title: Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans.
abstract: OBJECTIVE
  Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioral symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioral approach for managing challenging dementia-related behaviors in its Community Living Center (CLCs, nursing home care) settings. This study describes how the program was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention.
  
  
  METHODS
  One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviors. The frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.
  
  
  RESULTS
  Seventy-one Veterans completed the intervention. Behaviors clustered into 6 types: care refusal or resistance, agitation, aggression, vocalization, wandering, and other. Frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favorably.
  
  
  CONCLUSIONS
  This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioral intervention for managing challenging behaviors among residents with dementia in CLCs.
authors.affiliation: Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia. Michele.Karel@va.gov.
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Karel
authors.affiliation: School of Nursing, University of Washington, Seattle.
authors.forename: Linda
authors.initials: L
authors.lastname: Teri
authors.affiliation: Durham VA Geriatric Research, Education, and Clinical Center, Durham, North Carolina. Duke University School of Nursing, Durham, North Carolina.
authors.forename: Eleanor
authors.initials: E
authors.lastname: McConnell
authors.affiliation: Serious Mental Illness Treatment Resource and Evaluation Center, Veterans Affairs Ann Arbor Healthcare System, Michigan.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Visnic
authors.affiliation: Education Development Center, Inc., New York, New York. School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Karlin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D003704:Dementia / Q000523:psychology / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
keywords: Challenging behaviors; Dementia; Interdisciplinary training; Nursing homes; Veterans