The Skinner Approach to Adult Learning
Project Demonstration
By:
Heather Ervin and Jody Barkley

Introduction of Heather’s Project…
I work in the health care field, specializing in Dementia care. I wanted to create a program that included all staff members. I wanted to find a training program that would prepare all staff members to work with this specialized group of people.
The main program I want to introduce is specialized training for my employees working with Dementia residents. I want to make sure we are providing the best care we can, and that we know how to help not only the residents, but also their families. I feel if my staff is adequately trained in Dementia care, we will be a top Dementia Unit in Muncie.
To relate the training program to Skinner’s views on Behaviorist learning, I had to get down to the “nitty-gritty”. What were the training programs doing that wasn’t working for staff? Skinner’s belief was to change one’s environment and attitude towards a subject would ultimately help them change their behavior.
Our old system of training staff wasn’t working. We still had major issues. I needed to find a way to show the staff that it wasn’t working, and to show them a new way of learning in a way that would make them want to learn a new process.

Introduction of Jody’s Project …
Behaviorist learning states that learning occurs because of a change in one's behavior and environment, which collectively teaches and shapes behavior. To discover what works for each individual learner, what motivates behavior change; I am researching the concept of person-centered planning (PCP). The purpose of this project is to teach an ongoing problem-solving process used to help people with disabilities plan for their future. In person centered planning, an individual has a team of people, with the individual being the center, who focus on that individuals dreams and desires of their future.

Findings of Heather’s Project …
Upon reviewing other similar training programs, the biggest goal was making sure the information was available to all staff members.
The second goal was making sure the information was relatable. Staff had to “connect” to the information.
The third goal was to prove that the old training wasn’t working. Staff had to know that the old system wasn’t working. They needed more advanced training. We had to change their behavior. We needed to show them the new way to work with resident’s with Dementia.
Finally, the last goal was to make sure we reinforced our new training program.

Findings of Jody’s Project
This project will develop training classes for the focus person and the staff called 'It's my Life'. This class will teach people with ID/DD how to advocate for their wants and needs and teach staff how to help the focus person accomplish his/her dreams long term. The course outline will include topics taught to the consumer such as what is PCP, how do I select my team and how do I communicate what I want to do with my life. The agenda for the staff training will be how to help consumers plan for their future and staff role in implementation of a plan.

Applications of Heather’s Project …
The main features that were in my program design were the features I deemed appropriate for our population (older adults with Dementia or AD).
1. Easily understood by all staff, as not all staff members are on the same education level as others. For example, Certified Nursing Aids don’t have the same education as our Medical Directors.
2. The information has to be relatable. As we have discussed in this class, we have to relate to the subject we’re learning about, or adult learners aren’t as willing or motivated to learn the new information.
3. The information has to be presented in a way that interests the staff and connects the information to their personal residents.
4. Lastly, the information has to be ever changing. Part of the program will be continued training at different times of the year. As one of the instructors, I have to make sure I’m getting the most updated and top of the line information for my learners. Within the health care field, most information changes constantly and we as a facility have to make sure we take part in educating ourselves in the new information.

Heather’s Action Plan…
-Training Modules at orientation
-Hands on and video training before working alone on Dementia Unit
-Being sent to a fellow dementia unit to see how they run
-Bi monthly training and Q+A with the employees working Bethel Way
-Suggestion box for staff and family members
-Semi-Annual dementia training from professionals

Applications of Jody’s Project …
The client's caseworker will teach 'It's my Life' curriculum. It is a set of curriculum that I have developed to help teach clients advocacy skills and staff the importance of plan implementation.
‘It’s my Life’ curriculum consist of the following classes: how to advocate for myself, how do I select my team and what do I want out of my life.
‘It’s my Life’ curriculum also teaches staff the following techniques: how to help the focus person learn to advocate for themselves and how to implement the plan

Evaluation of Heather’s Program …
To make sure my program was feasible and to find any holes in the system, I wanted my trusted colleagues to evaluate my program. The two ladies I had evaluate my program have a total of 30 years experience in health care, including Dementia care. These are their thoughts:
Christina M., Director of Nursing, Bethel Pointe Health and Rehab 
Pro- “I liked the versatility of Heather’s program. They way her design was laid out she was able to reach all employees working on the Dementia Unit. This includes CNA’s, Nurses, Activities and Social Services staff. All successful Dementia Unit’s that I have worked with are a group effort ran by all staff working together.”
Pro-“I also liked that she broke down the program training into different levels of training and each group has their own training time. Not everyone is lumped into one training module. All staff is trained with other’s that will be working along side them. I think this program can be successful. If all staff participates and the educator has the right information and can present in the way staff will accept and learn the new information, this program has the potential to be very successful.”

