Dementia Training Approval: ANNUAL IN-SERVICE APPLICATION

Introduction/Overview

Please complete this IN-SERVICE Application for your annual dementia in-service training to be reviewed for approval by LeadingAge Oregon.

Beginning January 1, 2019, OAR 411-054-0070 requires that all direct care staff complete six hours of annual training on dementia care by the anniversary of their hire date in 2020. The training must reflect current standards for dementia care and be informed by the best evidence in the care and treatment of dementia.

The six hours of annual dementia care training may be included in the required minimum of 12 hours in-service training required for direct care staff within ALFs/RCFs.

If approved, the annual in-service training does not have to be submitted annually for approval. If the approved training is changed or added to, then it would need to be submitted for approval.

Question Title

* 1. Name of Applicant/Company/Organization

Question Title

* 2. Type of Training Entity

Provider or Provider Organization

Non-profit (other than provider or provider organization)

Individual/Consultant

Academic Institution

Other (vendor, etc; please specify)

Question Title

* 3. Application Submission Date

Question Title

* 4. Address (Address, City, State, Zip)

Question Title

* 5. Name of Person Submitting Application for Approval

Question Title

* 6. Email Address of Primary Contact Person for the Application

Question Title

* 7. Phone of Primary Contact for the Application

Question Title

* 8. Are you using one or more of the following "pre-approved" dementia training content sources to meet the in-service training requirements?

* Oregon Care Partners
* Relias Learning
* IPCed / Easy CEU / OnCourse
* CARES Health Care Interactive
* M.O.V.E. Person Centered Training
* Teepa Snow PAC training

View the full pre-approved list on the DHS Website

Yes, I am using one or more of the in-service training sources listed above.

No, I am not using one of the in-service training sources above.

If you answered "YES" to Question 8, your training is Pre-Approved and do not need to continue to complete this application. Individual providers are responsible for keeping documentation to present to state regulators.

If you need to print the list of pre-approved training for documentation for your records, visit DHS's Dementia Training Webpage.
__________________________________________

If you answered "NO" to Question 8, please proceed with completing this application.

Question Title

* 9. Please submit a PDF of your training material, not to exceed 25 pages. If additional information is required for review, it will be requested later.

DOCX, DOC, JPEG, GIF, JPG, PNG file types only.

Choose File

Question Title

* 10. Indicate training format. (If the training includes more than one format, choose the category that represent the largest portion of training time.)

In-Person/Classroom

Online/Web-based/Webinar

Written/Self-Study

Other (please specify)

Question Title

* 11. Indicate training content sources (e.g., name of book, author, name of video, copyright date, year training developed).

First Reference

Second Reference

Third Reference

Fourth Reference

Fifth Reference

Question Title

* 12. Indicate instructional methods/adult learning principles used. Check all that are used. Straight text or powerpoint slides without information on the instruction methods/adult learning principles will not receive a full review.

Visual learning techniques (e.g., video clips, charts, graphs, flip charts)

Audio learning techniques (e.g., listening, discussion, lecture)

Interactive learning techniques (e.g., discussion, small group work, exercised, role play, case review)

Other (please specify)

Question Title

* 13. Enter the estimated length of time it takes trainees to complete the training.

Question Title

* 14. Indicate whether passing a written exam is required for completing the training.

Yes