AIGNA Conference 2016 - presentation by Ms Jan Leeks, Senior Lecturer from the School of Health and Social Work, University of Hertfordshire, UK.

1. A year in the life of a cascade
trainer
Jan Leeks Consultant Nurse Dementia Care
Hertfordshire Partnership University Foundation Trust
Senior Lecturer University of Hertfordshire
Jan.leeks@hpft.nhs.uk
J.leeks@Herts.ac.uk

2. During this session we will explore
• The Drivers for Cascade training
• Definitions of cascade training
• Methods of effective cascade training
• The implementation of a cascade training model into acute
hospitals and the care home sector
• How cascade exercises work

3. National Dementia
Strategy
8 Improve the quality of
care for people in general
hospitals
11 Improve the quality of
care for people with
dementia in care homes
13 An informed and
effective workforce for
people with dementia
National drivers to introduce dementia training

4. Progress is being made
Newton Aycliffe care home
opens dementia-friendly
coffee bar
Care homes celebrate
improvement project work

5. Three care workers have been spared
jail after they were secretly filmed
abusing an elderly dementia victim
His 'personal hygiene needs were
plainly neglected', prosecutor claims
But there is still progress to be made

6. Definitions of cascade training
A process whereby something,
typically information or knowledge,
is successively passed on.
Training message flows down from
experts and specialists through
personnel
Delivers training messages at the
central level to the local level

7. The Literature
• Training alone is not sufficient to have a long term impact
(Lintern et al, 2000)
• On-going support and supervision can promote person-
centred approaches over the longer term (Fossey et al, 2006)
• Without senior management support, changing care cultures
is unlikely, regardless of the quality of training (Nolan et al,
2008)
• Intermediate level training is needed to have an impact on
staff feelings of caring efficacy and satisfaction (Surr et al
2015)

8. Training is based in adult learning theory
• Experiential learning
• Group discussion
• Reflection
• Problem solving
Kolbs’ reflective cycle

9. Developing a bespoke cascade model
Budget
Training needs
analysis
Developing
materials

10. Delivery of a typical model
Facilitation
training
Participants
deliver materials
Feedback and
reflection
Feedback to group Participants deliver
materials
Feedback and sign
off as peer
facilitator
Part one
Part two

11. Becoming a Dementia Champion – acute hospital staff
4Hoursfoundationtraining
• 30 minutes
sessions
• Building
knowledge
and
confidence
for hospital
staff
DevelopingFacilitationSkills
• Am
Facilitation
skills
workshop
• Pm
• delivery of
foundation
session
• Competencies
to be achieved
to enable
successful
completion of
training
2Daysintermediateleveltraining
• Reflection on
work-based
practice
• The Social
Environment
• The Physical
Environment
• Redefining
‘challenging
behaviour’
2DaysintermediateTraining
• Reflection on
work-based
practice
• Involving
people living
with
dementia in
decision
making
• Challenging
non person
centred
practice

12. Usual contents of the training
Foundation/tier one
Communication
Person-centred
approaches
Impact of dementia
Meaningful activities
Life stories
Sexuality
End of life
Working with families
Care planning

13. Workbooks are designed to be
• Interactive through group
work and discussion
• Practice based with
examples and case
studies
• Experiential with
scenarios and reflections
• Reflective to embed
change in work practice

14. Subscribe to practice change
• I will change the language
that I use
• I will make time to talk to
people
• I am going to find out more
about them
• I am going to stop seeing
dementia as a problem

15. Challenges of the cascade model
• Work can become diluted
• Perceived as top down training
• Lack of commitment at a local level

16. Overcoming the challenges
• Onsite visits for quality control
• Planned meetings with facilitators/review
feedback
• Information and incentives

17. Challenges to implementation
• Releasing staff remains problematic
• Staff turnover equates to 25% drop out
• Follow up visits – often cancelled
• Cascade Trainers Network has poor
attendance
• Staff who are unable to facilitate sent on
the course

18. Overcoming the challenges
• Interview staff prior to attendance
• Meet with home managers
• Provide ongoing onsite support
• Data base of trainers and those trained
• Budget for extra training costs
• Perseverance

19. Individual exercise
If you were admitted to a care home what would
you NOT want staff to do or would NOT want to
happen to you?
List 2-3 things
that you would
not want to
happen

20. Discuss with your partner
How would you act or react if these things
did happen?

21. Busting the myth – people with dementia can’t communicate
The naming game
Think of 5 male actors whose first name begins with a K
and write it below;
1………………………………………
2………………………………………
3………………………………………
4………………………………………
5.....................................................

22. Busting the myth – people with dementia can’t communicate
Think of 5 female actors whose first or last name begins
with a K and write it below
1 Grace……………………………
2…………………………Winslett
3 Penelope……………………….
4……………………………Turner
5 Felicity......................................

23. Discussion
Which did you find the easier of the two exercises? It is most likely to
be the second exercise; this is because you were asking your memory
to work differently. The first time you were asked to remember you
were trying to recall specific information. The second time you were
trying to remember you were using recognition to help you, in that you
had either the first or last name. For someone living with dementia
memory can work the same, so whilst a person may find it hard to
recall specific information such as “what have you done today?” they
may be able to answer if given suggestions ie “I had a long walk in the
park today, have you been out?” or “Kathy tells me you enjoyed the
entertainer who came this morning.”

24. Its all worth while when
“I walked into the bay (in the
coronary care unit) and I didn’t
meet a 93 year old dementia
patient who was aggressive and
resisting care……………
……I met Tom, a 29 year old
joiner and Burnley Football Club
supporter who was worried about
what was happening”

25. Thank you for listening
Any questions?
Jan.leeks@hpft.nhs.uk
j.leeks@Herts.ac.uk