Evaluation of Heather’s Program Cont’d.…
Christina M., Director of Nursing
Con-“I’ve seen many programs like this within my years or working as a nurse manager. The only concern I have is that we as a facility would have to stay on top of this program. The bad thing about Nursing Homes is our employee turnover rate. We have so many new staff coming and going that Heather would have to stick to her program to make sure all trainings are attended and all workers have the needed knowledge before working within the Dementia Unit. Not only for the safety of the resident’s, but also for the safety of the staff. Heather would just have to make sure she took the management position seriously and not be hesitant in taking corrective actions against the staff that don’t participate in the required training.”
Holly G., MDS Coordinator/Case Manager
Pro-“I truly think it’s beneficial and would be a great training program for not only our Dementia Unit, but also as an all staff new training/orientation program. When we first started our Dementia Unit we felt thrown to the wolves. While we had outside staff come in to train us, we had two, four-hour trainings on Dementia and that was it. I know Heather, as Unit Director for the first time was overwhelmed. I think she took the feelings of frustration she felt about not feeling prepared and put them into a program that would help ALL staff feel safe and adequately prepared to work with Dementia patients within our unit. I think this program will and can work.”

Evaluation of Heather’s Program Cont’d...
Holly G., MDS/Case Manager
Con-“I think it would be a good idea to not only have new staff go through the program, but also have the older staff. Some staff members have been there for years and set in their ways. I think it would be good for them to be updated in Dementia Unit care. As with any continuing education, the information is updated and everyone needs to be on the same page. I’m also wondering what we would do about staff that chooses not to attend all meetings because it’s time consuming. We can’t even get them to come to all staff meetings half the time, and we even offer snacks. How would we assure that staff would be receiving the much-needed training?”

Evaluation of Heather’s Program Cont’d...
I’m very thankful I had my colleagues review my program design. Here is how I would revise my program:
I would implement a policy that all current staff takes part in the training. I think it’s vital. If current employees refuse to take part in the training then working with the Director of Nursing, they will not be allowed to work on the Dementia Unit. I also would like to implement a disciplinary action. So if new or current employees refuse attend the trainings then not only are they not able to work the Dementia Unit, but they also get a write up in their file showing that they aren’t being compliant with training.
We do have a lot of staff turnover and they only way to make sure staff is getting the adequate training when they come in is to have Human Resources keep track of their training. We need to make sure all employees receive the training needed for them to work in the Dementia Unit. I think this would be a good way for all training to be maintained.
Overall, I’m glad I got some insight into my program design. I found out some quality information that I needed to add to my program and I still feel like it’s a program I can be proud of. I will be working with our Director or Nursing to implement this new program into our Dementia Unit training.

Evaluation of Jody’s Program …
Evaluator #1 indicates my idea was great. She acknowledged her agency uses a person-centered program (PCP) but that it is faulty on execution. She stated the problem boils down to three issues: 1) high rate of industry turnover, 2) staff not understanding their role in the PCP process and 3) clients not understanding the PCP process themselves. She reported her agency turn over rate is 42% annually. Her concern is that the program design did not address how the information gained during the PCP process would be passed from one staff to the next considering the high industry turnover.
Evaluator #2 indicates my program design rates 4 out of 5. He commented that the idea is great but he is never aware of when his client's annual meetings are. He felt the efficacy of the action plan rated at a 2 with a comment it would be unlikely his agency would have more meeting.
After interviewing and reviewing the evaluations, I would add a step to document the PCP outcomes formally so that the information can be passed from staff to staff as this is a very valid concern. I would also cut the pre annual meeting training from4 sessions to 2 to reduce the associated costs. I would not make any additional changes other than be more encouraging to agencies to implement a PCP process for the benefit of their stakeholders.

Implications of Heather’s Program …
I truly believe that by reinforcing our new training program, our staff will change their behavior, attitude, and beliefs towards Dementia training and care.
We want our staff to know we support them. We heard their concerns about not feeling adequately trained and we addressed it. We were able to ultimately change their behaviors.
This will ultimately show our community that our staff can provide the best care for our residents and their family members.

Implications of Jody’s Program …