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Tools and skills to facilitate running Cognitive Stimulation Therapy (CST) groups effectively.

Tools and skills to facilitate running Cognitive Stimulation Therapy (CST) groups effectively. Amy Streater & Elisa Aguirre Research Assistants & PhD students a.streater@ucl.ac.uk e.aguirre@ucl.ac.uk. OC077. Conflict of Interest Disclosure Amy Streater & Elisa Aguirre, MPhil.

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Tools and skills to facilitate running Cognitive Stimulation Therapy (CST) groups effectively.

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  1. Tools and skills to facilitate running Cognitive Stimulation Therapy (CST) groups effectively. Amy Streater & Elisa Aguirre Research Assistants & PhD students a.streater@ucl.ac.uk e.aguirre@ucl.ac.uk OC077

  2. Conflict of Interest DisclosureAmy Streater & Elisa Aguirre, MPhil. Has no real or apparent conflicts of interest to report.

  3. Overview • CST for dementia • Background • CST principles / structure / sessions • Practicalities of running CST groups • Settings • Facilitation • Evaluation

  4. NICE-SCIE guidance (2006) www.nice.org.uk People with mild/moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme … irrespective of any anti-dementia drug received …’

  5. CST Background • ‘Reality Orientation’ (RO) marked a breakthrough in dementia care • Criticism of RO: applied in a rote, uninspired way, (Dietch, Hewitt and Jones, 1989), insensitive to individual needs (Powell-Proctor & Miller, 1982) • RO Cochrane Review (Spector et al., 2000)

  6. CST trial (Spector et al., 2003) • multicentre Randomised Control Trial (RCT) • n= 201 BL / 168 FU, 23 centres • Found a significant improvement in the primary outcome measures: cognition and quality of life. • No significant results were found for the secondary outcome measures: mood (depression and anxiety) & activities of daily living. • CST shown to be more cost-effective than usual activities and compared favourably with anti- dementia drugs (Knapp et al., 2005).

  7. Maintenance CST • Pilot Maintenance CST (Orrell et al., 2005) found that maintenance CST led to continuous cognitive benefits. Whereas, CST only led to a gradual decline. • Pilot involved 16 weekly session following CST programme • Piloted in 2 experimental homes, 2 control homes • Limitations: Small sample (35), homes volunteered • Currently a multicentre RCT of Maintenance CST is being carried out by UCL / NELFT

  8. Cognitive Stimulation Cognitive Stimulation Therapy… ★ Targets cognitive and social function ★ Social element enhanced by having in a group environment or with the family caregiver. ★ Cognitive activities do not primarily consist of practice on specific cognitive modalities

  9. Concepts of CST sessions • Aim to be mentally stimulating, yet for people to feel empowered rather than de-skilled • 45 minutes / 14 sessions • Group name • Theme song • Warm-up activities • Roles for members • RO board

  10. CST Key Principles • Orientating people sensitively / when appropriate • Information processing and opinion rather than factual knowledge  implicit learning • Multi-sensory stimulation • Flexibility in the activities to cater to the groups needs • Using reminiscence (as an aid to here-and-now) • Building / strengthening relationships • Empowering for staff running groups

  11. CST/MCSTSessions

  12. Household Treasures

  13. Session Structure • Introduction • Theme Song • Current Affairs • Main Activity • Closure

  14. Setting up the group • Ideally 5-8 people in groups, run by two facilitators • Each session has choice of activities, to cater for interests and abilities of group • Group members should ideally be at similar stages of dementia, so activities can be pitched accordingly • Attention should be paid to gender mix

  15. Inclusion Criteria Diagnosis of dementia (DSM IV) with CDR 0.5 / 2 Can s/he have a “meaningful” conversation? Can s/he hear well enough to participate in a small group discussion? YES Is her/his vision good enough to see most pictures? YES Is s/he likely to remain in in a group for 45 minutes? YES N O YES N O N O N O N O Y E S THIS PERSON SHOULD NOT BE INCLUDED IN THE GROUP THIS PERSON CAN BE INCLUDED IN THE GROUP

  16. Preparing for the groups • Assessment of individuals – strengths, sensitive areas, interests, literacy, etc • Explaining nature and purpose of CST groups. • Discussing continued assent – that people can withdraw at any time, with no negative consequences. • Organising transport, a room, staff. • Preparing folders for group members.

  17. Monitoring Progress • Keeping records of attendance, notes following all sessions • Monitoring progress form included in the CST manual • Outcome measures, including: ★ MMSE - to measure cognitive change ★ QoL-AD - to measure quality of life • Feedback from group • Regular supervision is essential

  18. Future of CST • Development and evaluation of the Maintenance CST programme. • An evaluation and comparison of the effectiveness of two different CST training approaches and its implementation in practice. • Individual CST (iCST)

  19. Useful resources • Speechmark Publishers www.speechmark.net • Winslow www.winslow-cat.com • The Robert Opie Collection (reminiscence) http://www.robertopiecollection.com • Toy museum www.pollockstoymuseum.com

  20. Thank you for listening

  21. References Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B and Orrell M (2006). Cognitive Stimulation Therapy for people with dementia: Cost Effectiveness Analysis. British Journal of Psychiatry, 188:574-580. Orrell M, Spector A, Thorgrimsen L & Woods B (2005). A pilot Study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia. International Journal of Geriatric Psychiatry, 20:446-451 Spector A, Orrell M, Davies S & Woods B (2000). A systematic Review of the use of Reality Orientation in dementia. The Gerontologist, 40 (2): 206-212.

  22. Spector A, Thorgrimsen L, Woods B & Orrell M (2005). Making a difference…An evidence-based group programme to offer cognitive stimulation therapy (CST) to people with dementia. UK: Hawker Publications. Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M & Orrell M (2003). Efficacy of an evidence-based Cognitive stimulation therapy programme for people with dementia: Randomised controlled trial. British Journal of Psychiatry, 183: 248-254 CST website: www.cstdementia.com

  23. Acknowledgements Maintenance Cognitive Stimulation Programme (ISRCTN26286067)) is part of the Support at Home - Interventions to Enhance Life in Dementia (SHIELD) project (Application No. RP-PG-0606-1083) which is funded by the NIHR Programme Grants for Applied Research funding scheme. The grantholders are Professors Orrell (UCL), Woods (Bangor), Challis (Manchester), Moniz-Cook (Hull), Russell (Swansea), Knapp (LSE) and Dr Charlesworth (UCL). This report/article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research sheme (RP-PG-060-1083). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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