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

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 analysis demonstrated an increase in correct use of a task analysis and L-M prompting for all three participants during intervention compared to baseline, for ADL1: assistance to stand (effect sizes, d=5.39; d=9.38; and d=6.79); ADL2: assistance with drinking (effect sizes, d=3.27; d=8.55; and d=3.67); and ADL3 assistance to brush teeth (effect sizes, 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 as an effective training strategy to increase opportunities for independent responding for PLwD in care environments. The influencing contingencies on staff behaviour require attention within the healthcare environment.