Behavioural support
Instead, professionals such as carers, psychologists, social workers, and Admiral nurses were expected to have advanced understanding of behaviour and how it can be affected by dementia. In 2022, an exploratory service for
PACT was commissioned by The North Wales Social Care and Well-being Services Improvement Collaborative and was piloted across the six counties of North Wales. The goal was to provide behavioural services to clients living with dementia, prevent placement breakdown by reducing distressed behaviours, reduce the prescription of antipsychotic medication for behavioural needs, improve quality of life for clients, and train caregivers to provide effective care to meet the needs of people living with dementia. Over 18 months, we worked with clients diagnosed with dementia living in a range of settings including care homes, supporting caregivers with behaviours such as personal care refusals, wandering, aggression, and agitation. Many of the caregivers were burned out and the clients were at risk of placement breakdowns. Following our input, caregivers were better placed to care for their clients and reported feeling more competent after being coached with behavioural skills to support them with distressed behaviours. However, overwhelmingly what we
experienced was that care staff really wanted to do their best, but they simply did not have the specific behavioural skills or knowledge to be able to do so. Some reported that they had received zero training about dementia, or how to support someone who had it, and felt vastly inadequate in their caring ability. Others reported that they had had a small amount of training, but still did not feel competent when the person
Older adults deserve to be treated in a way that meets their needs with compassion and dignity
they were caring for exhibited different behaviours.
Importantly, we identified that many of the clients who were referred to us could have been supported more effectively by care staff if the staff had been given the opportunity to have behavioural training and coaching about changing their care to prevent the behavioural issue from occurring in the first place. So, knowing that there are only a small number of behaviour analysts available for bespoke individualised support, we began to create a new approach to training. We wanted to create broad-scale up-skilling of carers of people living with dementia in care homes based not only on our experience of working directly with carers but also with our advanced understanding of how staff actually learn best.
While there is an abundance of E-learning courses to choose from, few people want to sit passively watching videos and clicking multiple choice questions just to get a meaningless certificate at the end. This approach does not evidence an increased or improved skill set. At the same time, live training can be a logistical nightmare, when staff miss out if they are unwell or on holiday. Full training days are often ineffective because staff can find it difficult to retain the content when they feel overwhelmed at the overload of information. To deliver our behavioural training, we
combine the best from both online learning and live training sessions. This results in a skills-based coaching programme that develops staff ability to put what they learn into practice. Staff have the flexibility to take learning at their own pace and work it around their schedule, and also have all the specialist live support they need when using their new skills. A cohort approach means that learners gain a sense of community as they progress through and feel confident and competent in delivering excellence in care. When staff are trained in this way, they are able to proactively prevent distressed behaviours rather than reactive strategies which are often not based on positive methods.
Cultural change
Our ambition is to create broad-scale cultural change in the care sector for people living with dementia. This can be achieved by training staff and changing the norms of what good care looks like. When staff are equipped with basic behavioural skills to proactively prevent distressed behaviour, staff turnover and behavioural incidents reduce, and job satisfaction and quality of life increases. Once support staff have basic behavioural skills, behaviour influencers can be trained; individuals who have more in depth knowledge and more specialist training can guide their peers to assist in dealing with behavioural issues when they arise.
Older adults deserve to be treated
in a way that meets their needs with compassion and dignity and which prevents the occurrences of distressed behaviours. At the same time, care staff deserve to feel competent and confident in supporting their clients to live the best life possible. We believe that we can do that through evidence-based, data-driven, and person- centred knowledge of human behaviour and how to change it. Behaviour analysts are experts in
training staff to understand and care in a way that prevents distressed behaviours. This in turn can reduce staff turnover, placement breakdowns, and over prescription of antipsychotic medications. Using a proactive rather than reactive approach saves money in the long term by improving quality of life and reducing the need for escalating care costs by providing care staff with behavioural knowledge and practical skills. We invite you to join us on this journey in creating a behavioural cultural shift in care across the UK.
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www.thecarehomeenvironment.com January 2024
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