Can staff training reduce behavioural problems in residential care for the elderly mentally ill?

Abstract

The effect of a brief in‐service training programme on the psychosocial management of behavioural disturbance in residential care is described. Although the incidence of problematic behaviour did not change 3 months after training, staff in the experimental homes reported a significant improvement in their management of problematic behaviour, as compared to the control home. However, these effects were not maintained a year later. The importance of post‐training supervision and the sociocultural context of the home in the maintenance of psychosocial intervention in residential settings is discussed. © 1998 John Wiley & Sons, Ltd.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…A previous pilot study of functional analysis-based intervention for CB, which used face-to-face workshops for all care staff in three homes, noted a positive post-training effect at 4 months' but not 12 months' follow-up. 63 The effect of the present e-learning course appears to be less sustained. Compared with the 4-month follow-up of the pilot study, 63 the planned 4-month follow-up in this present study of 27 care homes averaged 7.8 months, ranging from 5 to 11.5 months (see Figure 2).…”

“…63 The effect of the present e-learning course appears to be less sustained. Compared with the 4-month follow-up of the pilot study, 63 the planned 4-month follow-up in this present study of 27 care homes averaged 7.8 months, ranging from 5 to 11.5 months (see Figure 2). A study of decision support DOI: 10.3310/pgfar05150 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL.…”

“…This was higher than the original estimate of 15%, which was based on previous local studies. 63,131 The ICCs from the NPI and CMAI data were between 0.03 and 0.06 (except for the NPI distress subscale; see Table 25), and so were higher than the value of 0.03 used in the original sample size estimation. The dropout rate in the other residents group, consisting of residents with dementia or with CB but not both, was 17% and, therefore, closer to our original estimate of 15%.…”

“…60 Examples of outcomes for people with dementia living in residential care have been reductions in frequency and perceived severity of the target behaviour and general practitioner (GP) call-outs, 50 reductions in antipsychotic use, 27 reductions in agitated behaviour and increases in observed participant pleasure, 61 reductions in behaviour frequency and perceived severity, hospitalisations, antipsychotic use, and drug side effects; 26,62 and for staff, reductions in stress and short-term improvements in the perception of how challenging staff found the behaviour. 63 Systematic interventions of this type, targeting a variety of outcomes within family care settings, are less common, but they can be found, including within NHS settings in England, where they have demonstrated reductions in CB and improvements in carer mental health. 55,64,65 Many of these studies, especially those involving supervision, required expert clinicians to work with family carers or with residential care facilities.…”

“…1,13,68,69,98 Learners were guided through interactive video-clips, resources that are relevant to the person with dementia, such as life story information or case notes, audio-clips on views of others within the care context, and then provided with structured feedback to set their observations of the person's CB in the context of 'causation'. 49 The learning focused on guiding staff to use 'why' questions 63 to consider the potentially multiple causes for what they had observed about the person and the behaviour in the vignette. 13 Through using information about the person's current health and functional status, their life story and how others respond to the person with dementia during an episode of CB, key concepts for managing CB 13,99 were systematically covered to address causation and possible methods of remediation.…”