HCGNE - The Geriatric Mental Health Training Series (GMHTS)

A Brief Overview

• Overview of the Need
• The Geriatric Mental Health Training Project
• Detailed Training Materials
• Module Topics/Titles
• Independent Evaluation
• Project Outcomes
• Revisions and Updates

Overview of the Need. The need for geriatric mental health and illness training in long-term care (LTC) settings was highlighted in the years following the Nursing Home Reform Act of the Omnibus Reconciliation Act of 1989. This need continues to grow as the Baby Boom generation ages and increases the sheer number of older individuals who experience mental disorders. Today, as in 1989, as many as 70% to 90% of all residents living in long-term care settings suffer from some sort of mental disorder, with depression and dementia being the two most frequently encountered disorders. Although considerable progress has been made in providing training to long-term care (LTC) staff, assistance to better understand and manage behavioral problems associated with mental illness, or threats to mental health, is often needed.

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The Geriatric Mental Health Training Project. In 1989, Kathleen C. Buckwalter, PhD, RN, FAAN, received a three-year grant from the Division of Nursing, Bureau of Health Professionals, Department of Health and Human Services, to provide training to nursing home personnel on geriatric mental health topics. A two-year extension was granted in 1992 to further refine and expand work completed in the first three years including evaluation of the programs' relevance to other populations and settings. The program materials provided here are revised and updated by Marianne Smith, GMHTS, project director, from the original Geriatric Mental Health Training Series (GMHTS) that was developed during this project.

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Detailed Training Materials. Realizing that most LTC nurses are already faced with competing demands for their time and attention, training materials were specifically designed to be easy-to-use and understandable. The comprehensive six-part manual that resulted was organized to facilitate quick access to pertinent information, and included all needed materials to train additional staff. Complex concepts were reduced and explained in understandable language, and psychiatric jargon was eliminated to facilitate understanding. All materials were designed to help LTC nurses be more knowledgeable about the causes of "problem" behaviors, techniques to manage those troubling behaviors, and the influence of the care providers' own feelings and behaviors in response to resident behaviors (e.g. the role of values and beliefs, personal needs, and stress in the work place). The training materials were designed to be flexible, and strongly encouraged individual trainers to adapt the modules to meet their unique needs and audiences. Throughout the training materials, trainers are urged to personalize the materials by using real-life examples from their facility, try out suggested interventions with residents prior to training staff, and use as many meaningful examples as possible to help staff apply the program concepts in their day-to-day practice.

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Module Topics/Titles. Six topics that are based on needs assessment survey are believed to be the cause of many behavioral difficulties in LTC settings were the focus of the training series. Six "core" modules were developed and evaluated in Years 01-03 of the project, including an overview of mental illness, problems related to control issues, communication strategies, depression, dementia, and management of aggressive behavior. Additional, supplemental modules were developed and evaluated in Years 04-05 to complement and supplement the core program, including topics like delirium, paranoia, and anxiety.

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Independent Evaluation. To verify the effectiveness of the training materials and model, the project employed an independent evaluation based at the University of Iowa. Nurse trainers and their trainees both gave the program materials and training an average rating of 4.5 or above on a six-point scale were 1=poor and 6=excellent. The written remarks were overwhelmingly positive with few comments made under the "least useful" section. A variety of articles were published describing the outcomes, as highlighted next.

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Project Outcomes. Over the course of this 5-year project, over 2,800 nurses and nursing personnel were provided new knowledge using a train-the-trainer format to disseminate research, theory and best practice literature to nurses who might otherwise not come into contact with this knowledge. Detailed program materials were purposefully assembled in a "user-friendly" format to encourage busy nurses to tackle training that might otherwise be deemed too time-consuming or difficult. Each is structured to lead staff from commonly encountered behaviors (perceived as "difficult" or "problematic") through a brief discussion of the underlying causes of the behavior, methods to better assess and understand the behavior, and finally to practical, hands-on interventions designed specifically with day-to-day care providers in mind. Although this project employed specialized training for trainers to enhance their comfort and confidence with the program concepts, the materials have been used successfully by health care providers who have not attended special training. Finally, the program materials have been used with diverse audiences, including a wide range of LTC facility staff, as well as with acute care, adult day health care, and home health care personnel.

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Revisions and Updates. The original structure of the GMHTS modules, as described in the section above, is maintained in the modules provided by the HCGNE. Training modules are updated to reflect current research and practices and are provided in electronic format. To facilitate widest dissemination and use of the training modules in the GMHTS, the original paper and slide format has been modified so that materials may be accessed as electronic versions. Updated copies in Microsoft Word and PowerPoint, as well as materials converted to PDF format, are provided. Permission is granted for individuals to print, copy and otherwise reproduce these program materials in an unaltered form for use as personal development activities, inservice education programs, and other continuing education programs for which no fees, or only fees to cover expenses, are charged. Use of these materials for personal profit is prohibited. Users are asked to give credit to the Hartford Center of Geriatric Nursing Excellence, College of Nursing, University of Iowa, for use of the training materials.