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Objective: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. Design: Two-centre, cluster feasibility randomized controlled trial and process evaluation. Setting: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. Subjects: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. Interventions: Intervention homes ( n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes ( n = 3) received usual care. Outcomes: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. Results: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. Conclusions: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records.

The effects of token reinforcement upon the grooming behavior of seven deinstitutionalized mentally retarded adults were examined. The project was conducted in a community-based program which provided the "least restrictive" environment. A multiple baseline design across subjects was utilized. Substantial increases in grooming behavior were recorded under the token reinforcement condition. Analysis of individual subject data revealed that each demonstrated a positive change. Interpretations of the data were confounded by intersubject variability noted in baseline and in the rate of acquisition of grooming behavior. Variables potentially related to this intersubject variability were enumerated and discussed. The general applicability of the present token program and the need for additional research with deinstitutionalized populations in community-based programs were emphasized.