Care staff training in residential homes for managing behavioural and psychological symptoms of dementia based on differential reinforcement procedures of applied behaviour analysis: a process research.

Previous studies of care staff training programmes for managing behavioural and psychological symptoms of dementia (BPSD) based on the antecedent-behaviour-consequence analysis of applied behaviour analysis have not included definite intervention strategies. This case study examined the effects of such a programme when combined with differential reinforcement procedures. We examined two female care home residents with dementia of Alzheimer's type. One resident (C) exhibited difficulty in sitting in her seat and made frequent visits to the restroom. The other resident (D) avoided contact with others and insisted on staying in her room. These residents were cared for by 10 care staff trainees. Using an original workbook, we trained the staff regarding the antecedent-behaviour-consequence analysis with differential reinforcement procedures. On the basis of their training, the staff implemented individual care plans for these residents. This study comprised a baseline phase and an intervention phase (IN) to assess the effectiveness of this approach as a process research. One month after IN ended, data for the follow-up phase were collected. In both residents, the overall frequency of the target behaviour of BPSD decreased, whereas the overall rate of engaging in leisure activities as an alternative behaviour increased more during IN than during the baseline phase. In addition, the overall rate of staff actions to support residents' activities increased more during IN than during the baseline phase. However, the frequency of the target behaviour of BPSD gradually increased during IN and the follow-up phase in both residents. Simultaneously, the rate of engaging in leisure activities and the staff's treatment integrity gradually decreased for C. The training programme was effective in decreasing BPSD and increasing prosocial behaviours in these two cases. However, continuous support for the staff is essential for maintaining effects.