Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial

Abstract

Some, but not all, 'trained' CMHNs used the PSI to help family carers reduce behavioural problems. A relatively long but not intensive PSI of 12-18 months was needed to moderate carer mood. Dementia-specific practice arrangements, training and sustained clinical supervision are important for the delivery of effective psychosocial interventions in dementia.

Raising the standard of applied dementia care research: addressing the implementation error

“…Implementation science places an implementation error as equivalent to type I and II errors, naming this 'the type III error' (Hulscher et al, 2005). Implementation errors threaten internal validity and undermine the credibility of an otherwise successful intervention, thus rendering effect analyses and positive outcomes meaningless (Moniz-Cook et al, 2008), with associated wasted effort and resources (Glasgow, Klesges, Dzewaltowski, Estabrooks, & Vogt, 2006).…”

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

“…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. However, Bird et al 26 showed that the individualised formulaic 'case-specific' approach was no more time consuming when compared with 'usual care' practice in residential care settings, but it still required a mean of 5.5 clinical visits per case.…”

“…The majority of these (n = 13) were within family care settings and just three were conducted in care homes. Of these, only two family care studies were conducted in England, in Kent 64 and Hull, 65 and only one care home study, in Manchester. 83 The review concluded that functional analysis within multicomponent interventions that are geared to the context of either the family or the care home shows promise.…”

“…For community settings, we used the Problem Checklist, 109 as this was based on the concerns of UK family carers and had been used effectively in our previous study. 65,109 This was seen as important, as many guidelines for the management of aggression, for example, have poor representation of some of the important individualised and contextual characteristics necessary for management. 110 Having chosen the person's behaviour to work on, the staff member or practitioner is then asked to input selective information about the person with dementia and CB, as they had discovered was necessary in module 3 of the e-learning course.…”

“…This summary includes documentation of the potential cause(s) or function(s) of the behaviour that was based on the staff member's or practitioner's responses (see Appendix 1, Box 7). 65,109 The practitioner is thus provided with a systematic assessment framework where questions they considered covered important aspects of the person's life story, health status and other factors 13 (see also Appendix 1). The next part of the decision support system is the 'algorithmic' flow of the information into considering what interventions can be tried.…”