust support for the long-term sustainability of BCC. It is anticipated that most of the expenses
will be covered by in-kind donations, monetary donations, supplemented by grants, with a focus
on volunteer support.

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Marketing & Branding
The marketing and branding plan (see Appendix H) seeks to create a trustworthy and
attractive brand to engage donors and end users by posting on various social media platforms
including Instagram and Facebook. Key strategies include postings on social media to spread
publicity for BCC and provide education on caregiver stress as well as completing speaking
engagement opportunities at public events to market BCC. Miss Vietnam California 2024, who is
the program designer, will use lived experiences, storytelling, expertise in the field, and an
attractive visual identity to foster widespread community engagement through social media and
through in-person interactions.
Evaluation Plan
Measuring Social Change and Impact
For program designers of BCC to determine if the solution is successful, there will be an
emphasis on key metrics and data collection plan through the user feedback loop, benchmark
data, and assessment tools. These evaluation tools will enable BCC to track the level of
engagement, such as the total number of participants, participation return rates, and referrals by
partner programs as well as changes in caregiver stress knowledge and levels. Through data
collection, analysis and evaluation, a determination can be made if BCC is making a social
change or impact.
Data Collection Plan:
The Program Manager also serves as the data collector and analyst. As a data collector,
the Program Manager will tally the benchmark numbers for program outcomes, which include
number of participants for the week, number of referrals for the week, and number of returning
participants. The Program Manager will also tally scores for the APA Caregiver Self-Assessment

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(Epstein-Lubow et al., 2010), which provides a score between 0 to 18 to monitor caregiver stress
reduction. Benchmark targets will include 12 weekly participants, five new weekly referrals, a
50% participation return rate of six participants, and 80%, or 9 participants who show
improvement in their APA Caregiver Self-Assessment score. Additionally, the user feedback
loop will be distributed by group facilitators through the post module questionnaire to determine
if design criteria and BCC’s goals are met and will cover the following questions:
● Were there challenges faced to access services?
● Do you feel like you can safely share your voice and learn in a non-judgemental way?
● Has your understanding of caregiver stress increased?
● Do you feel like you have a support network through BCC?
● Have you learned or utilized community resources for family caregivers?
● Are you experiencing a reduction in caregiver stress symptoms or improvement in
functioning?
Overall, data collection efforts by the Program Manager will be used to encourage
evidence-based informed decision making for program adaptability and improved performance
to ensure program objectives are met.
Communication Plan
The design criteria and goals will be monitored by BCC’s team, which includes the
master trainer, facilitator, program manager, and stakeholders. The prioritized outcomes include
increased awareness of caregiver stress, decreased caregiver stress through improved meaningful
social networking and stress management techniques, and increased utilization and knowledge of
caregiver stress community resources. To highlight progress and changes, there will be ongoing
meetings with stakeholders where presentations and discussion of themes in the user feedback
loop and key metric data will be captured. There will be successful testimonial and visual
diagrams of data. There will be opportunities to address gaps in services with an action plan. By
doing so, collaboration, transparency and accountability will be promoted. Examples of a
communication plan to stakeholders include the following:

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Challenges/Limitations
BCC must be aware of ethical and legal concerns that surface when working with
vulnerable populations such as older adults. Due to the statistical data that have revealed the
increased risk of elder abuse and neglect by family caregivers who experience caregiver stress
(Administration for Community Living, 2018), staff and program participants must understand
the legal requirements of mandated reporting. It may be an ethical dilemma for staff whose
mission is to reduce caregiver stress by helping end users but who must also report suspected
abuse and neglect. During the ground rule introduction of BCC, information on mandating
reporting must be provided and repeated to ensure ethical decision-making. Furthermore,
applying the design thinking principles, BCC used assumptions such as Vietnamese family
caregivers are motivated to take the time to learn about caregiver stress, are willing to come to a
physical space, and are inclined to engage in support group class setting. For adaptation and
sustainability, these assumptions must be further explored and tested and iterations must be made
to create an effective design. Finally, although there is little financial risk given the surplus that is
expected to be generated based on the startup budget report and first-year budget report, the
sustainability of the program will be met with setbacks for a possible growing number of
participants. Diversifying funding sources through grants, in-kind donations, fundraisers, and

