Training the Long-Term Services and Supports Dementia Care Workforce in Provision of Care to Sexual and Gender Minority Residents

培训长期服务和支持痴呆症护理人员，为性少数群体居民提供护理

• 批准号: 10523826
• 负责人: B R Simon Rosser
• 金额: $ 72.45万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10523826
• 关键词: Address; Adopted; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Assisted Living Facilities; Attention; Attitude; Caring; Client; Control Groups; Data Collection; Discrimination; E-learning; Educational Curriculum; Educational Intervention; Effectiveness; Elderly; Environment; Evidence based intervention; Family member; Fibrinogen; Fright; Funding; Gender Identity; Health; Heterosexuals; Hostility; Human Resources; Impaired cognition; Individual; Inferior; Instruction; Intake; Intervention; Knowledge; Lesbian Gay Bisexual; Long-Term Care; Long-Term Effects; Marketing; Medicare/Medicaid; Methods; Minnesota; Minority; Modeling; Nursing Homes; Outcome; Participant; Persons; Policies; Policy Analysis; Population; Prevalence; Quality of life; Randomized Controlled Trials; Regulation; Religion and Spirituality; Research; Risk; Rural; Safety; Service provision; Services; Sex Orientation; Sexual and Gender Minorities; Social Work; Statutes and Laws; Testing; Time; Training; Training Programs; Training Support; United States National Institutes of Health; Violence; Waiting Lists; aged; arm; base; cisgender; comparative effectiveness study; dementia care; design; efficacy evaluation; evidence base; follow-up; gender minority health disparity; health care availability; health disparity; improved; online course; online intervention; online version; peer; satisfaction; skills; sound; transgender

SUMMARY In the US, sexual and gender minority (SGM) older adults are disproportionately at risk for Alzheimer’s disease and related dementias (AD/ADRD) and more likely to rely on long-term services and supports (LTSS) than their cisgender, heterosexual peers. Without training in culturally responsive care of the LTSS workforce, SGM residents are vulnerable to receiving inappropriate and/or inferior care contributing to poorer quality of life and health outcomes. To address this, some states have recently mandated training of the LTSS workforce in the culturally responsive care of SGM older adults. There are two major barriers to this approach being successful. First, we lack research on LTSS policies governing SGM with AD/ADRD care (in states where cultural care training is not mandated), which would inform whether such state legislation is needed. Second, there are no scalable, sustainable, evidence-based training programs to train the LTSS workforce in SGM with AD/ADRD culturally responsive care. This application is focused on the Training to Serve curriculum, which has trained over 12,000 LTSS workers in 12 states. This acceptable, feasible, and promising curriculum employs a multilevel approach to train management and frontline LTSS staff in culturally responsive care to SGM with AD/ADRD. But, it has not been rigorously evaluated and relies solely on in person instruction. This mixed methods and comparative effectiveness study has three specific aims. In Aim 1, we will conduct a comprehensive policy analysis of 362 nursing homes and 362 assisted living facilities in Minnesota to assess the number and proportion of agencies that have explicit SGM affirmative policies in human resources, marketing, training, governance; anti-discrimination policies guiding culturally responsive care, and resident sexual orientation and gender identity (SOGI) data collection. These findings will inform Aim 2 curriculum. In Aim 2, to make Training to Serve more scalable nationally and with high fidelity, we will design and develop an asynchronous online version and pilot it with 30 LTSS management and 30 staff. In Aim 3, to assess the effects of training, we will conduct a 3-arm, management/staff stratified, group randomized, controlled trial of the in-person training versus an online curriculum versus a waitlist control group (in 62 LTSS agencies, with 310 management and 450 staff per arm). At the individual level, we will assess management and staff knowledge, attitudes, and skills providing care to SGM clients. At the agency level, at six months follow-up, we predict agencies who receive training will have more SGM explicit policies, more SGM welcoming environments, SOGI data collection at intake, and staff with significantly greater knowledge, comfort, and skills in providing SGM with AD/ADRD culturally responsive care.

概括 在美国，性少数和性别少数 (SGM) 老年人患阿尔茨海默病的风险不成比例 和相关痴呆症 (AD/ADRD)，并且更有可能依赖长期服务和支持 (LTSS) 他们的顺性别、异性恋同龄人。如果没有对 LTSS 员工进行文化响应式护理培训，SGM 居民很容易接受不适当和/或劣质的护理，从而导致生活质量较差 健康结果。为了解决这个问题，一些州最近强制要求对 LTSS 劳动力进行培训 SGM 老年人的文化响应式护理。这种方法的成功有两个主要障碍。 首先，我们缺乏对管理 SGM 和 AD/ADRD 护理的 LTSS 政策的研究（在文化护理的州） 培训不是强制性的），这将告知是否需要此类国家立法。其次，没有 可扩展、可持续、循证的培训计划，用于对 SGM 的 LTSS 员工进行 AD/ADRD 培训 文化响应式护理。该应用程序专注于“服务培训”课程，该课程已培训 12 个州超过 12,000 名 LTSS 员工。这个可接受的、可行的、有前途的课程采用了 多层次方法对管理人员和一线 LTSS 员工进行 SGM 文化响应式护理培训 AD/ADRD。但是，它尚未经过严格评估，并且仅依赖于亲自指导。这个混合的 方法和比较有效性研究有三个具体目标。在目标 1 中，我们将开展 对明尼苏达州 362 家疗养院和 362 家辅助生活设施进行全面政策分析，以评估 拥有明确SGM人力资源扶持政策的机构数量及比例， 营销、培训、治理；指导文化响应式护理和居民的反歧视政策 性取向和性别认同（SOGI）数据收集。这些发现将为目标 2 课程提供信息。在 目标 2，为了使服务培训在全国范围内更具可扩展性和高保真度，我们将设计和开发一个 异步在线版本，并以 30 名 LTSS 管理人员和 30 名员工进行试点。在目标 3 中，评估 为了评估培训的效果，我们将进行一项 3 组、管理层/员工分层、分组随机、对照试验 面对面培训、在线课程与候补名单对照组（在 62 个 LTSS 机构中，其中 每个部门 310 名管理人员和 450 名员工）。在个人层面，我们将评估管理层和员工 为 SGM 客户提供护理的知识、态度和技能。在机构层面，在六个月的随访中，我们 预计接受培训的机构将有更多SGM明确政策，更多SGM欢迎 环境、入院时的 SOGI 数据收集以及知识、舒适度和技能显着提高的员工 为 SGM 提供 AD/ADRD 文化响应护理。