Challenging behaviours in dementia exceed the capability of many care home staff precipitating admission to hospital even though ninety percent of problematic behaviours occur as a response to care practices or environmental factors. Instead, the reasons should focus on when, where, why and with whom these behaviours occur. In 2006, a five-month pilot study within the Northern Health and Social Services Board (NHSSB) (Northern Ireland), using the Newcastle Model, a bio-psycho-social intervention received 20 referrals involving 11 care homes.

The Newcastle Model formulates challenging behaviour in terms of peoples' needs, which are assumed to drive their behaviours. The model is a hybrid of well-established ideas from various psychological models, but its distinguishing feature lies in the unique integration of teaching, supervision and intense support provided to staff in care homes.

The NeuroPsychiatric Inventory Caregiver Distress (NPI-D) measures frequency and severity of behaviours and level of distress this causes staff. This was administered pre and post intervention. At discharge staff completed an anonymous satisfaction questionnaire.

Following interventions four hospital admissions were averted which, based on the average length of stay, would have cost an estimated £81,500. NPI-D scores decreased and staff questionnaires were positive.

The potential of this pilot study was noted by the Institute of Healthcare Management Quality Awards scheme prompting the NHSSB to fund a Behaviour Sciences Nursing Service. This preliminary study will form the basis of a study that will evaluate the service using a quasi-experimental intervention – comparison non-equivalent design.