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monetary donations will be beneficial and highlighting partnerships with other organizations can
improve the scalability and sustainability of BCC.
Conclusions and Implications
In conclusion, this Capstone Project’s mission is to improve the well-being of Vietnamese
family caregivers who are challenged by caregiver stress by reducing the stigma around getting
caregiver stress support and reducing stress through knowledge, awareness, and skill-building.
Lessons Learned
Throughout the design process and interaction with the design team, there was an
understanding that reinventing the wheel is not necessary. For example, PTC and its class
curriculum can be utilized because it has been studied and proven to be effective for caregiver
stress; it is recognized by the Administration on Aging and the Administration for Community
Living. Additionally, best practices in the field were identified and incorporated, including The
Family Caregiver Alliance guidelines, which state that eligibility requirements should be easy to
comprehend, local resources should be easy to identify, and programs should meet the needs of
the client, as well as the collaborative community based approach, which notes that physical
spaces that have pre existing cultural networks are an ideal place for education and engagement.
Implication for Practice & Future
This Capstone Project has the potential to serve as a best practice in the field of inclusive
caregiver stress programs, where other ethnic groups and populations can innovate and create
specialized interventions for specific populations. This Capstone Project also has the potential to
transition to a virtual space and to other physical environments where class sessions are held
face-to-face within the community and continue to promote the best practices for an inclusive
physical environment. In conclusion, this Capstone Project’s mission is to improve the

Ba Con Café 37
well-being of Vietnamese family caregivers who are challenged by caregiver stress by reducing
the stigma around getting caregiver stress support and reducing stress through knowledge,
awareness, and skill-building.
Action Plan
BCC is in the early stages of development, and the high-fidelity prototype is ready to be
field-tested as a pilot program. The next step is to submit the grant proposal to CalGrows,
collaborate with Miss Vietnam 501(c)(3) to market the program, gather referrals through
interested stakeholders to garner the first cohort of participants, and partner with Buddhist
Temple 501(c)(3) to have a physical space for BCC to be implemented.

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Action Step Description Timeline
Stage of
Implementation
Resources Needed
Secure Funding
Submit CalGrows Grant
Application. Continue to
explore other grant and funding
opportunities.
Next 3
months
Exploration
Write grant proposal
Submit grant proposal
Fundraiser material
Foster
Partnerships
Continue partnerships with
Miss Vietnam 501(c)(3) and
Buddhist Temple 501(c)(3)
who will provide a platform for
marketing, networking
opportunities, and physical
space for BCC.
Next 3
months
Exploration Partnership agreements
Marketing
Begin posting BCC
advertisements on social media
platforms and complete public
speaking opportunities to
market BCC and attract
attention and referrals.
Next 6 to
12 months
Installation Social media platforms
Pilot Ready
Pilot BCC at Buddhist Temple
501(c)(3) over the 5-week
social support group process
Next 6 to
12 months
Implementation
Prototype materials
Pilot sites
Monitor and
evaluate
Use the established user
feedback loop, key metrics, and
targeted benchmarks to monitor
and evaluate the social change
and impact of BCC. Use
testimonials of participants to
monitor success which is
conducted through BCC team
meetings
Ongoing Implementation
Data collector
Data collection tools
BCC weekly team
meetings
Scalability
Increase partnerships with other
local providers to increase the
reach of BCC.
After 1
year
Full Implementation
Partnership agreements
Scalability strategies

