RAMP?: A Mental Health Intervention for Long-Term Care Residents with Dementia

描述（由申请人提供）：本R34提案的长期目标是开发居民辅助蒙特梭利编程（RAMP（tm））作为长期护理（LTC）环境中工作人员实施的干预措施，以促进痴呆症居民的心理健康。如果RAMP（TM）在这个发展项目中显示出希望，将寻求随机临床试验的支持，以证明这种干预措施对LTC痴呆症患者的其他群体活动的公共卫生益处。RAMP（TM）是一种新的干预措施，其中早期痴呆症患者被培训为更晚期痴呆症患者小组的活动领导者。在一项小规模的试验中，RAMP（TM）已被证明可以在活动中增加参与度和积极影响。本研究的目的是进一步开发和试点测试RAMP（TM）。该研究分为两个阶段，以开发，测试和比较工作人员实施的方法与研究人员实施的干预措施。这两个阶段将涉及相同的设计、样本量、测量和分析。在每个阶段，培训和实施将发生在大克利夫兰地区的四个不同的长期护理设施。在每个阶段，RAMP（TM）条件（早期痴呆症患者将担任蒙台梭利活动的组长）和对照条件（早期痴呆症患者将担任非蒙台梭利活动的组长）将被使用。这两种情况将在两个站点并行发生，然后在另外两个站点并行发生。在第一阶段，研究人员将培训16名早期痴呆患者，让他们领导基于蒙台梭利的阅读小组活动或基于蒙台梭利的痴呆成年人文字游戏活动（RAMP（tm）条件），或领导基于替代的非蒙台梭利原则的小组活动（Zgola，1987; 1999）。每个领导人将领导一个由五名常驻参与者组成的小组（？玩家？）患有更严重的痴呆症将收集措施，以评估执行情况和参与者（领导者和参与者）的结果。第一阶段的结果将用于修改和改进培训程序。在第二阶段，RAMP（TM）和非蒙台梭利干预将在另外四个长期护理机构实施，不同的是，小组领导人的培训将由参加培训师培训计划的LTC工作人员（而不是研究人员）提供。该研究的目标是：1）通过RAMP（TM）干预，使患有早期痴呆症的长期护理居民能够担任更晚期痴呆症居民的团体活动领导者; 2）创建类似的干预措施，使患有早期痴呆症的居民能够担任更晚期痴呆症居民的非蒙特梭利团体活动的团体活动领导者; 3）评估RAMP（tm）和对照组干预对长期护理住院医师心理健康指标的影响; 4）开发一个培训培训员模式，使长期护理人员能够实施RAMP（tm）和对照组干预;和5）评估RAMP（tm）和对照组干预措施在培训一段时间后由LTC工作人员实施（而不是由研究人员实施）时产生的效果。

DESCRIPTION (provided by applicant): The long-term objective of this R34 proposal is to develop Resident Assisted Montessori-based Programming (RAMP(tm)) as an intervention that is implemented by staff in long-term care (LTC) settings to promote the mental health of residents with dementia. If RAMP(tm) shows promise in this developmental project, support will be sought for a randomized clinical trial to demonstrate the public health benefits of this intervention over other group activities for persons with dementia in LTC. RAMP(tm) is a novel intervention in which residents with early dementia are trained as activity leaders for small groups of residents with more advanced dementia. In a small-scale trial, RAMP(tm) has been shown to increase engagement and positive affect during activities. The purpose of the present study is to further develop and pilot test RAMP(tm). The study is designed with two phases to develop, test and compare an staff-implemented approach with intervention as implemented by research personnel. Both phases will involve the same design, sample sizes, measures and analyses. In each phase, training and implementation will occur at four distinct long-term care facilities in the Greater Cleveland area. In each phase, a RAMP(tm) condition (in which persons in early stage dementia will serve as group leaders for Montessori-based activities) and a control condition (in which persons in early stage dementia will serve as group leaders for non-Montessori-based group activities) will be used. Both conditions will occur at two sites in parallel, then in another two sites in parallel. In Phase 1, research staff will train sixteen persons with early stage dementia to lead either a Montessori-based reading group activity or a Montessori-based word game activity for adults with dementia (RAMP(tm) condition) or to lead group activities based upon alternate, non-Montessori principles (Zgola, 1987; 1999). Each leader will lead a group of five resident participants (?players?) with more advanced dementia. Measures will be collected to assess implementation and participant (both leader and player) outcomes. Results of Phase 1 will be used to modify and improve training procedures. In Phase 2, RAMP(TM) and the non-Montessori intervention will be implemented in four additional long-term care facilities, with the difference that training of group leaders will be provided by LTC staff (rather than research personnel) who take part in a train-the-trainer program. The objectives of the study are: 1) to enable long-term care residents with early-stage dementia to serve as group activity leaders for residents with more advanced dementia through the RAMP(tm) intervention; 2) to create a similar intervention that will enable residents with early dementia to serve as group activity leaders for non-Montessori-based group activities for residents with more advanced dementia; 3) to assess the effects produced by RAMP(tm) and the comparison group intervention on mental health indices of long-term care residents; 4) to develop a train-the-trainer model enabling long-term care staff to implement RAMP(tm) and the comparison group intervention; and 5) to assess effects produced by RAMP(tm) and the comparison group intervention when implemented by LTC staff (as opposed to implementation by research personnel) following a period of training.