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Effective Tools & Skills for Running Cognitive Stimulation Therapy (CST) Groups

Learn how to facilitate CST groups efficiently, follow NICE-SCIE guidance, understand CST principles, structure, sessions, and evaluation. Explore the benefits of Maintenance CST and key principles for successful CST sessions. Gain insights into CST concepts and setting up groups.

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Effective Tools & Skills for Running Cognitive Stimulation Therapy (CST) Groups

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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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