Dissertation (Masters) Responsive Behaviours in Dementia: Developing and Implementing the Behavioural Supports Ontario Initiative


Delia Sinclair Frigault


A policy initiative known as Behavioural Supports Ontario (BSO) was developed and implemented in Ontario between 2009 and 2013. This thesis seeks to identify the factors that led to BSO’s development and explore the factors that may have influenced its implementation. The thesis used case study methodology. Thematic analysis of semi-structured interview and document data sources identified the following factors. Overall, the factors leading to the development of the BSO initiative included: (1) an increasing awareness of the negative effects of inappropriate care; (2) the ineffective use of emergency departments; (3) high numbers of alternate level of care (ALC) days; (4) uncoordinated care across care provider organizations; and (5) ongoing staffing issues related to lack of time and training on how to provide appropriate care to people with problematic (responsive) behaviours. The factors that influenced the implementation of the BSO initiative included an expansion of funds available for the long-term care sector specifically, a growing sense of implementation fatigue among service providers, the effect of knowledge discontinuity when BSO trained staff left their positions, and the risk that funds and human resources earmarked for the BSO initiative could be reallocated by service providers responding to immediate staffing needs. The findings of this thesis support the theoretical concepts related to causal stories in agenda-setting and the policy development and implementation process.


Raisa Deber