Ba Con Café 39
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Appendices
APPENDIX A: DESIGN CRITERIA 49
APPENDIX B: LOGIC MODEL 50
APPENDIX C: USER FEEDBACK LOOP—POST MODULE QUESTIONNAIRE 51
APPENDIX D: MEASUREMENT OF SOCIAL CHANGE/IMPACT: APA’S CAREGIVER
SELF-ASSESSMENT 52
APPENDIX E: EVALUATION—KEY METRICS AND BENCHMARKS 54
APPENDIX F: GRANT PROPOSAL 55
APPENDIX G: LINE-ITEM BUDGET 56
APPENDIX H: MARKETING MATERIALS 58
APPENDIX I: LOW-FIDELITY PROTOTYPE FOR BA CON CAFÉ 59
APPENDIX J: MID-FIDELITY PROTOTYPE FOR BA CON CAFÉ 60
APPENDIX K: HIGH-FIDELITY PROTOTYPE FOR BA CON CAFÉ 65
APPENDIX L: BA CON CAFÉ STRESS MANAGEMENT KIT 76
APPENDIX M: BA CON CAFÉ COMMUNITY RESOURCE KIT 78

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Appendix A:
Design Criteria

Ba Con Café 48
Appendix B:
Logic Model

Ba Con Café 49
Appendix C:
User Feedback Loop: PostModule Questionnaire

Ba Con Café 50
Appendix D:
Measurement of Social Change/Impact–
APA’s Caregiver Self-Assessment

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Epstein-Lubow, G., Gaudiano, B. A., Hinckley, M., Salloway, S., & Miller, I. W. (2010). Evidence for the validity of
the American Medical Association’s caregiver self-assessment questionnaire as a screening measure for
depression. Journal of the American Geriatrics Society, 58(2), 387–388.
https://doi.org/10.1111/j.1532-5415.2009.0271.x

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Appendix E
Evaluation: Key Metrics and Benchmarks
Key Metric Data Collection Method Target
Measurement
Frequency
Number of participants
weekly
The Program Manager will
record by tallying 12 Weekly
Number of referrals weekly
The Program Manager will
record by tallying 6 Weekly
Participant Return Rate:
Number of participants that
return to attend an additional
session
The Program Manager will
record by tallying 6 (50%) Weekly
Number of participants that
showed improvement in
APA’s Caregiver
Self-Assessment Score (Score
0-18)
The Program Manager will
record by tallying 9 (80%) Weekly

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Appendix F:
Grant Proposal

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Appendix G:
Start-up Budget and First Year Budget
Ba Con Cafe
START-UP BUDGET
September 2024 - August 2025 (12 months)
ITEM COMMENTS AMOUNT
REVENUE
In-kind donations 10,000
Monetary donations 10,000
CalGrows Grant
The grant proposal needs to
be submitted by September
2024 100,000
Fundraisers 10,000
TOTAL REVENUE 130,000
EXPENSE
Personnel Expenses
Master trainer PT 20 hours 20,800
Facilitator PT 20 hours 20,800
Site Manager/Event Coordinator/Social Media
Coordinator/Referrals Coordinator/Volunteer
Recruiter FT 40 hours 41,600
Total Personnel Expenses 83,200
Non-Personnel Expenses
PTC Course Material and office supplies 500
Virtual technology equipment
Will be donated by Miss
Vietnam 501(c)(3) 0
Gas and car for referrals and engaging donors 6,000
Fundraiser material 1,000
Consultant and Data Analyst 10,000
Rent/Utilities
Will be donated by Buddhist
Temple 501(c)(3) 0
Other Non-Personnel Expenses 17,500
TOTAL EXPENSES 100,700
Net Profit 29,300

Ba Con Café 55
Ba Con Cafe
STEADY-STATE ANNUAL OPERATING COST
ITEM COMMENTS AMOUNT
REVENUE
In-kind donations 20,000
Fundraiser 20,000
Monetary donations 20,000
Grants 50,000
TOTAL REVENUE 110,000
EXPENSE
Personnel Expenses
Master trainer PT 20 hours 20,800
Facilitator PT 20 hours 20,800
Site Manager/Event Coordinator/Social Media
Coordinator/Referrals Coordinator/Volunteer
Recruiter FT 40 hours 41,600
Total Personnel Expenses 83,200
Non-Personnel Expenses
PTC Course Material and office supplies 500
Technology equipment
Will be donated by Miss
Vietnam 501(c)(3) 0
Gas and car for referrals and engaging donors 6,000
Fundraiser material 1,000
Consultant and Data Analyst 10,000
Rent/Utilities
Will be donated by Buddhist
Temple 501(c)(3) 0
Other Non-Personnel Expenses 17,500
TOTAL EXPENSES 100,700
Net Profit 9,300

