Erin Hardy gives a reflective account of the pros , cons and the potentials of Dementia Care Mapping in occupational therapy practice .
In February 2024, I completed a four-day course to become a Dementia Care Mapper. Facilitated by Dementia Care Mapping™ (DCM) experts, the course included opportunities to explore and reflect on ways to optimise person-centred care, learn the specifics of behaviour coding and how to use this in observations, and action planning to promote change and improve wellbeing for individuals living with dementia.
DCM is an established approach to achieving and embedding person-centred care for people with dementia (University of Bradford 2018).
Originally a tool developed by Professor Tom Kitwood at the University of Bradford in 1992, it involves recording observations of individuals with dementia and understanding what they do and what support will help to maintain and improve their care and wellbeing going forward.
Dementia Care Mappers are trained over four days in the areas of behaviour coding, wellbeing, and ill-being markers and how to support settings to improve the support they offer adults in their care.
DCM has 23 behaviour category codes (BCC) that DCM mappers will identify and decide upon during five-minute intervals. Mappers will also decide on a mood/engagement (ME) value.
The ME value is linked to the BCC and can be a helpful indication as to what may either improve or negatively affect mood and engagement.
Personal detraction or personal enhancer identify what staff may be doing that helps to contribute or hinders an individual living with dementia’s psychological needs or personhood.
A Dementia Care Map can take place in several formats: whether that is a ‘full map’, which involves at least two DCM trained staff members attending a clinical space for up to five hours and ‘mapping’ the patient population; or an individual DCM trained staff member spending a couple hours mapping an individual to help inform care planning in their clinical area of work.
The decision for either is dependent on need and multidisciplinary team decision making. The multidisciplinary team can advocate for certain individuals not to be mapped if this would be detrimental to them.
The mappers will feed back their findings to the clinical team and encourage an action plan to be created, to aid supporting change that will promote wellbeing to individuals residing in that environment.
Opportunities and challenges
The Prime Minister’s Challenge on Dementia , published as part of the coalition government between 2010-2015, detailed a focused approach on further improving dementia care by 2020 (DH 2015).
Occupational therapy is founded on the principles of access to meaningful activity as a mean of increasing wellbeing and a sense of belonging.”
As part of this, individuals living with dementia identified that having the ability to ‘live in an enabling and supportive environment where [they] feel valued and understood’ is of high importance.
I have worked in older adults inpatient mental health services for over three years, and now seven months [at time of writing this article] working into the specialist dementia care assessment ward for females.
I was provided with the opportunity to attend DCM training to not only expand on my understanding of dementia care, but to reflect on the role of occupational therapy and how we may contribute to the work being carried out.
Following completion of the course, I asked myself: Why is this the tool to use? How will it benefit my patients and the service I offer? I wanted to know how I could link what I had learned to my role in a meaningful way that made sense to occupational therapy, but also the wider service.
Occupational therapy is founded on the principles of access to meaningful activity as a mean of increasing wellbeing and a sense of belonging. I think the purpose and principles of DCM encapsulate this and the strive to improve what is offered and how support is delivered to adults living with dementia.
The ability to observe and understand behaviour is at the forefront of our practice, whether that is through standardised or nonstandardised assessment tools. We are trained to observe and analyse the way people do and why.
It feels like DCM will not only compliment practice and how occupational therapy considers observation as part of a wider understanding of function, but will formalise this in a way that can highlight and then action plan strategies, with colleagues from the wider multidisciplinary team, to develop a greater understanding of what needs to change.
The challenge, as with a lot of practice, is the time that DCM requires. Whether that be the planning, execution or the actioning and review process that follows.”
DCM also feels like an opportunity for colleagues in other disciplines to use some of the principles that occupational therapy practises. It helps to frame and understand ‘doing’ in a cohesive and joined up manner.
The challenge, as with a lot of practice, is the time that DCM requires. Whether that be the planning, execution or the actioning and review process that follows.
DCM doesn’t always need to be the full patient population over a longer period. It could be a snapshot of a few hours with an individual informing care planning on the ward, or approaches that could increase wellbeing, skill retention and the quality of care provided.
What’s next?
To use it; whether this is in full day maps with multidisciplinary team colleagues or on individual, smaller maps on the ward to compliment the occupational therapy assessment.
It is another tool in the toolbox of assessments and strategies I can use and support action planning to increase wellbeing for those I work with.
I am passionate about service development and the role of occupational therapy in this, but also about the importance of a plan and the impact of proactive and positive change to support the quality of life for individuals living with dementia.
My plan is also to protect study time to develop my understanding of Communication and Interaction Training (CAIT) (James and Gibbons 2019) to further guide and enhance my use of DCM and my understanding of dementia care.
Ultimately, this will be difficult as opportunities to attend training are sparse, however I was fortunate enough to attend a two-day course in June 2024 that provided and consolidated my understanding of dementia care practice that could make a difference.
Perhaps a future reflection on using DCM in practice or CAIT will be coming up.
Department of Health (2015) The Prime Minister’s Challenge on Dementia 2020. Available at https://bit.ly/401BzGj – GOV.UK ( www.gov.uk ) [accessed 1 July 2024).
James IA and Gibbons L (2019) Communication Skills for Effective Dementia Care: A Practical Guide to Communication and Interaction Training (CAIT). London: Jessica Kingsley
University of Bradford (2018) Dementia Care Mapping, Process and Application. Bradford: Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford.
Words ERIN HARDY, Specialist Occupational Therapist, working for Cumbria, Northumberland Tyne and Wear NHS Trust Inpatient Older Persons Services, Monkwearmouth Hospital. Email [email protected]