Table 1.
Overview of Intervention Protocol
| Session # | Week # | Type of Contact | Interventionist | Session Content |
|---|---|---|---|---|
| ACTIVE PHASE – Step 1 – Assessment of Patient, Caregiver and Environment | ||||
| 1 | 1 | Home visit | OT | Rapport building; Review education material; Review and prioritize target behaviors; Appraise caregiver’s management techniques; Evaluate home environment for safety, impact on problem areas using the HEAP. Identify first target behavior and specific treatment goal (e.g., reduce frequency of behavior, increase quite time); Ask CG to record when behavior occurs and events leading up to occurrence. Provide CG with workbook which includes tips, recording strategies and education materials. |
| 2 | 2 | Home visit | NU | Rapport building; Provide overview of intervention; Basic information about caregiving, dementia, disruptive behaviors; Review of patient medication; Obtain urine and blood samples |
| 3 | 3–4 | Telephone contact | NU | Provide feedback about medical tests; Refer CG/CR to physician if necessary; Assist caregiver in making arrangements; Reinforce education; Review signs and symptoms of underlying medical causes. |
| ACTIVE PHASE – Step 2 – Introduction of Prevention and Management Techniques | ||||
| 4 | 4 | Home visit | OT | Reinforce and help facilitate referral to physician if necessary; Review behavioral occurrence for first target behavior; Introduce communication techniques; Show ASPEN video on communication and provide written tips sheet; Identify which techniques CG will practice and help CG identify times to practice. Recommend CG practice techniques and record behavioral outcome. |
| 5 | 5–6 | Home visit | OT | Review use of communication technique; Introduce environmental simplification and equipment (if appropriate and place order if necessary and agreed upon by caregiver); Use role play, demonstration to reinforce communication and simplification techniques; Evaluate with CG what works and what does not, modify strategies accordingly; Recommend CG practice techniques and implement environmental strategies. |
| 6 | 7–8 | Home visit | OT | Review communication techniques and environmental strategies and evaluate what was effective; Refine/modify strategies and equipment order if necessary); Introduce stress management techniques; Target second disruptive behavior if first behavior resolved or significant progress towards resolution is made; For next behavior, identify behavioral goal, problem solve as to antecedents and consequences; use active modeling, demonstration, role play to reinforce techniques; Recommend CG practice specific stress reduction, communication and environmental simplification techniques. |
| 7 | 9–10 | Telephone contact | OT | Review progress and use of all strategies; Reinforce use of techniques |
| 8 | 11–12 | Home visit or telephone contact | OT | Review CG progress; Reinforce use of communication, environmental and stress reduction techniques; Instruct in use of equipment (if ordered); Identify third disruptive behavior and behavioral goal if resolution to other target behaviors; Problem solve as to antecedents and consequences and follow procedures for contact 6. |
| 9 | 12–13 | Home visit or telephone contact | OT | Review CG progress; Target fourth disruptive behavior if appropriate; Identify behavioral goal; Problem solve as to antecedents and consequences; Review strategies and modify to address new problem area. |
| 10 | 14–15 | Home visit or telephone contact | OT | Review CG progress and reinforce use of techniques |
| 11 | 16 | Home visit | OT | Review CG progress and use of all strategies and determine which are in use and effective. Review steps involved in preventing, managing disruptive behaviors (identifying antecedent behaviors, goal setting, modification of environment. Help caregiver understand how to generalize strategies to behaviors that may occur in the future. |
| MAINTENANCE – Step 3 – Closure and Generalization to New Problem Areas | ||||
| 12 | 18 | Tele-contact | OT | Review CG progress and reinforce use of techniques; help caregivers generalize strategies to other areas; begin discussing closure |
| 13 | 21 | Tele-contact | OT | Review CG progress and reinforce use of techniques; validate caregivers skill in use of strategies |
| 14 | 24 | Tele-contact | OT | Review CG progress and reinforce use of techniques; obtain closure; If no improvement in target behaviors, refer to PCP |