LGBTQ-Inclusive Care Training for Alzheimer's Disease

(MILLS Trial)

Overseen By Simon Rosser, PhD,MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Minnesota

Disqualifiers: Non-English speakers

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to enhance care for LGBTQ+ individuals with Alzheimer's and related dementias by training long-term care providers in culturally responsive practices. It compares the effectiveness of in-person versus online training programs, specifically the eTTS online training and the Training to Serve (TTS) in-person training. The trial seeks nursing or housing service providers in Minnesota willing to participate in policy reviews and who have a team of at least five managers and five staff. Participants must be able to speak and read English. As an unphased trial, this study offers a unique opportunity to contribute to improving care practices for LGBTQ+ individuals.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this training is safe for improving SGM culturally responsive care?

Research has shown that the "Training to Serve" programs, available both online (eTTS) and in person, are safe and easy to handle. More than 12,000 workers in long-term care services across 12 states have completed the training, finding it practical and well-received.

No reports of negative effects have emerged from these training programs, which aim to improve care for sexual and gender minority individuals with Alzheimer's Disease and related dementias. The training has increased caregivers' knowledge and confidence, proving it helpful without causing harm.

Overall, these findings confirm the safety of both the online and in-person training methods. Participants can feel assured about the safety of taking part in this training. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these training programs because they aim to enhance LGBTQ-inclusive care in Alzheimer's treatment settings, an area often lacking in existing protocols. Unlike traditional Alzheimer's care, which may not specifically address the unique needs of LGBTQ individuals, these trainings focus on increasing healthcare providers' awareness and competence in serving sexual and gender minority clients. The online versions (eTTS) offer flexibility for participants to complete the modules at their own pace, making it accessible for busy healthcare professionals, while the in-person TTS provides an interactive, immersive learning experience. This dual approach could significantly improve providers' comfort and effectiveness in delivering inclusive care, which is crucial for a more equitable healthcare system.

What evidence suggests that this trial's training programs could be effective for improving SGM culturally responsive care in Alzheimer's Disease?

Research has shown that the "Training to Serve" program, available both online (eTTS) and in person (TTS), has successfully trained over 12,000 long-term care workers in 12 states. This trial will evaluate the effectiveness of both training methods in improving care for sexual and gender minority (SGM) individuals with Alzheimer's Disease and similar conditions. Past applications have found the training well-received and practical. Early results suggest that this approach can enhance the quality of care for SGM older adults, making it a promising tool for improving their care experience. Both training methods focus on increasing caregivers' understanding and sensitivity, which is essential for effective dementia care. ^{6 7 8 9 10}

Who Is on the Research Team?

Simon Rosser, PhD,MPH

Principal Investigator

University of Minnesota

Tetyanna Shippee, PhD

Principal Investigator

University of Minnesota

Are You a Good Fit for This Trial?

This trial is for licensed Minnesota nursing or housing services staff who manage or supervise at least 5 people. They must be willing to review policies and environment now and in 6 months, and speak/read English. It's not for those unable to communicate in English.

Inclusion Criteria

I am willing to review policies and environment now and in 6 months.

Having at least 5 managers/supervisors and 5 staff

Licensure in Minnesota to provide nursing and/or as a housing with services establishment

Exclusion Criteria

Participants who cannot speak and read English

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Training

Participants undergo either in-person or online training to improve SGM culturally responsive care

1 day for in-person, 1-2 hours for online

1 visit (in-person) or online access

Post-Intervention Assessment

Participants complete post-intervention surveys to assess knowledge, attitudes, and skills

Immediately post-intervention

Follow-up

Participants are monitored for changes in organizational factors and staff competencies

6 months

Follow-up survey

What Are the Treatments Tested in This Trial?

Interventions

• eTTS online training
• Training to Serve online training (eTTS)
• Training to Serve (TTS) in person training
• TTS in person training

Trial Overview The study compares two training programs aimed at improving care for LGBTQ seniors with Alzheimer's or related dementia: an in-person program (TTS) versus an online version (eTTS), against a waitlist control group, to see which is more effective.

How Is the Trial Designed?

Group I: Training to Serve online training (eTTS) Experimental Treatment 1 Intervention

Participants are provided a unique identifier to access the online website. The opening page welcomes them to the study, then directs them to the chunked consent materials and baseline survey. As soon as they have completed this, they receive access to the intervention, which for management is expected to take 1-2 hours and for staff, 30-45 minutes (i.e., the online equivalent of 3-4 and 1 hour, respectively). After completion of the required modules, participants receive access to the optional modules as well as the posttest survey to evaluate the training. Once the post-test is complete, they are thanked for their involvement and informed they will receive an e-mail to access a follow-up survey in six months' time.

