The Contented Dementia Trust (the Trust) is a small independent UK charity which has developed a care management model based on a novel conceptualisation of memory and how this changes in dementia. This is known as the SPECAL method, a person-centred, practice-based approach to the care of people with dementia (SPECAL Method).
King’s College London (King’s) is one of the UK’s leading public research universities, whose nine faculties include the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, a world leader in integrating nursing, midwifery and palliative care.
The interest of King’s in the evaluation project was initially aroused by the contrast between the positive findings of the Royal College of Nursing (RCN)’s evaluation of the SPECAL Method – which reported significant improvements in the quality of life of the person and those involved in their care – and the negative public statement reiterated over many years by the Alzheimer’s Society detailing its ‘serious misgivings’ about the SPECAL Method.
King’s designed a research programme (the Research Programme) to provide an independent evaluation of the efficacy of the SPECAL Method and to inform the development of psychosocial interventions in caring for people with dementia; it was intended to lead to a randomised controlled trial comparing the SPECAL Method to usual care. The objectives of the Research Programme were to devise appropriate training of NHS care professionals and assess the feasibility of family carer courses facilitated by NHS staff.
The outcomes of the Research Programme show that:
(1) NHS trainees found the SPECAL Method concepts challenging in the context of their previous learning whilst expressing confidence in their rationale, application and the apparent benefits to participating family carers, who reported enhanced interaction, transformed relationships and greater resilience.
(2) The feasibility study has demonstrated that the SPECAL Method course for family carers, and the accompanying assessment process, is viable and acceptable. While the results indicate that empathy, harmony and resilience are boosted by the knowledge and application of SPECAL Method understanding and skills, wider systemic evaluation is now required.
(3) The mechanisms of the SPECAL Method were explored in a separate study with family and professional carers who had applied its principles and practices over many years. All participants found the SPECAL Method helpful in caring for a person with dementia. Analysis of the core themes by the Investigators – empathy, harmony and resilience – contributes to a proposed model of the mechanisms of the SPECAL Method.
The opportunity for the Trust to work collaboratively with King’s has begun to build the academic and scientific evidence base so urgently needed by the Trust, and to underpin its ambition to extend the benefits of the SPECAL Method to the post-diagnostic support available to families. The support from high level professionals in the research field has galvanised the Trust’s efforts to standardise an integrated, practical dementia communication toolkit and further develop the training essential for professionals qualified to manage, train and support future generations of both family and professional carers. Penny Garner, Founder of the Contented Dementia Trust says “The collaboration with King’s and publication of the associated research in academic journals* has promoted awareness and understanding of the SPECAL Method; this recognition will lead to further research initiatives in the near future. Topics under discussion include: analysis of the impact of dementia on communication; comparison of SPECAL-informed care with other dementia care systems; and application of the SPECAL Method to a range of integrated services within a locality model’.
Ian Norman, Emeritus Professor of Mental Health & former Executive Dean, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London says “Research by members of the King’s team has generated increased interest in the SPECAL Method as a communication approach 8
to enable family carers to keep pace with progressive cognitive challenges in dementia and sustain well-being through to the end of life. It has shown that training family carers in the SPECAL Method is feasible and that the method is highly valued by family carers who use it. It has also highlighted the value of the SPECAL Photograph Album as a metaphor that appears to enhance family carers’ understanding of what it may feel like to have dementia. In addition the research has identified some preliminary mechanisms through which the SPECAL Method may have a positive impact on the person with dementia which would need to be tested in future research studies’.
*McCrae N., Penhallow J. (2018) SPECAL: First evaluation of a course for carers. Journal of Dementia Care (Nov/Dec 2018) McCrae N., Penhallow J., Rees O., Norman I. (2019) The Specialized Early Care for Alzheimer’s method of caring for people with dementia: an investigation of what works and how. The Scandinavian Journal of Caring Sciences (12 December 2019)