CLEAR Dementia Care Training for Carers: Understanding Behaviour

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1 CLEAR Dementia Care Training for Carers: Understanding Behaviour Dr Frances Duffy Consultant Clinical Psychologist Marc Harvey Team Leader / Approved Social Worker

2 Agenda CLEAR Dementia Care Training for Care Staff Train the Trainer Programme

3 Dementia Home Support Team (DHST) DHST accept referrals for people with a diagnosis of dementia who present with behaviours that carers may find difficult to understand.

4 What is behaviour? Aggression Agitation Sexually disinhibited behaviour is this distress? is this lack of purposeful activity? is this misunderstanding?

5 Behaviour of any kind is a form of communication and is often driven by need Northern Health & Social Care Trust 2017.

6 Mrs Jones 64-year old diagnosed with Alzheimer-type dementia Referral stated: Inappropriate toileting Pacing and attempts to exit building Verbal aggression

7 CLEAR Dementia Care Northern Health & Social Care Trust 2017

8 Behaviour Record Charts Northern Health & Social Care Trust 2017.

9 Behaviour Record Chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun

10 Pre - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 A A A I A A C A 9-10 C C C C C C I A C I C C P C C I A P C C P C C P A C C C P C P P I P C I P P I I I A A P C P A A C C A A P C C P A P C P A P C P P P A P P P A P A P P P A P P P A P I P P A P P P P P A P A A P A P A P P P S S A S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 I P A S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S C 5-6 S S P S S S C 6-7 A S P S S S I P A 7-8 A S P S S S P A

11 Pre - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 A A A I A A C A 9-10 C C C C C C I A C I C C P C C I A P C C P C C P A C C C P C P P I P C I P P I I I A A P C P A A C C A A P C C P A P C P A P C P P P A P P P A P A P P P A P P P A P I P P A P P P P P A P A A P A P A P P P S S A S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 I P A S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S C 5-6 S S P S S S C 6-7 A S P S S S I P A 7-8 A S P S S S P A

12 Pre - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 A A A I A A C A 9-10 C C C C C C I A C I C C P C C I A P C C P C C P A C C C P C P P I P C I P P I I I A A P C P A A C C A A P C C P A P C P A P C P P P A P P P A P A P P P A P P P A P I P P A P P P P P A P A A P A P A P P P S S A S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 I P A S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S C 5-6 S S P S S S C 6-7 A S P S S S I P A 7-8 A S P S S S P A

13 Pre - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 A A A I A A C A 9-10 C C C C C C I A C I C C P C C I A P C C P C C P A C C C P C P P I P C I P P I I I A A P C P A A C C A A P C C P A P C P A P C P P P A P P P A P A P P P A P P P A P I P P A P P P P P A P A A P A P A P P P S S A S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 I P A S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S C 5-6 S S P S S S C 6-7 A S P S S S I P A 7-8 A S P S S S P A

14 Pre - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 A A A I A A C A 9-10 C C C C C C I A C I C C P C C I A P C C P C C P A C C C P C P P I P C I P P I I I A A P C P A A C C A A P C C P A P C P A P C P P P A P P P A P A P P P A P P P A P I P P A P P P P P A P A A P A P A P P P S S A S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 I P A S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S C 5-6 S S P S S S C 6-7 A S P S S S I P A 7-8 A S P S S S P A

15 Behaviour and what might help Activity Mrs Jones always liked to be busy. Appropriate meaningful activity is important for all of us. A member of staff to accompany Mrs Jones to the local shop each afternoon to purchase a newspaper. Mrs Jones to assist staff with folding laundry every afternoon.

16 Understanding Mrs Jones Reason for referral Life story Behaviours and what might help

17 Outcomes Change in staff approach Placement maintained Mrs Jones less isolated. Presented as more content within the care home.

18 Pre - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 A A A I A A C A 9-10 C C C C C C I A C I C C P C C I A P C C P C C P A C C C P C P P C C C C C C C C P A A C C A A P C C P A P C P A P C P P P A P P P A P A P P P A P P P A P I P P A P P P P P A P A A P A P A P P P S S A S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 I P A S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S C 5-6 S S P S S S C 6-7 A S P S S S I P A 7-8 A S P S S S P A

19 Post - chart I Incontinence P Pacing A Aggression C Content S Sleeping Time/Day Mon Tues Wed Thurs Fri Sat Sun 8-9 C C C C C C A 9-10 C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C P A C C C A C C C C C C P C C C C C C C C P C C C C C C C C P C C C P C C C C C C C C C S S C S S S S S S S S S S S S S S S S S S S S S S S S 00-1 S S S S S S S 1-2 S S S S S S S 2-3 S S S S S S S 3-4 S S S S S S S 4-5 S S S S S S S 5-6 S S S S S S S 6-7 S S S C S S S 7-8 S C S C S S S

20 CLEAR Dementia Care Documentation Process Flow Chart Referral Form Checklist for assessment of the 5 domains of the model Aide Memoire to support assessment Initial Contact Form Review Form Medication Record Chart Northern Health & Social Care Trust Behaviour Record Chart Pain Checklist Understanding document Discharge Summary Manual with detailed complex case examples

21 Outcomes for CLEAR Dementia Care Clinical effectiveness Clinical efficiency Waiting times Cost savings - 100,000 in community Reduced hospital admissions savings to be calculated Service User Experience

22

23 CLEAR Dementia Care Training for Care Staff 3 Hour Session Types of dementia Symptoms of dementia Understanding behaviour

24 CLEAR Dementia Care Training for Care Staff The importance of perspectives Experiential learning Video - Powerpoint - Case studies

25 Who attended training? All categories of care home staff 59 care homes 623 staff

26 Outcomes Northern Health & Social Care Trust 2017.

27 Your awareness of different symptoms of dementia Before After Sample 563 staff Self rated Good or Very Good 20 0 Percentage

28 Your awareness of different symptoms of dementia Before After Sample 563 staff Self rated Good or Very Good 20 0 Percentage

29 Your overall knowledge of behaviour in dementia Sample 563 staff Before After Self rated Good or Very Good Percentage

30 Your overall knowledge of behaviour in dementia Sample 563 staff Before After Self rated Good or Very Good Percentage

31 Evaluations

32 Interest in CLEAR Dementia Care from other organisations

33 CLEAR Dementia Care Train the Trainer Programme Comprehensive 2 day programme Enables staff to implement CLEAR Dementia Care within their organisation

34 Who attended training? 194 staff from all Health and Social Care (HSC) Trusts in Northern Ireland. All categories of HSC staff (psychology, psychiatry, social work, nursing, occupational therapy, support workers...)

35 Outcomes Northern Health & Social Care Trust 2017.

36 Do you think the training will benefit your practice? Sample Not at all A little Somewhat A great deal

37 Do you think the training improved your knowledge of behaviour in dementia? Sample Not at all A little Somewhat A great deal

38 Following the training, do you feel more able to engage with care staff and help them to support people with dementia? Sample Not at all A little Somewhat A great deal

39

40 Acknowledgements Reference Duffy, F (2016) Look at all of me a Clear model for dementia care. The Journal of Dementia Care, 22(3), Northern Health & Social Care Trust 2017.

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