Presentation on theme: "Living well with dementia"— Presentation transcript:
1Living well with dementia Extending the evidence base forCognitive Stimulation Therapy (CST)This is the story of 25 staff setting off into the unknown territory of participating in a multi site research trial –
2What is CST ? World Alzheimer’s Report 2011: Cochrane review 2012 A structured group intervention for people with mild / moderate dementiaRecommended in the NICE guidelines for Dementia (2006)World Alzheimer’s Report 2011:“CST should be routinely offered to people with early stage dementia”.Cochrane review 2012Established benefits of CST:Cognitive functioning ( improvements equivalent to the anti dementia drugs)Quality of Life /wellbeingMood/confidenceProvided in most KMPT Memory Assessment ServicesNot sticking electrodes in the brain…
3What is CST ?It comprises 14 group sessions covering a series of themed activities aimed at stimulating specific cognitive processes e.g. executive functioning, languageThemed activities include: Food, childhood, sounds, categorising objects, current affairs, using moneyOrientation and memory are addressed indirectly to avoid experiences of failureIt is delivered in an inclusive and empowering way allowing choiceIt aims to provide a pleasurable experience- funSpecific staff training required is minimal: Brief manual provided and maximum 1 day training course
4Local interestExtending CST groups beyond 14 sessions- seems beneficialWhat training is needed for staff to be effective?
5SHIELD Support at Home, Interventions to Enhance Life in Dementia 3 Cognitive Stimulation Therapy studiesUniversity College LondonProf Martin OrrellStudy advertised - on the national portfolio of research – multi site study
6The research projectsStudy 2 : Evaluation and Comparison of the Effectiveness of Staff Training in Maintenance CST- staff are the “ subjects”Study 3 : What is the effect of providing 24 weeks of maintenance CST over and above standard CST ( 14 sessions) ?Lo and behold – address local interests. Mention both studies but focus on study 3 – evaluating maintenance CST
7Why get involved ? Benefits for : me: Service line role to promote research; help develop the psychosocial evidence baseservice users: enhance provision and quality of CST across the trust; provide extra treatmentfor staff: use their therapeutic skills ,develop research experience ; extra staff training in CSTfor the trust : reputation; FT research requirements ; research targetsLooks interesting, but how would I sell this ?
8Getting started Summer 2011 Identify the local PI : Negotiations between UCL & KMPT & CLRNLocal Research ApprovalsIdentify “interested” sites and staffAre we up for it?- local R&D approval process
9The cast5 sites – Tunbridge Wells ,Thanet, Maidstone, Canterbury and Sittingbourne24 staff - OTs , Nurses, support workers, therapy technicians, assistant psychologistResearch nurse- K&M Comprehensive Local Research Network( CLRN)- none had previous research experience
10Summer 2012 Lift off …. Induction to the studies from UCL researcher 24 Staff consent for study 222 Staff complete baseline questionnaires
12The “ real” study – study 3 Recruitment of participants from those who’ve recently received a diagnosis of dementia in Memory Assessment Services.46 people screened38 people consented38 Baseline assessments completed : QoL- AD; CDR; MMSEScreening : identifying those who met inclusion criteria; Informed consent ; Baseline assessments-more than usual clinical practice .
14What then?5 groups started and ran for 14 sessions +24 sessions maintenanceGroups involved about membersAssessments completed at baseline, endof 14 sessions and end of 24 maintenance sessions for research participants.But persevered and signed up 38 people (89 needed for whole study )almost 50%
15Autumn 2013 All CST groups have finished 18 follow up assessments are completed so far (5 dropped out due to ill health/ died)UCL study team doing a focus group with 9 staff to hear their observations18 Staff have completed their final on line assessments – study 2 ( 22 staff started)Where are we now?
16The outcomes for participants Formal data not yet analysed, butLocally, staff observed improvements inconfidencesocial functioningskillsmoodi.e. Living better with dementia
17The staff experienceMy observations of staff- A mixed experience for staff – varied over time
18How was it? The voices of some participants Heidi Suzanne Lets hear how some of those involved have experienced it
19What have we learned ? Research takes time and energy KMPT staff can really step up to the plate- but exhausting without a research supportive environment5 sites and 2 studies at once was maybe over ambitious !
20What next….. Plans to engage with new multi site study -IDEAL Develop our own research study and get research funding to implement it