Behavioral and Team Functioning to Meet Resident Needs

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DESCRIPTION: (provided by applicant) This revised application is the competing continuation for Staff Management System for Behavioral Skills (R01NR03497; L. Burgio, PhD [PI]; A. Stevens, PhD; P. Paul, DNS; K. Burgio, PhD [Co-PIs]) originally funded in 1993. Findings from the original study suggest that: 1) certified nursing assistants (CNAs) could be taught to perform behavior management skills (behavioral techniques and communication skills) during care routines with residents, 2) a formal staff motivational system enhanced CNA's long-term use of communication skills, and 3) changes in staff therapeutic skills were associate with modest declines in resident agitation. The original efficacy study, however, included substantial research staff involvement, which limits the external validity of the findings. Moreover, nursing homes currently face considerable difficulty training and maintaining a CNA workforce. Accordingly, two methodological refinements to the original project define this proposal: 1) focus of the study has been shifted towards an effectiveness trial by incorporating indigenous staff into all aspects of the program, and 2) our successful training protocols were modified to reduce CNA training demands. The main intervention goals of the current application (A. Stevens, PhD), [PI]; L. Burgio, PhD; L. Davis, RN, PhD [Co-PIs] are: 1) to improve the efficacy of the intervention by using behavior management skills similar to the original study, but conceptualized within a broader model based on the need-driven dementia-compromised behavior (NDB) model (Algase et al., 1996), and 2) enrich the staff motivational system used in the original project by improving team functioning and the overall social climate of the work environment. The first aim of the study is to evaluate the relative effects of a Behavioral Programming and Team Functioning (BPTF) intervention as compared to a minimal treatment (MinTx) control condition on CNAs performance of behavioral strategies prescribed by individualized, problem-focused behavioral programs that will be developed by the indigenous nursing home care plan coordinator using our BPTF web page. The second aim is to compare changes in resident NDBs (problematic behaviors) across the two conditions. The third aim is to examine the effects of BPTF on the work milieu of the nursing home. Extensive treatment implementation procedures will be used to document staff's adherence to the BPTF intervention protocol. Multi-level data analytic strategies will be used, when necessary, to address nesting issues that are inherent in our design.