Understanding the Current and Future States of Behavioural Supports Ontario: Protocol for a Mixed Methods Pilot Study

Behavioural Supports Ontario (BSO) was created in 2010 as a provincially defined and regionally implemented program in Ontario, Canada, to support older adults living with responsive behaviors in long-term care homes, hospitals, and at home, and to also support their family care partners. There are 14 different BSO regions in Ontario, each with its own service delivery model to provide (1) system coordination and management, (2) integrated service delivery, and (3) knowledgeable care teams and capacity building. In 2023, BSO teams across Ontario supported approximately 33,300 older adults with expressions of responsive behaviors, the majority of whom had dementia, and 20,100 family care partners.

This study aimed to understand how BSO is currently affecting service providers and family care partners across all BSO care settings (ie long-term care, community, and acute care), and how BSO service delivery models can be modified to best meet the current needs of these target populations. This pilot study will be conducted in the western Ontario region, which comprises 4 different BSO regions; this will enable comparison between different BSO service delivery models to identify which service model elements may be best used to support BSO care providers, care recipients, and family care partners in the future.

Following a 2-phase mixed methods sequential explanatory design, this study will invite BSO staff and leaders to complete an anonymous web-based survey, followed by focus groups and interviews to share their perspectives on BSO's current functioning, areas of weakness, and opportunities for growth. Family care partners will also be invited to complete one-on-one interviews to share information about their experiences with BSO, areas of weakness, and opportunities for growth.

This study began in January 2024; data collection was completed in December 2024. Overall, 360 participants completed the anonymous survey; 51 staff and leaders and 11 family caregivers completed an interview or focus group. Data analysis is anticipated to be completed by September 2025 with results published by December 2025. Quantitative data will be analyzed using descriptive and inferential statistical techniques to identify similarities and differences in the perspectives of BSO staff and leaders across the 4 BSO regions. Qualitative data will be managed and analyzed through descriptive coding and thematic analysis to provide meaningful explanations of BSO staff, leaders, and family care partners' experiences with the program. This study was approved by the Western University Health Sciences Research Ethics Board (124599).

The study findings will support improvements in BSO services across the western region of Ontario. The findings will also be leveraged to support the modernization of the program to better meet the needs of patients and family care partners who depend on the service each year, while also supporting the needs of service providers within the program.

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