The Behavioural Revolution: Creating Cultural Change in Person-Centred Dementia Care to Improve Quality of Life and Reduce Distressed Behaviours

Dr Emma Williams and Dr Zoe Lucock, Positive Ageing Consultancy

5th September 2023

Supporting adults with dementia who are experiencing distressed behaviours can be challenging for carers. They are often expected to possess an advanced understanding of behaviour and behaviour change science that is generally not covered as standard in carer training. Specialist behavioural based support and training for carers can mean the difference between clients with dementia who are unengaged for large portions of the day and have frequent distressed behaviours, and clients who are engaged with activities throughout the day, empowered to be independent, retain skills for longer, and have their needs met effectively.

Despite NICE guidelines outlining that carers should receive training on how to understand behavioural changes and person centred care, until recently, there have been few professionals in the UK with the specialist qualifications in behaviour change science able to train staff to provide care in this way. However, we are on the cusp of a cultural shift in the provision of care and the care industry is starting to recognise the benefits of utilising an expert in behaviour change science in settings where people are living with dementia; a behaviour analyst.

What is a Behaviour Analyst?

Many people are unaware that behaviour analysts even exist, and are not familiar with the type of work that behaviour analysts do and what they can support with. A behaviour analyst is an expert in human behaviour and in creating behaviour changes to improve quality of life using evidenced based, positive strategies.

To find out why a specific behaviour is happening, a behaviour analyst is able to conduct a range of observations and assessments with the person living with dementia. From their analyses of that complex data set, they design a bespoke intervention and train caregivers to proactively prevent or reduce the need for the behaviour to happen by meeting the person’s needs ahead of time.

As of June 2023, there were 62,856 registered Board Certified Behaviour Analysts in the world including 413 UKBA (cert)s in the UK, with the majority specialising in supporting people with other diagnoses. There are only a small number of behaviour analysts that have received the necessary training to enable them to work with older adults, but the number is growing.

Positive Ageing Consultancy & Training Ltd

Dr Zoe Lucock and Dr Emma Williams are UK based Board Certified Behaviour Analysts (UKBA cert) who founded Positive Ageing Consultancy & Training Ltd (PACT) in 2021 to ensure that people living with dementia and their caregivers could access expert person centred behavioural services. They provide support across the country for people who have dementia and their caregivers living in the community, residential and nursing homes, or hospitals. Dr Williams and Dr Lucock provide bespoke behavioural support and specialised behavioural staff training at varying levels of skills and knowledge. They support caregivers with a range of behaviours such as wandering, refusal of personal care support, aggression, agitation, apathy, and disengagement, reteaching lost skills, regaining independence during daily living, and increasing engagement in meaningful activities.

Recently, Dr Lucock and Dr Williams have been providing their specialist behavioural support services to people across North Wales commissioned by The North Wales Social Care and Well-being Services Improvement Collaborative. This was part of an initiative to reduce distressed behaviours by coaching and supporting caregivers to proactively prevent them, lower placement breakdowns, and reduce the over prescription of antipsychotics for behavioural issues. There is a common theme that caregivers report; that due to a lack of behavioural training they do not feel able to effectively meet the needs of clients with distressed behaviours they work with day to day.

Broad Scale Cultural Behaviour Change

There is a nationwide deficit in the practical behavioural skills that carers are equipped with. This is through no fault of their own, however, when carers feel more confident and competent to do their job effectively it creates a trickle down effect where a behavioural approach is seen as standard and other carers coming into the setting are more likely to gain skills from observing others they work with. It is time to make steps towards developing a cultural shift with behavioural input as standard within dementia care settings to improve outcomes.

When people’s needs are proactively being met by carers who have been equipped with  behavioural knowledge and practical skills, it results in measurable outcomes such as a reduction in distressed behaviours, reduced escalated care needs, fewer placement breakdowns, lower staff burnout and turnover, and fewer prescriptions for antipsychotics for behavioural management.

Behaviour analysts are highly skilled professionals who can make a huge difference to person centred care and staff skills in preventing distressed behaviours, which in turn increases the quality of life of clients with dementia on a broad scale. We are on the precipice of an explosion of behavioural services within dementia care in the UK and here at PACT we are proud to be at the forefront of that cultural upskilling.

To find out more, visit their website here.

Email Dr Emma Williams: emma.williams@positiveageingconsultancy.co.uk

Email Dr Zoe Luckock: zoe.lucock@positiveageingconsultancy.co.uk