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

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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.