Examples of possible pathways for clients in referral to Severe Behaviour Response Teams (SBRTs)
Service Delivery Pathway
Triage
1. DBMAS – no SBRT involvement required



Risk Assessment by
Dementia Behaviour
Management Advisory
Service (DBMAS)
Case Management
78 year old, long term resident in residential aged care
home with Alzheimer’s Disease
Referred for calling out in the late afternoons,
increased apathy, some agitation
2. DBMAS referral to SBRT defined as SEVERE

65 year old, new resident to a residential aged care home
with alcohol related dementia

Referred for hitting out at residents and staff

Highly mobile in secure dementia unit with frail residents
over 80
Takes pain relief for pre-existing shoulder injury
3. DBMAS referral to SBRT defined as VERY SEVERE/EXTREME

71 year old of age with frontal lobe dementia

Currently in psychiatric unit but returning to residential aged care
home within 48 hours

Referred by residential aged care home for ongoing aggression
and agitation, breaking furniture and windows, history of
attempting to leave
No risk to self or others and no risk of being restrained.
Does not have other illnesses or injury that may cause the
agitation.
Risk to others and risk of being administered mood/ behaviour
altering drugs. Already on a range of drugs due to depression.
Risk of loss of accommodation
No referral to SBRT
Referral to SBRT required - assessed as SEVERE
High risk to self and others and risk of being administered mood/
behaviour altering drugs and being physically restrained.
Risk of imminent loss of accommodation, care home contemplating
refusing to enable him to return
Referral to SBRT required - identified as VERY SEVERE/EXTREME
Within 4 hours
 Interim strategies based on information gathered (e.g.
appropriate spaces; environmental factors; pain
assessment)
Within 4 hours
 Additional dementia trained staff provided for transition period
from psychiatric unit to care home pending SBRT consultant
arriving

Pain management assessment completed to
determine level of pain associated with shoulder injury

Review of medication to identify whether increased
apathy could be caused by medications that affect
mood or behaviour (psychotropics)



More issues identified
Social history and environmental factors investigated
for potential causes for bouts of apathy and agitation

Evening as trigger – additional staff supported during this
period
Observation and discussion with family

Medication review with Pharmacist

Development of interim strategies based on level of
pain with shoulder injury

Assistance in increasing staff knowledge and
confidence with the support of both DBMAS consultant
and additional education and mentoring
DBMAS referral completed
Within 48 hours face to face on site
 Observation of resident across shifts and with different
staff
Within 48 hours face to face on site
 Psychogeriatric review including review of care plan and
behavioural triggers

Staff discussions and observational analysis

Teleconference with transition care team involved to identify
opportunities and challenges during recent stay and discharge

Occupational therapy assessment

Behaviour modelling and mentoring during this period

Provision of engagement materials suited to social history

Define profile and care needs

Engagement of support for family

Engage psychologist part time for 3 months to assist
resident and aged care provider staff

Engage Psychogeriatrician for medication review every 2
months for 6 months

Ongoing modelling and mentoring on the ground and care plan
reviewing/charting
SBRT referral completed
SBRT referral completed
Supporting people with severe symptoms of dementia in residential
aged care – Q&A
Question - What is a Severe Behaviour Response Team?
A Severe Behaviour Response Team (SBRT) is a specialised team of professionals able to
assist residents exhibiting very severe and extreme Behavioural and Psychological
Symptoms of Dementia (BPSD), assess the causes, and assist care staff in residential aged
care homes to address and deal with these behaviours.
Question – Why are Severe Behaviour Response Teams needed?
Residential Aged Care providers manage a range of dementia behaviours as part of their
core business, and can if necessary call in Dementia Behaviour Management Advisory
Service for advice and assistance.
There is however, a need for additional support to assist with the management of residents
exhibiting very severe or extreme Behavioural and Psychological Symptoms of Dementia.
Question - How will the SBRT differ from and interact with the existing Dementia
Behaviour Management Advisory Services?
DBMAS provides advice and assistance to home care providers, residential aged care
providers and hospitals on caring for people with dementia. The SBRT on the other hand will
focus solely on aged care residents posing a significant risk to either themselves or others.
This means that SBRTs and DBMAS will coordinate and work closely together, as SBRTs
will form a top-tier to the already existing supports provided by DBMAS.
This will provide a source of specialist assistance for aged care homes who request
assistance with residents experiencing extreme behaviours.
Question – What level of support will be provided?
Following the referral from DBMAS, SBRTs will hold a case conference with the resident and
aged care provider to assess the causes of the resident’s behaviours and advise care staff
on how to resolve the immediate crisis. This case conference will be conducted either faceto-face or via tele-health where appropriate.
They will then work with the provider to develop immediate and longer term care plans for
the resident, and provide follow up assistance as needed.
Question – How was the service provider selected?
The Department of Social Services undertook an open competitive grants round to select a
service provider. The grants round opened on 4 June and closed on 15 July 2015, providing
applicants with six weeks to submit an application.
Question – How were applications assessed?
The Department undertook a thorough selections process that included two independent
subject matter experts and Department officials, to ensure that SBRTs were based on a high
quality service delivery model that would best meet the needs of the residential aged care
sector.
Question – Will this be a national service as previously announced?
SBRTs will deliver a national service from day one.
The SBRTs will operate seven days a week (including public holidays) from 7am to 7pm.
Referrals will be sent via email or phone from a DBMAS. Out of hours the referral will be
addressed by the consultant on call the following morning after 7am.
Supporting people with severe symptoms of dementia in residential
aged care – Q&A
Question – Who can utilise the SBRTs and how can the service can be accessed?
SBRTs will provide coverage for all Commonwealth funded Residential aged care facilities
and flexible funded services. These services include Multi-Purpose Services, National
Aboriginal and Torres Strait Islander Flexible Aged Care, Transition Care and Innovative
Care. Referrals will be made via DBMAS using a Risk Based Assessment Tool.
Question – How quickly will the SBRT respond to a request for assistance?
The SBRTs handling the initial response will call the aged care home within 4 hours of the
receiving the referral and assist care staff with interim strategies for the resident’s care.
Following this, the SBRTs will hold a face to face or telehealth case conference with resident
and aged care provider within 48 hours and work with the provider to develop immediate and
longer term care plans.
Question – Are these response times sufficient?
Yes, referrals to SBRTs will be made through the DBMAS, which provides a 24 hour
assistance line
SBRTs will provide an intense service using specialised professionals between the hours of
7am and 7pm. If there is an identified need SBRTs will also respond out of hours as
required. Given the number of calls will vary from day to day, a maximum response time of
4 hours to adequately assess and triage the situation is appropriate. It is important to note
that SBRTs are a specialist dementia support service, not a substitution for state and
territory government emergency and mental health services.
This is the first time aged care providers will be able to access assistance from a specialised
team of clinicians within 48 hours.
As is currently the case, all emergencies will be referred to the appropriate state based
paramedic service, who are responsible for providing an immediate emergency response.
Question – What about rural and remote locations?
The SBRTs will be required to provide the same level of service across all states, territories
and regions, regardless of the location.