1. Training for care assistants in Parkinson’s disease: A comparison of self study and an interactive training day Lesley Axelrod, Karen Bryan, Heather Gage, Julie Kaye, Peter Williams, Patrick Trend and Derick Wade. Guildford Parkinson’s Disease Research Group, University of Surrey and Royal Surrey County Hospital NHS Trust. BACKGROUND: CARE ASSISTANTS IN THE BRITISH NHS More than one million non-registered staff work in health and social care in the British National Health Service (NHS). Many are involved in the care of older people, either in their own homes or residential settings. Rising concerns about quality of care and the skill levels of care assistants led to the introduction of new training requirements in 2000. PARKINSON’S DISEASE Parkinson’s disease is a degenerative neurological condition, affecting about 1% of those over 65, 2% over 80 years, and up to10% care home residents. Although primarily a movement disorder, it additionally inflicts a range of distressing non motor symptoms. As the disease progresses, people with Parkinson’s become increasingly dependent, and a considerable burden is carried by family carers. The mainstay of management is a medical regimen which becomes less effective and more complex as the disease progresses, and is supported by multidisciplinary rehabilitative therapies, assistive technologies and occasionally surgery. Many Care Assistants are not aware of the special issues facing people with Parkinson’s, and the most appropriate ways of helping them, and a need for specific training had been identified. SERVICES FOR PEOPLE WITH PARKINSON’S DISEASE The National Service Framework for Long Term Conditions promotes disease specific nurses coordinating multidisciplinary teams to prevent emergency hospitalisations. The NICE guidelines for Parkinson’s disease (2006) prescribe an extended role for Parkinson’s specialist nurses, and case load of 300 patients. The future implementation of these recommendations is constrained by a shortage of community resources. Over half of Parkinson’s specialist nurses report case loads in excess of 500. The specific training of care assistants in Parkinson’s disease to work with Parkinson’s specialist nurses and multidisciplinary teams of healthcare professionals in the community could alleviate the pressure on nurses. PARKINSON’S TRAINING MATERIALS FOR CARE ASSISTANTS RANDOMISED TRIAL OF INTERACTIVE TRAINING VS SELF STUDY 116 care assistants nominated by 37 employers/managers Background information collected. Baseline knowledge assessment (Quiz 1) Adjusted random allocation to groups. Attend 5 hour training day, n=48 Post training evaluation. Knowledge quiz 2 or 3 n=48 Self study of 4 modules (20 x 15 minute fact sheets = 5 hours) sent by mail n=68 6 week follow up evaluation Knowledge quiz 3 or 2 n=39 After 1 month, post training evaluation. Knowledge quiz 2 or 3 n=44 6 week follow up evaluation Knowledge quiz 3 or 2 n=32 Note: the self study group was larger because late applicants (n=10) had missed the training days. Interventions: The training day included talks and videos from members of the multidisciplinary team, sessions with people with Parkinson’s and carers, and team exercises in problem solving. Care assistants in the self study group received their modules by mail and were asked to read one fact sheet per day in their coffee break, and keep a diary of their study. Employers received reimbursement for 5 hours time for each participant. Care assistants completing the trial received a certificate. ASSESSMENTS Baseline (pre randomisation) background information: age, first language, education and training, caring experience including people with Parkinson’s, preferred method of training. Parkinson’s specific knowledge/ learning outcomes: two tests,- pre training, immediately post training, and 6 weeks after the end of training: True / false knowledge quizzes (25 questions) based on the material in the modules, and compiled using a two-stage validation process. Four facts about Parkinson’s: score range 8 – 0. At 6 week follow up - how the training had affected them in their work. Views about the training: feedback from care assistants and their employers/ managers, about the training per se, and about its practical impact. THEORETICAL BASIS The training evaluation was based on Kirkpatrick’s four levels: 1. Teaching – what the student felt about the training 2. Learning – the resultant increase in knowledge or capabilities 3. Transfer – behaviour change / improvement 4. Effect on business environment or client outcomes D. Kirkpatrick. Evaluating training: the four levels. 1998 FINDINGS Characteristics of participants at baseline (n=101): Only one care assistant was male, the age range was 18 – 65 years. More than 90% had never had training in Parkinson’s disease. Nearly 40% had never had formal generic training. No significant difference between groups in: Self study group, compared to training group, had:  Age distribution  General education  Experience of patients with Parkinson’s disease  Worked longer in caring jobs (10.2 vs 6.4 years), p=0.02  More likely English as first language (89% vs 70%), p=0.024  More likely NVQ2 qualifications (61% vs 40%), p<0.05 Preferences for type of training: Self study is more convenient for some care assistants and employers because backfill arrangements do not have to be made. Training day groupSelf study group Refused allocated methodn = 40 Allocated to preferred method95%25% Learning outcomes: No significant difference in knowledge scores between groups at baseline. Self study did significantly better in the four facts exercise at baseline but had the materials to consult. Knowledge scores of both groups improved significantly after training, and the improvement was maintained at 6 week follow up. No significant difference in knowledge gain between groups. Views on training: High levels of satisfaction with both methods of training from both the care assistants and their managers. CONCLUSIONS Care assistants are willing to undertake disease specific training and are supported by their managers (when backfill is provided) Both interactive training and self study resulted in improved knowledge of care assistants about Parkinson’s disease Training completion rates are higher with interactive training. Self study provides more flexibility, and is preferred by some care assistants and employers Limitations: Learning based on written materials (whether interactive or self study) needs to be supplemented by practical experience No evidence about how the training affected practice, although the care assistants and their line managers reported positive effects on their understanding of Parkinson’s disease and the quality of care they could offer. MESSAGE FOR OTHERS Disease specific training for care assistants that is tailored to their backgrounds, abilities and workplace needs is required, welcomed by relevant stakeholders and effective at improving knowledge. ACKNOWLEDGEMENTS: This work was supported by a project grant from the Parkinson’s Disease Society. The authors are grateful to Philip Qiao for assistance with data entry, and Surrey Joint Health and Social Care Training Office for help with recruitment. SS444839 TD514533 Difference between groupsnsp=.006ns SS change from previous---p=.000p=.03 (fall) TD change from previous---p=.000ns Baseline Post training 6 weeks follow up ( Range 0 -25) SS474839 TD394335 Difference between groupsp=.003ns SS change from previous---ns (fall)Ns TD change from previous---p=.002ns Baseline Post training 6 weeks follow up ( Range 0 -8) Completion rates: there was higher drop out in the self study group GUILDFORD PARKINSON’S DISEASE RESEARCH GROUP