Using Behavioural Skills Training with Healthcare Staff to Promote Greater Independence for People Living with Dementia: A Randomised Single-Case Experimental Design

TL;DR

This study shows how training healthcare staff with behavioral skills can help people with dementia become more independent in daily tasks.

Contribution

The study introduces the use of Behavioral Skills Training with a randomized single-case design to improve staff facilitation of independence for people with dementia.

Findings

Healthcare staff showed significant improvement in using task analysis and prompting procedures during ADLs.

Maintenance data showed high correct responses at follow-up, indicating lasting skill retention.

Staff successfully generalized learned skills to new activities, demonstrating training effectiveness.

Abstract

Approximately 72% of older adults in residential care have dementia and present with different levels of functioning. People living with dementia (PLwD) may not always be facilitated to independently carry out activities of daily living (ADLs) in care, increasing the likelihood of excess disability. This study incorporated Behavioural Skills Training (BST) to train healthcare staff how to increase opportunities for independence for PLwD by using task analyses and least-to-most (L-M) prompting procedures during ADLs. Three healthcare staff, two female and one male (mean age = 42.67, SD = 16.82), participated in the intervention. The What Works Clearinghouse (WWC) Single-Case Design Technical Documentation guided the study’s design. A randomised single-case experimental (N-of-1) design was employed, using a multiple-baseline design (MBD) across participants (n = 3) for three separate ADLs. The dependent variable (DV) was the percentage of correct staff responses when implementing the L-M prompting procedure for each step during ADLs. Visual and statistical analyses demonstrated an increase in the correct use of a task analysis and L-M prompting for all three participants during the intervention compared to the baseline: for ADL1 (assistance to stand), effect sizes were d = 5.39, d = 9.38, and d = 6.79 for the three participants, respectively; for ADL2 (assistance with drinking), effect sizes were d = 3.27, d = 8.55, and d = 3.67; and for ADL3 (assistance to brush teeth), effect sizes were d = 5.99, d = 12.93, and d = 9.39. Maintenance data ranged from 70% to 100% correct responses at follow-up (mean = 93.11% SD = 7.85). Participants successfully generalised skills learned to two new ADLs (PLwD eating a meal and putting on a jumper). BST was demonstrated to be an effective training strategy to increase opportunities for independent responding for PLwD in care environments. The contingencies influencing staff behaviour require attention within the healthcare environment.

Figures