Using Behavioural Skills Training with Healthcare Staff to Promote Greater Independence for People Living with Dementia: A Randomised Single-Case Experimental Design
BST with task analysis and least-to-most prompting quickly teaches care staff to promote independence in daily tasks for people with dementia.
01Research in Context
What this study did
Hanniffy et al. (2025) worked with care-home staff who support people living with dementia.
The team used Behavioural Skills Training (BST) plus a task list and least-to-most prompting.
They ran a multiple-baseline design across staff to see if the training would stick.
What they found
Staff jumped from low baseline scores to near-perfect use of the prompting plan.
The gains were large and stayed high when checked later.
People with dementia showed more independent steps during daily tasks after staff changed their style.
How this fits with other research
Weiss et al. (2001) did the same thing first. They taught restaurant staff to offer choices and prompt adults with severe disabilities. Both studies show BST plus prompting works across very different groups.
Clayton et al. (2019) and Matos et al. (2020) also saw big staff jumps after short BST, but they trained DTT skills. Hanniffy et al. (2025) proves the jump happens in dementia care too, not just autism classrooms.
Ampuero et al. (2025) found brief feedback can replace full BST for paraeducators. Hanniffy kept every BST step and still got fast, high results. The difference is setting and risk: dementia care may need the full package for safety and respect.
Why it matters
If you train residential or day-program staff who work with older adults, this paper gives you a ready script. Use BST with a clear task analysis and least-to-most prompting. Staff master it fast, and clients stay more independent. No extra gadgets or long workshops needed.
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02At a glance
03Original abstract
Approximately 72% of older adults in residential care have dementia and present with different levels of functioning. People living with dementia (PLwD) may not always be facilitated to independently carry out activities of daily living (ADLs) in care, increasing the likelihood of excess disability. This study incorporated Behavioural Skills Training (BST) to train healthcare staff how to increase opportunities for independence for PLwD by using task analyses and least-to-most (L-M) prompting procedures during ADLs. Three healthcare staff, two female and one male (mean age = 42.67, SD = 16.82), participated in the intervention. The What Works Clearinghouse (WWC) Single-Case Design Technical Documentation guided the study’s design. A randomised single-case experimental (N-of-1) design was employed, using a multiple-baseline design (MBD) across participants (n = 3) for three separate ADLs. The dependent variable (DV) was the percentage of correct staff responses when implementing the L-M prompting procedure for each step during ADLs. Visual and statistical analyses demonstrated an increase in the correct use of a task analysis and L-M prompting for all three participants during the intervention compared to the baseline: for ADL1 (assistance to stand), effect sizes were d = 5.39, d = 9.38, and d = 6.79 for the three participants, respectively; for ADL2 (assistance with drinking), effect sizes were d = 3.27, d = 8.55, and d = 3.67; and for ADL3 (assistance to brush teeth), effect sizes were d = 5.99, d = 12.93, and d = 9.39. Maintenance data ranged from 70% to 100% correct responses at follow-up (mean = 93.11% SD = 7.85). Participants successfully generalised skills learned to two new ADLs (PLwD eating a meal and putting on a jumper). BST was demonstrated to be an effective training strategy to increase opportunities for independent responding for PLwD in care environments. The contingencies influencing staff behaviour require attention within the healthcare environment.
Behavioral Sciences, 2025 · doi:10.3390/bs15070870