Ba Con Café 56
Appendix H:
Marketing Material (Social Media Posts)

Ba Con Café 57
Appendix I:
Low-Fidelity Prototype

Ba Con Café 58
Appendix J:
Mid-Fidelity Prototype

Ba Con Café 59

Ba Con Café 60

Ba Con Café 61

Ba Con Café 62

Ba Con Café 63
Appendix K:
High-Fidelity Prototype
Ba Con Cafe: A Targeted Approach for Caregiver Stress Among Vietnamese Caregivers
Caring for Family Members who Independently Live in their Homes is a groundbreaking
innovative solution aiming to address caregiver stress by Vietnamese family caregivers of older
adults living independently at home who require assisted daily living assistance. BCC
recognizes the significant impact of caregiver stress on the mental and physical health of
caregivers and the importance of targeted interventions for specific cultural communities. The
project leverages evidence-based tools and a culturally informed curriculum to create an
inclusive and safe space for Vietnamese caregivers to overcome caregiver stress. BCC is a
5-week facilitator led social support group. The goal of BCC is to increase awareness of
caregiver stress, decrease caregiver stress through improved meaningful social networking and
stress management techniques, and increase utilization and knowledge of caregiver stress
community resources. To achieve these goals, the first class will provide an overview of family
caregiver stress including signs, symptoms, and negative outcomes as well as how it uniquely
affects Vietnamese family caregivers due to cultural factors. The next four classes will follow
the four-week curriculum outlined by PTC and include an additional 30-minute session to apply
the topics to the unique experiences and needs of Vietnamese family caregivers. There will be a
discussion question and practicing of a stress management skill that targets this population to
facilitate understanding, discussion, heading, and recovery of caregiver stress. At the end of the
session, participants will complete the APA’s Caregiver Self-Assessment and a post module
questionnaire to monitor program outcomes. The Program Manager will be the data collector of
identified key metrics to also help with monitoring program outcome.

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Appendix L:
Ba Con Cafe Stress Management Kit with
Guided Zen Meditation Material

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Appendix M:
Ba Con Cafe Community Resource Kit

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Abstract (if available)

Abstract Family caregiver stress is not only prevalent in the United States where it impacts 71% of the 41.8 million family caregivers providing services to adults over the age of 50, but also has significant consequences for the aging system and health care system, and the health and safety of caregivers and their care recipients. The American Academy of Social Work and Social Welfare has emphasized eradicating social isolation and loneliness (SI/L); research has found SI/L to be a root cause of family caregiver stress. Effective evidenced-based interventions like the Powerful Tool of Caregivers (PTC) and Stress-Busting Program for Family Caregivers have promising outcomes of reduction of caregiver stress. However, the current research and solution landscape have focused on the general caregiver population, which has created barriers and gaps in services. For example, Vietnamese family caregivers are not utilizing these resources, have reported poor comprehension of the resources, and are not always aware that the resources exist. In response to these issues, this Capstone Project developed the Ba Con Café (BCC) (Translation: parent, children, grandparent, grandchildren, and community Café). The BCC is a culturally-informed approach for Vietnamese family caregivers caring for family members who can independently live in the home and who only need assistance with daily living activities. BCC provides prevention and self-care options for caregiver stress through education and community support. BCC recognizes the effectiveness of current models to address caregiver stress while being mindful of the unique challenges and belief systems that Vietnamese family caregivers face. BCC seeks to bridge the gaps in support services and knowledge about caregiver stress by creating culturally-informed solutions.

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Asset Metadata

Creator Nguyen, Linda (author)

Core Title A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members [capstone paper]

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-08

Publication Date 07/26/2024

Defense Date 07/24/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag and culturally responsive social supports,caregiver stress,family resiliency,Loneliness,OAI-PMH Harvest,social isolation,Vietnamese caregivers

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Smith-Maddox, Renee (committee chair)

Creator Email lindanguyen.thu@gmail.com,lnguyen3@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC1139990GS

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Document Type Capstone project

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