Table 2 Description of adapted SCA program

Introduction, dementia education, and acknowledging competence

1. Trainer and caregivers introduce themselves

2. The SCA program is introduced

3. Typical progression of dementia and its effects on communication

4. How to acknowledge the competence of individuals with dementia

•Group members establish a connection and rapport with other members and the trainer.

•Caregivers are educated on how dementia will likely lead to greater difficulties in communication over time. Eliminating distractions and carefully wording questions will become more important as the disease progresses.

•Caregivers are taught the importance of acknowledging confidence in improving participation of the individual with dementia in conversation. Acknowledging competence can be achieved by speaking in a natural voice and tone, reassuring their partner in their abilities, and avoiding quizzing.

•Caregivers are also taught to take the lead and initiate conversation topics and to throughout interject with expressions of acknowledging competence: I know you’re competent/smart.

Revealing competence and getting the message in

1. Discussion of how home practice of skills went

2. Review of previous topics

3. Description of revealing competence

4. How to get the message in with individuals with dementia

•Caregivers are taught that revealing competence requires getting the information in, getting the correct information out, and verifying the message.

•To get the message in, use yes/no questions as much as possible when a longer conversation is not required for communication. Otherwise, use short, simple, and direct sentences without the use of pronouns such as she/him.

•Use an expressive voice and easily understood gestures

•Write key words on a sheet of paper in large, bold print

•Eliminate distractions as much as possible

Getting the message out

1. Discussion of how home practice of skills went

2. Review of previous topics

3. How to get the message out of individuals with dementia

•Caregivers are taught that to help get the message out, caregivers should only ask one question at a time and give the partner adequate time to process and respond.

•Focus on the here and now and provide as much context as possible

•Ask partner for clues through the use of gesture

•Provide paper and pencil

Getting verification of the message

1. Discussion of how home practice of skills went

2. Review of previous topics

3. How to verify the message

•Caregivers are taught that to verify the message they must reflect, expand, and summarize what was said.

•Reflecting requires the caregiver to repeat the message.

•Expanding requires the caregiver to tell their partner what they think the message was.

•Summarizing requires the caregiver to recall and summarize the conversation as a whole.