1. My CLAHRC Year: Balancing Science and Practice Alistair Gaskell

2. The context Also the year in which I have had a major shift of role – clinical lead CAMTED Unhelpful parts: role conflict and time conflicts Helpful part has been the overlaps: (Action Learning more for support in practice rather than research)

3. The project A largish scale complex intervention Training plus practice development in dementia care to care homes in Hunts Intervention was flexible and developing Implementation challenges were considerable Desired outcomes are distant from the intervention How to find a manageable and meaningful evaluation plan

4. Evaluation plan Project-wide evaluation of satisfaction / perceived utility of training Project-wide evaluation of health outcomes (antipsychotic prescription and emergency hospital admissions) Detailed Case studies of three homes – Overall well-being (Dementia Care Mapping) – Agitation (Cohen- Mansfield Agitation Inventory) – Staff attitudes (Approaches to Dementia Questionnaire)

5. A potential chain of evidence Staff satisfaction with / perception of usefulness of input Measurable change in staff attitudes / approaches Improved Clinical Outcomes Effect on financially relevant variables

6. Challenges Development / elaboration of the intervention was more difficult than anticipated Internal problems at one of the three homes led to curtailment of the intervention Gathering data – harder than anticipated – DCM on too few subjects Hospital admission data is also flawed but we now have a method of cleaning it Issue of independence – maybe not given as much prominence as it should Slippage of the timescale – importance of giving the intervention enough time to work. Service constraints meant that the bidding for continuation funding had to take place in the absence of much data.

7. Initial Results: Core Training Evaluations 76% 78% 88% 76%

8. Attitudes to Dementia Questionnaire Total Scores: data from 21 participants: three homes p=0.001

9. The process of bidding for substantive funding Timetable meant that we needed to be making the case without having had the chance to evaluate properly Business case was put forward on the basis of national evidence plus soft local evidence Initial indications were positive – but interim funding has been refused – may now need to wait until we have more detailed data

10. Learning Design of the project needed to be tighter and smaller scale to allow the evaluation to be more detailed Timetabling of the intervention needed to allow for data to be gathered earlier – starting and finishing more quickly in 1 or two homes The route between intervention and outcome needed to be less complex Fascinating exposure to a different / more evidence-focussed way of thinking