Training and support interventions for paid home care workers · 2019-02-25 · Interventions to...
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Training and support interventions for paid home care workers Penny Rapaport & Claudia Cooper Alzheimer’s Society Independence at Home Centre of Excellence UCL Division of Psychiatry
Transcript of Training and support interventions for paid home care workers · 2019-02-25 · Interventions to...
Training and support interventions for paid home care workers
Penny Rapaport & Claudia Cooper
Alzheimer’s Society Independence at Home Centre of Excellence
UCL Division of Psychiatry
Talk Plan
• Brief intro to NIDUS programme (Claudia)
• Latest evidence: what helps home carers delivering home care (Claudia)
• Learning from care home interventions (Penny)
Stream 4: implementation and impact
STREAM 1:
Literature
review
Qualitative
study
Interventions to improve older people’s home care
A systematic review evaluating the impact of paid home carer training, supervision, and other interventions on the health and well-being of older home care clients; Cooper C, Cenko, B, Dow, B, Rapaport, P. International Psychogeriatrics 2017 Apr;29(4):595-604. doi: 10.1017/S1041610216002386. Epub 2017 Jan 16
Methods
• First systematic review of interventions to improve older people’s home care
• Outcomes: – clients' health and well-being
– paid carers' well-being, job satisfaction, and retention
Results
• 10 papers – Four in USA, three in Australasia and one in UK
– 3 “higher quality”
Who were the clients
• Aged care teams/ home care teams
• Most clients didn’t have dementia
What did interventions involve?
• Training in general approach, skills
• Specific training e.g. in life story
• Additional support/ intervention
• Training only
• A specialist dementia home care team
What worked?
• A goal-focussed intervention improved quality of life and reduced staff turnover
• Training increased knowledge
• carers valued: greater flexibility to work to a needs-based rather than task-based model; learning more about clients; and improved communication with management and other workers.
What ways of intervening worked best?
Training + additional implementation
regular supervision, appointing champions, buddy visits, or
ongoing support from other staff
What ways of intervening worked best?
Setting goals + skills and flexibility
role flexibility to focus care around the client, their needs and their goals
What else helped?
• Training on managing challenging behaviours
• Communication skills training
• Reducing travel time
• Maximising client continuity
• Matching carers/ clients on language
• Getting to know clients
What can we learn from our work in care homes?
1. Systematic
review of what
works
2. Interviews with
care home staff 3. Piloting the
intervention
• The evidence from quantitative interventions studies of what works immediately and where there is sustained effects on outcomes for people with dementia and care staff.
• Qualitative research exploring what components of interventions were considered to have worked and to have been practicable to implement.
• Included studies that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported both staff and resident qualitative or quantitative outcomes.
1. Systematic review of what works in care homes
Results
Included:
• 27 Qualitative studies - 6 were
“higher quality”
• 22 Quantitative intervention
studies - 6 were “Higher
quality”
• Successful elements included interactive training, post-training support, written materials to keep and building the intervention into routine care.
• Management support was perceived as key to successful implementation.
• High quality studies which showed effect on resident outcomes up to six months post-intervention used ‘reinforcing’ and ‘enabling’ strategies.
Key findings from review
Improving communication
Reflection facilitated good
practice
Enhanced understanding
of residents Whole team
attendance
On-site
support
Lack of time
& resources Lack of
management
support
Building
interventions into
routine care
Lack of team
ownership &
engagement
Active &
interactive
learning
methods Seeing
positive
effects
Concern
regarding
skills &
practices
Fear of
getting
attached
Coping with
aggression
What makes it harder? What makes it easier?
• Purposive sampling of care homes and staff
• Conducted semi-structured individual interviews
• Conducted interviews no new themes emerging
• Each transcript coded by two raters and discrepancies discussed
• Thematic analysis chosen as flexible method
2. Qualitative interviews with care home staff
Qualitative interviews with 26 care staff in three nursing and three residential homes:
54% of those interviewed did not speak English as a 1st language
What can we learn from staff: What works well?
We need to consider the impact of the role on staff
What makes it harder and easier to put training and support interventions into practice?
3. Piloting the intervention in one care home
• Three meetings held with management and unit leadership to facilitate set up and delivery
• Intervention delivered in one residential home in three groups
• Intervention delivered to all eligible day staff
• 90 % eligible staff attended all sessions or individual catch ups
• Managers & champions supported implementation in home
Key components of the intervention content & process:
• Staff have their own copy of the manual
• Practice within and between 6 sessions
• Two psychology graduate facilitators running each group
• Combines information giving, group discussion, practical exercises and practicing new skills
• Staff stress reduction component in each session
• Building on existing skills and direct experiences
• All staff including managers attend & delivered to fit in with home
• Each care home will have at least two ‘champions’
• Following training there will be supervision with a clinical psychologist & reinforcement sessions with facilitators
Thank you for listening
• Please get in touch if you are interested in taking part - we’d love to hear from you!
