Adapting Changing Talk: Online (CHATO) to CHATO-Inclusive

NCT06636214 | Not Yet Recruiting DMC

• 1 other identifier: R01AG085177
• Study Type: interventional
• Target: 1,200
• Locations: 0 countries
• Sites: N/A

Brief Summary

The study will adapt and test the current CHATO training to be more culturally acceptable for nursing homes with diverse staff and residents.

Conditions

Dementia

Keywords

ADRD; Nursing Home Staff Communication; Elderspeak

Outcome Measures

Primary Outcomes (6)

• Test CHATO's effects on Behavioral and Psychological Symptoms of Dementia (BPSD) - Change in MDS E0200 pre/post intervention

  CMS MDS Quarterly data - E0200 Presence and Frequency of Behavioral Symptoms in the last 7 days; The steps for assessment are to review the medical record, observe the resident in a variety of situations, and interview staff, across all shifts and disciplines. Coding Instruction: Code 0, behavior not exhibited, Code 1, behavior of this type occurred 1-3 days, Code 2, behavior of this type occurred 4-6 days, but less than daily, or Code 3, behavior of this type occurred daily.

  pre (3 months) / post (3 months) post intervention

• Test CHATO's effects on Behavioral and Psychological Symptoms of Dementia (BPSD) - Change in MDS E0800 pre/post intervention

  CMS MDS Quarterly data - E0800 Rejection of Care - Presence and Frequency over past 7 days; The steps for assessment are to review the medical record, observe the resident in a variety of situations, and interview staff, across all shifts and disciplines. If the resident exhibits behavior that appears to communicate a rejection of care (and that rejection behavior has not been previously determined to be consistent with the resident's values or goals), ask him or her directly whether the behavior is meant to decline or refuse care. Coding Instruction: Code 0, behavior not exhibited, Code 1, behavior of this type occurred 1-3 days, Code 2, behavior of this type occurred 4-6 days, but less than daily, or Code 3, behavior of this type occurred daily.

  pre (3 months) / post (3 months) post intervention

• Test CHATO's effects on Behavioral and Psychological Symptoms of Dementia (BPSD) - Change in MDS E1100 pre/post intervention

  CMS MDS Quarterly data - E1100 Change in Behavioral or Other Symptoms: The steps for assessment are review responses provided to items E0100-E1000 on the current MDS assessment, compare with responses provided on prior MDS assessment, and then taking all of these MDS items into consideration, make a global assessment of the change in behavior from the most recent to the current MDS. Rate the overall behavior as same, improved, or worse. Coding Instructions: Code 0, same: if overall behavior is the same (unchanged), Code 1, improved: if overall behavior is improved, Code 2, worse: if overall behavior is worse, or Code 3, N/A: if there was no prior MDS assessment of this resident.

  pre (3 months) / post (3 months) post intervention

• Test CHATO's effects on psychotropic medication - Change in MDS N0410 pre/post intervention

  CMS MDS Quarterly data - N0410 Medications Received: The steps for assessment are review the resident's medical record for documentation that any of these medications were received by the resident during the 7-day look-back period (or since admission/entry or reentry if less than 7 days) and review documentation from other health care settings where the resident may have received any of these medications while a resident of the nursing home (e.g., valium given in the emergency room). Coding Instructions: N0410A, Antipsychotic,N0410B, Antianxiety, N0410C, Antidepressant, N0410D, Hypnotic, N0410E, Anticoagulant, N0410F, Antibiotic, N0410G, Diuretic

  pre (3 months) / post (3 months) post intervention

• Test CHATO's effects on psychotropic medication - Change in NHQM Prescribed Antipsychotic pre/post intervention

  CMS Quarterly Nursing Home Quality Measure: Prescribed Antipsychotic (Long-stay quality measure 419) The percentage of long-stay residents who are receiving antipsychotic drugs in a 7-day look-back period. Exclusions: Residents with a diagnosis of schizophrenia, Tourette's syndrome, or Huntington's disease. Reported by nursing homes quarterly and gathered from Nursing Home Compare.

  pre (3 months) / post (3 months) post intervention

• Test CHATO's effects on psychotropic medication - Change in Survey 757 and 758 Noncompliance

  Survey 757 and 758 (prior 319), Noncompliance due to unnecessary medications and level of deficiency - Noncompliance due to unnecessary medications and level of deficiency (immediate jeopardy, actual harm, no actual harm \& isolated, pattern and occurrence).

  pre (3 months) / post (3 months) post intervention

Secondary Outcomes (3)

• Analyze NH strategies to engage staff and maximize CHATO effects _ Change in Knowledge at post intervention

  post intervention

• Analyze NH strategies to engage staff and maximize CHATO effects _ Change in Communication Ratings

  post intervention

• Analyze NH strategies to engage staff and maximize CHATO effects _ Implementation Strategies utilized during the training phase

  post intervention

Study Arms (2)

CHATO Inclusive Intervention

EXPERIMENTAL

Behavioral: CHATO-I

Waitlist Control

NO INTERVENTION

Interventions

CHATO-I BEHAVIORAL

Online communication education program

CHATO Inclusive Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Medicare certified NHs (N=40) caring for 75% White, non-Hispanic residents, and care for residents diagnosed with AD/ADRD.
• CNAs, nurses, and other direct care staff who are permanent employees of participating NHs and who provide direct care at least 8 hours weekly will complete the CHATO-I training, available by URL link.
• All staff will be encouraged to participate as high staff participation is desired to achieve facility-wide communication change. NHs will provide the number of eligible staff participants.
• Data for residents in participating NHs with AD/ADRD documented on the MDS Active Diagnoses list will be included in the analyses as well as MDS data for: age, sex, race and ethnicity, frailty (MDS-CHESS scale), and level of cognitive function (MDS Cognitive Performance Scale).

You may not qualify if:

• NHs serving 25% of residents admitted prior to age 65 will be excluded (screening out NHs serving primarily younger persons with serious mental illnesses).
• Resident data excluded from MDS includes active psychiatric diagnoses (bipolar disorder, major depressive episode, schizophrenia or schizoaffective disorder, mood disorder with psychotic features, psychotic symptoms, hallucinations, or delusions); terminal illness (on hospice); and lack of response to staff (MDS section B).

Sponsors & Collaborators

• University of Kansas Medical Center: lead
• University of Oklahoma: collaborator
• University of Iowa: collaborator

MeSH Terms

Conditions

Dementia

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders

Study Officials

• Kristine Williams, RN, PhD

  University of Kansas

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Kristine Williams, RN, PhD

CONTACT

785-979-7879; kwilliams1@kumc.edu

Carissa Coleman, PhD

CONTACT

ccoleman3@kumc.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 23, 2024
• First Posted: October 10, 2024
• Study Start (Estimated): August 31, 2026
• Primary Completion (Estimated): August 31, 2029
• Study Completion (Estimated): August 31, 2029
• Last Updated: August 11, 2025

Record last verified: 2025-08