Group II: Training to Serve (TTS) in person training Experimental Treatment 1 Intervention

Participants are provided access to the pretest one week before the training. On the day of training, when the trainers arrive, participants have a final opportunity to complete the baseline survey before the intervention. Tablets will be available to complete pre- and post- surveys. The training for management takes 3-4 hours, and for staff, one hour. For consistency and feasibility, both trainings are conducted by the same trainers at the same visit. Immediately after the intervention, participants complete the post-intervention seminar evaluation assessing knowledge and attitudes/comfort in serving SGM clients.

Group III: Waitlist control Active Control 1 Intervention

Participants complete the baseline survey, then they receive a note thanking them for completing all activities and informing them the intervention will be available in 6 months' time.

Who Is Running the Clinical Trial?

University of Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Published Research Related to This Trial

The Innovations in Dementia Empowerment and Action (IDEA) trial is the first randomized controlled trial designed specifically for sexual and gender minority (SGM) older adults with dementia, aiming to address their unique needs through a culturally responsive intervention.

IDEA enhances the existing Reducing Disability in Alzheimer's Disease (RDAD) program by incorporating empowerment practices that focus on SGM-specific issues like discrimination and stigma, with expected outcomes including improved physical activity, reduced stress, and increased social support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners. Fredriksen-Goldsen, K., Teri, L., Kim, HJ., et al.[2023]

An online training module for long-term care staff significantly increased their knowledge about the unique needs of LGBT Veterans, highlighting the importance of cultural competence in healthcare settings.

While the training improved knowledge, it did not significantly change staff skills or attitudes, suggesting that further training may be needed to translate knowledge into practice for better care of LGBT residents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serving All Who Served: Piloting an Online Tool to Support Cultural Competency with LGBT U.S. Military Veterans in Long-Term Care. Donaldson, W., Smith, HM., Parrish, BP.[2020]

The Alzheimer's Society of Lower Saxony developed a comprehensive training program for hospital staff to improve care for patients with cognitive impairment or dementia, which included a 14-hour training for staff and a 160-hour qualification for trainers.

The initiative was recognized with prestigious awards in 2012, highlighting its effectiveness and impact on enhancing the treatment and care of dementia patients in general hospitals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caring for people with dementia in general hospitals: an education curriculum from the Alzheimer's Society of Lower Saxony, Germany. Gurlit, S., Thiesemann, R., Wolff, B., et al.[2021]

A 10-week competency-based training program for In-Home Supportive Services (IHSS) caregivers significantly improved their confidence and knowledge in caring for individuals with Alzheimer's disease and related dementias (ADRD).

The program, which included 35 hours of training delivered in English and Spanish to 60 IHSS workers, focused on essential caregiving skills and resulted in statistically significant gains in participants' overall caregiving abilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Competency-based training for in-home supportive services providers of consumers with ADRD. Guerrero, LR., Eldridge, C., Tan, ZS.[2020]

A survey of 61 healthcare staff in Germany and Greece revealed a strong interest in future dementia training programs, with 96% of German and 100% of Greek participants expressing willingness to participate.

Despite high attendance in general educational programs, participation in specific dementia training was low (24% in Germany and 5.5% in Greece), indicating a gap that future training initiatives should address by focusing on practical skills and advice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expectations of nursing personnel and physicians on dementia training : A descriptive survey in general hospitals in Germany and Greece. Schneider, J., Gkioka, M., Papagiannopoulos, S., et al.[2022]

A pilot study involving 16 undergraduate nursing students showed that remote training on culturally sensitive care significantly increased their knowledge and self-efficacy (p < .01).

The training model, which consisted of four weekly sessions, demonstrated high compliance (94%) and satisfaction, suggesting it is a flexible and effective approach for integrating cultural sensitivity into nursing education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Cultural Sensitivity Training on Undergraduate Students' Knowledge, Self-Efficacy, and Ethnocultural Empathy. Butte, KJ., Hristova, L.[2023]

A study involving 184 service providers in Minnesota found that 90% were interested in participating in LGBT cultural competency training, highlighting a strong demand for such education.

Participants preferred shorter training sessions and online formats, suggesting that future curricula should be developed to accommodate these preferences for better accessibility and engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Working with LGBT older adults: an assessment of employee training practices, needs, and preferences of senior service organizations in Minnesota. Moone, RP., Cagle, JG., Croghan, CF., et al.[2014]

Cultural competence training is essential for graduate programs in Communication Sciences and Disorders, but current instructional methods may not effectively prepare students for working with culturally and linguistically diverse clients.

The proposed three-part active learning model enhances clinical training by fostering a supportive environment, focusing on problem-solving skills, and encouraging self-reflection, which can lead to better assessment and treatment outcomes for clients from diverse backgrounds.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Active Learning Strategies to Strengthen Cultural and Linguistic Diversity Training in Communication Sciences and Disorders Programs. O'Fallon, MK., Garcia, F.[2023]

The Transgender Standardized Patient Simulation (TSPS) was developed to enhance nursing students' cultural competence in providing care to transgender patients, particularly in oncological emergencies.

