Staff training in assisted living: Evaluating treatment fidelity

OBJECTIVES: To investigate a protocol for identifying and evaluating treatment fidelity in Staff Training in Assisted-living Residences (STAR), a structured but flexible program to train direct care staff to improve care of residents with dementia. DESIGN: Multisite feasibility trial. SETTING: Assisted living facilities (ALFs). PARTICIPANTS: Forty-four direct care staff and 36 leadership staff. INTERVENTION: STAR is a comprehensive, dementia-specific training program to teach direct care staff in ALFs to improve care and reduce affective and behavioral problems in residents with dementia. It is conducted on-site over 2 months through 2 half-day group workshops and four individualized sessions. MEASURES: Treatment fidelity was assessed following the National Institute of Health Behavior Change Consortium model utilizing observations and self-report of trainers, direct care staff, and leadership. RESULTS: Each key area of treatment fidelity was identified, measured, and yielded significant outcomes. For example, significant increases included direct care staff identifying activators, behaviors, and consequences (an essential component of training); understanding basics of dementia care; and applying STAR techniques. CONCLUSIONS: Results support that STAR is ready to be translated and disseminated into practice. Because ALFs will continue to provide care for individuals with dementia, the need for effective, practical, and sustainable staff training programs is clear. STAR offers one such option. It is hoped that this report will encourage others to conduct comprehensive evaluations of the treatment fidelity of their programs and thereby increase the availability of such programs to enhance care.