Home' Australian Ageing Agenda : AAA Jan-Feb 2017 Contents Professor Marita McCabe
assume it was a one-off. Now they are able to
recognise that something is wrong, and know
exactly how and where to refer residents
Following the training, McCauley says the
site implemented the Stop and See approach,
which puts residents who are identified as unwell
on watch for 48 hours, and embedded the new
mental health tools.
“The simple checklist was also put into our
three-monthly care reviews. These have now all
been cemented into our procedures.”
The reviews are done by care workers in
consultation with nursing staff and the approach
was rolled out across the 75-bed facility, which
includes the dementia-specific unit and general
areas, says McCauley.
It has brought the staff at Camber well
Gardens closer together and made a big
difference to staff wellbeing, which McCauley
largely attributes to the reduction in physical
abuse directed toward them.
“The staff are not being hit. The behaviours
are being managed in a way that it is pleasant
to go to work. We don’t have that occupational
health and safety risk anymore.”
As a result of the positive outcomes at this
facility and in comparison to its other sites, Gold
Age rolled out the program at its own expense to
its other two facilities, where the implementation
went just as well, says McCauley.
“Across all the sites, our aggression has
decreased and our incidents have decreased
because all our policies and procedures are
the same across all of the sites. We have the
Stop the See. We use that tool. We use a
These results were mirrored across the other
participants of the program, which was created
and evaluated by ACU’s Institute for Health
and Ageing (IHA) to improve on its previous
While the training was shown to improve
knowledge and skills among aged care staff in
dealing with depression and BPSD, it was not
achieving long-term change in practice, says
Professor Marita McCabe, IHA director.
“There was no change because the residential
care facilities are set up in such a way that it
wasn’t their job to do those things because
[facilities] are ver y hierarchical. We felt that there
was a need to change the way the organisation
worked if that training was to be put into
practice, ”McCabe tells AAA.
The study involved 21 residential care facilities
across five different organisations, 252 staff and
378 residents divided into three conditions.
The first condition received the training, the
second received the training and clinical support,
and the third was a control group (meaning
business as usual).
Each provider had both inter vention
and control conditions allowing for
The training is split into four sessions.
The first two focus on increasing the levels of
knowledge and skills to better diagnose and
manage depression and BPSD respectively
while the remaining two focus on the
The third session involves facility leaders
and on-the-floor staff working together to
enhance the organisational climate so they are
more supportive of one and other, McCabe
says. The goal is to increase trust, cohesion
and communication so staff can share the
management of depression and BPSD, she says.
Each training group involves equal numbers
of senior staff and junior staff. “It was important
to have senior staff there because they gave
permission to the junior staff to get involved in
this program,” says McCabe.
After staff practice the new approach – it
was for four weeks in the trial – they return for
the fourth session, which is a problem-solving
workshop to identify barriers and ways to
After the program and at follow up, the
researchers found a major improvement in the
detection and management of depression as
well as a significant reduction in challenging
dementia-related behaviours in the inter vention
groups compared to the care as usual approach.
There were also improvements in the mental
health referral process in facilities and to whom
referrals were made.
The inter vention also resulted in staff
experiencing significant and sustained
improvements in knowledge and confidence
in working with residents with depression and
dementia, lower carer strain and a significant
improvement in organisational factors including
workplace trust, cohesion and support.
According to the findings, the training alone
was the powerful factor in shaping the skills and
abilities of staff and facility change processes
while the additional clinical support did not
“We found that the number of people
who were both identified and referred for
depression went up at post-test and also at three
month follow up. Incidence of those dementia
behaviours went down at post-test and also at
follow up,” says McCabe.
Most pleasing was evidence it had become
embedded in practice because of the change in
the organisational factors, she says. The biggest
change was with carers who reported feeling
much more supported, far and above what the
RNs and the managers identified, says McCabe.
“They felt like they were an important part
of the team and they felt supported in their role.
The level of absenteeism and turnover of staff
reduced. That was because they felt more a
part of the place, more empowered and greater
Seeing the impact the program made at their
inter vention facilities compared to their control
sites, participating providers went on to roll out
the training program to their other facilities,
More recent feedback indicates the model is
still working 18 months later and incidences of
BPSD are continuing to fall, she says.
“More teamwork in the management of
depression and BPSD is the type of model of
care that we need to have within residential care
for the wellbeing of both residents and staff. If
we have teamwork then that will mean support,
cohesion and communication.” n
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