THE BCAT® APPROACH
The BCAT® Approach is a unique applied concept for assessing and working with people who have memory and other cognitive impairments. It is designed for any clinical and residential setting in which cognitive functioning and cognitive impairment is a central issue. The BCAT® Approach integrates three systems: The BCAT® Test System, the BCAT® Interventions (the BCAT® Online Brain Rehabilitation Modules, the BCAT® Working Memory Exercise Books, the MemPics® Book Series, MemPics® Grab N’ Go, and the 3D Behavior Management Program), and the ENRICH® Brain Health Program. All programs are person-centered and used by healthcare professionals, facilities, patients, caregivers, and other stakeholders. All programs are validated by science.
All BCAT® programs have specific training modules to enhance learning and proficiency.
The BCAT® Test System
The BCAT® Test System is comprised of six unique assessment instruments. The primary and foundational test is the Brief Cognitive Assessment Tool (BCAT®), which is multifactorial. It can be administered in 10-15 minutes by professionals and techs, is sensitive to the full spectrum of cognitive functioning (normal, MCI, dementia), produces separate Memory Factor and Executive Functions Factor scores, and can predict basic and instrumental activities of daily living (ADL, IADL). The BCAT has also been shown to help predict discharge dispositions, identify those most likely to be readmitted to hospitals shortly after discharge, facilitate level of care determinations, aid in fall prevention programs, and help with non-pharmacological behavior management.
The BCAT®-SF is designed as a shorter version of the full BCAT®. The Short Form can be administered in three minutes or less. While it is not as robust or comprehensive as the full BCAT®, the short version has strong reliability, construct validity, and predictive validity. When time is particularly limited (e.g., primary care settings), the six-item, 21-point short form is a dependable cognitive screening tool. The Short Form can differentiate between persons with and without dementia. It can be downloaded or used as an online tool. The short form is frequently used within an inter-professional model as a screening tool to identify who should receive broader BCAT® testing and BCAT® interventions.
The Brief Anxiety and Depression Scale (BADS®) is a brief screening tool for mood impairment developed for older adults. It can be administered by a clinician, by proxy (knowledgeable informant), or self-administered for those who are cognitively capable. The BADS® can be administered in less than three minutes. The online interactive scoring program yields a depression and an anxiety factor score. They can provide an indication of probable clinical depression and/or anxiety, but a diagnosis should not be based on the BADS® alone.
The Kitchen Picture Test of Judgment (KPT®) was designed as a visually presented test of practical judgment. The KPT® is one of the two judgment instruments in our suite of tools. It is intended to identify those who require supervision of IADLs. The KPT® utilized an illustration of a kitchen scene in which potentially dangerous situations are unfolding. Patients are asked to describe the scene as fully as they can, to identify the problem situations, to rank the order of importance of each situation in terms of dangerousness, and to offer solutions that would resolve the problems. The KPT® has been found to have construct validity (it measures the construct "judgment") and can be used to differentiate between those who have dementia and those who do not.
The Verbal Test of Practice Judgment (VPJ®) is our second judgment test. It is designed to detect more nuanced and subtle judgment problems. The VPJ® consists of 10 novel applied situations that require reasonable judgment. The VPJ® not only identifies judgment skills level but identifies specific IADL dependencies associated with levels of impaired judgment. Like all BCAT® tests, The VPJ® has specific reports that can be integrated into an electronic health record.
The Brief Cognitive Impairment Scale (BCIS®) was designed to assess the cognitive functioning of patients with severe dementia. The BCIS® is an 11-item, 14-point scale. It was developed to not only track cognitive changes in patients with advanced dementia specifically, but to provide information to better manage behavior problems. We recommend using the BCIS® when severe cognitive impairment has already been established, or when the patient scores under 25 on the BCAT®. It is most effective in confirming severe impairment and tracking cognitive changes over time in advanced dementia.
The BCAT® Intervention Programs
Online BCAT® Brain Rehabilitation Modules (BRM). This program is used either as cognitive rehabilitation (return the patient to baseline or improve cognitive performance) or to promote positive cognitive functioning (and buffer against cognitive decline). The main modules are interactive and online; and they target attention, memory, and executive functions. We refer to this triad as the "cognitive task manager" used for everyday functioning. The program is ideal for rehabilitation therapists, and can promote positive rehab outcomes in physical therapy, occupational therapy and speech therapy. BRM is also used effectively as facility activities and by residents in their homes.
The BCAT® Working Memory Exercise Books (WMEB). There are two WMEB, one for professionals (professional edition) and one for patients/clients (home edition). Working memory is the ability to mentally hold and manipulate information over a short period of time. You might think of it as a cognitive “workspace” in which we temporarily store information we hear, see, or feel (tactile) in order to do something with it. From a functional perspective, working memory is a foundational cognitive skill that allows one to successfully perform IADLs and ADLs. Reduced or impaired working memory means that one cannot efficiently make new memories and may be limited in performing daily life tasks. Improvement in working memory can improve cognition and function. For professionals, the WMEB is a powerful treatment tool, linked to the BCAT® Test System, to improve cognition and function. For patients/clients, the WMEB is an evidence-based method for improving cognition and function, either after or independent of treatment by a professional.
The MemPics® Book Series. The MemPics® series is based on research, some of which was funded by the Centers of Medicare and Medicaid Services (OHCQ Maryland & CMS). MemPics® books are designed to meaningfully engage participants who have memory loss in appropriate cognitively enhancing activities. The books activate old memories through pictures and conversations about familiar people, places, objects, and events. Activating old memories provides a foundation for engaging participants in directed conversation to improve cognitive performance. The MemPics® books have six separate activities. Each activity has four components: a picture, fun facts, prompting questions, and a brief story.
MemPics® can be used individually or in small groups. Participants can use the books by themselves, with family members and friends, and as part of a group event. They can also be used by a clinician as a specific intervention. For each activity, one can utilize all four features, or focus on just the picture, fun facts, prompting questions, or the story. You can choose any exercise and proceed through the book in any way you choose. A therapeutic extension of the MemPics® books series is MemPics® Grab N’ Go. In this book, the MemPics® books are extended to activities that involve sight, hearing, touch, smell, and taste. Like the foundational MemPics® books, Grab N’ Go is routinely used by recreation staff, speech and language pathologists, occupational therapists, social workers, and psychologists.
The 3D Behavioral Management Program is a non-pharmacologic approach to managing difficult behaviors associated with dementia. These are the so-called BPSD (behavioral and psychological symptoms of dementia). Examples of BPSD include physical and verbal aggression, wandering, disrobing, and exit-seeking.
The ENRICH® Brain Health Program
The ENRICH® program, is designed to improve brain health. To learn more, click here. Visitors to this web-based program can learn about the six brain-healthy behaviors, take the ENRICH® calculator to determine how well they are currently doing with respect to their brain health, and take a cognitive self-assessment, called myMemCheck®. All three are free. ENRICH® is an excellent resource for caregivers and families.