Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study.

Miriam Stanyon,David Challis,Amy Streater,Jennifer Yates,Tom Dening,Shirley Mitchell,Juanita Hoe,Fiona Poland,Martin Orrell,Donna Maria Coleston-Shields,David Prothero,Brynmor Lloyd-Evans,Esme Moniz-Cook

doi:10.2196/14781

Abstract

BackgroundTeams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams.ObjectiveThe aim of this study is to develop a “best practice model” for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a “best practice model.”MethodsParticipants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit.ResultsData were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice.ConclusionsThis is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers.International Registered Report Identifier (IRRID)RR1-10.2196/14781

Highlights

BackgroundHome-orientated care is a key objective in the UK Dementia Strategy [1] to help people with dementia maintain their independence; fluctuations in health and the social needs of people with dementia and/or their caregivers can result in a breakdown of the caring process, making it difficult for the person with dementia to remain at home
Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice
Community support for people of working age is well specified, with identified teams in place to avoid hospital admission, but a national survey found that only 16% of these general adult crisis teams accept people with dementia onto their caseload [4]

Summary

Introduction

Home-orientated care is a key objective in the UK Dementia Strategy [1] to help people with dementia maintain their independence; fluctuations in health and the social needs of people with dementia and/or their caregivers can result in a breakdown of the caring process, making it difficult for the person with dementia to remain at home This can lead to a crisis where the person with dementia may have to be admitted to an inpatient setting unless skilled management of the situation within the community can be employed. A subsequent online scoping survey of 62 managers of teams managing crisis in dementia identified wide variations in care pathways and types of services managing crisis in dementia Such services include dementia intensive support teams, mental health intensive recovery teams, dementia crisis support teams, dementia rapid response teams, and intensive recovery intervention services [5]. Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams

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