In a pilot test with 32 participants, students reported strong agreement that TSPS met their learning needs and significantly improved their confidence and skills in delivering culturally sensitive care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transgender Standardized Patient Simulation: Management of an Oncological Emergency. Ozkara San, E., Maneval, R., Gross, RE., et al.[2020]

A training program developed for healthcare professionals significantly increased their knowledge and skills in addressing the unique healthcare needs of sexual and gender minority (SGM) prostate cancer survivors.

Both live and on-demand training formats were effective, indicating a strong demand for further education on SGM healthcare needs in the context of cancer care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Affirming Care for Sexual and Gender Minority Prostate Cancer Survivors: Results from an Online Training. Pratt-Chapman, ML., Goltz, H., Latini, D., et al.[2023]

The innovative three-part online cultural sensitivity training program for faculty and staff in a psychiatry department effectively equipped participants with skills to address diversity in clinical practice, as indicated by positive evaluations after the second module.

Participants reported feeling more comfortable interacting with diverse backgrounds but expressed less confidence in intervening during microaggressions, highlighting areas for further development in cultural humility and antiracism within departmental practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lessons Learned: Developing an Online Training Program for Cultural Sensitivity in an Academic Psychiatry Department. Trinh, NH., O'Hair, C., Agrawal, S., et al.[2021]

The STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) program needs cultural adaptations to better serve Latino caregivers, as identified through interviews with 30 caregivers and 14 healthcare providers.

Key adaptations include increasing awareness about dementia, revising stigmatizing language, and incorporating cultural elements that reflect traditional Latino family structures and caregiving practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia. Ramirez, M., Duran, MC., Penfold, RB., et al.[2023]

The Chinese Dementia Specialist Education Program (CDSEP) successfully trained 16 bilingual health care providers, who then assisted over 70 families and conducted 76 workshops, reaching more than 400 individuals in the Chinese American community.

The program highlights the effectiveness of the 'Train the Trainer' model in enhancing dementia care capacity and awareness in minority communities, demonstrating a significant impact on both service delivery and community education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chinese Dementia Specialist Education Program: training Chinese American health care professionals as dementia experts. Lombardo, NB., Wu, B., Hohnstein, JK., et al.[2022]

Citations

1. reporter.nih.gov reporter.nih.gov/project-details/10845636

RePORT RePORTER - National Institutes of Health (NIH) | The randomized controlled trial will rigorously test the effects of an in- person versus an online training program on improving SGM culturally responsive care.

2. reporter.nih.gov reporter.nih.gov/search/14E9CE024F8FC5D27598B8961CAA4A01A2FFCEB861BF/project-details/11124930

RePORT RePORTER - National Institutes of Health (NIH) | This application is focused on the Training to Serve curriculum, which has trained over 12,000 LTSS workers in 12 states. This acceptable, feasible, and ...

3. dev-site.sph.umn.edu dev-site.sph.umn.edu/news/new-study-designed-to-improve-the-care-of-sexual-and-gender-minority-sgm-older-adults-and-support-training-of-dementia-care-workforce/

New study designed to improve the care of sexual and gender ... The study will involve the first evidence-based training for the care of SGM older adults with AD/ADRD, and the first randomized control study on this ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1041610225003266

Review Article Dementia training for healthcare professionals We aimed to explore how dementia training is best delivered to healthcare workers to improve dementia care and worker wellbeing.

5. reporter.nih.gov reporter.nih.gov/search/oBjlAw9ClUiG4Tds-nlPjg/project-details/10845636

Project Details This application is focused on the Training to Serve curriculum, which has trained over 12,000 LTSS workers in 12 states. This acceptable, feasible, and ...

6. reporter.nih.gov reporter.nih.gov/search/5cgUQpeAO0GY50VdIfgn5g/project-details/11124930

Project Details The randomized controlled trial will rigorously test the effects of an in- person versus an online training program on improving SGM culturally responsive care.

7. apply07.grants.gov apply07.grants.gov/grantsws/rest/opportunity/att/download/348471

Alzheimer's Disease Programs Initiative (ADPI) • Health promoter: Deliver person-centered, relevant dementia education to people living with dementia and/or caregivers; Train individuals ...

8. taggs.hhs.gov taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=K02AG095384&arg_ProgOfficeCode=102

Award Information | HHS TAGGS Leadership Training in Real-World Data Analytics: Sleep and Alzheimer's Disease. Award Number: K02AG095384. ORGANIZATION: NATIONAL INSTITUTE ...

9. ihs.gov ihs.gov/alzheimers/grants/dementiagrantees

Dementia Models of Care Grantees Training caregivers with culturally responsive resources. Developing culturally tailored care plans. Launching a Caregiver Champion mentorship network ...

10. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12179336/

Competency‐based training boosts dementia knowledge ... The training significantly improved caregivers' dementia knowledge and self‐efficacy but did not reduce caregivers' distress and depression, nor ...