Underpinning Research

6D Dementia is grounded in clinical psychology, established research and real-world practice.

The approach is designed to support understanding, empathy, consistency and early intervention, with the aim of reducing distress for people living with dementia and improving confidence and wellbeing for the workforce.

This page sets out the evidence that underpins the 6D Dementia model, alongside early outcomes and learning from implementation.

Why Evidence Matters

Dementia training is most effective when it goes beyond awareness and supports meaningful change in how staff understand and respond to distress. Evidence consistently shows that psychologically informed approaches can improve outcomes for people living with dementia, carers and services.

6D Dementia is built to align with this evidence and to translate it into practical, usable frameworks for everyday care.

Evidence Informing the 6D Approach

6D Dementia has been developed as an evidence-informed workforce training approach. The framework brings together established research in dementia care and clinical psychology with learning from practice, translating this evidence into practical tools that can be used in everyday care.

Use the tabs below to explore the evidence.

6D Dementia is a clinically developed approach created by Dr Frances Duffy, Consultant Clinical Psychologist. The framework builds on her published work in dementia care and psychological practice and has been developed into a distinct digital workforce training platform.

Dr Duffy is also the author of CLEAR Dementia Care (Jessica Kingsley Publishers), a psychologically informed model described in professional and academic publications.

Foundational publications include:

Duffy, F. (2016). ‘Look at all of me’ – a CLEAR model for dementia care. The Journal of Dementia Care, 24(3), 27–30.
Duffy, F. (2017). Measuring outcome in a dementia home support team. FPOP Bulletin, 139, 67–70.
Duffy, F. (2019). CLEAR Dementia Care ©: A model to assess and address unmet need.
London: Jessica Kingsley Publishers.

The principles underpinning 6D Dementia are consistent with a substantial body of peer-reviewed research and national policy evidence demonstrating that psychologically informed dementia training can:

improve understanding of behaviour as communication
reduce distress and inappropriate escalation
support more appropriate use of psychotropic medication
improve quality of life for people living with dementia
strengthen staff confidence, wellbeing and retention

This evidence includes large-scale trials, systematic reviews and national policy reports addressing:

person-centred and formulation-informed dementia care
training effectiveness and workforce capability
prevention, early response and reduction of crisis
system impact, including hospital use and costs

Key sources include research published in peer-reviewed journals and reports from national organisations such as Alzheimer’s Society and NHS benchmarking bodies.
Full references are available on request.

How this evidence is used

6D Dementia has been designed to translate this evidence base into clear, role-relevant tools that support consistency of understanding and response across teams and settings. The approach complements existing pathways and professional judgement and is intended to support earlier, calmer and more psychologically informed responses to dementia-related distress.

Early learning and ongoing evaluation

6D Dementia is currently in use across a range of health and social care settings. Early delivery feedback indicates positive impact on staff understanding, confidence and shared language. Ongoing evaluation focuses on understanding impact over time and across different settings, with learning used to refine and strengthen delivery.

The 6D Dementia approach draws on a substantial body of published research demonstrating that:

Dementia-specific training can reduce behaviours that staff find challenging and distressing
Psychologically informed care reduces inappropriate prescribing of antipsychotic medication
Improved staff understanding is associated with reduced escalation, admissions and placement breakdown
Workforce wellbeing, confidence and retention improve when staff are supported to understand behaviour rather than manage it reactively

Key research areas informing the model include:

Behaviour as communication in dementia care
Psychological formulation and person-centred care
Prevention and early intervention
Workforce capability and culture change

(Full references and publications are available on request.)

Early outcomes from 6D Dementia Delivery

Initial delivery across health and social care settings indicates strong early impact on staff understanding, confidence and care culture.

Reported outcomes by tier:

Tier 1 – Online micro-learning

94 percent of staff report greater understanding of dementia and how to respond to behaviours that challenge
Improved confidence using shared language across teams

Tier 2 – Care-planning workshops

100 percent of participants report increased confidence in supporting colleagues to understand and respond to behaviour
Improved consistency in care planning and team communication

Tier 3 – Leadership and implementation clinics

Senior staff report greater confidence embedding psychologically informed approaches within existing pathways and organisational processes

Culture and practice change

Beyond individual learning outcomes, teams describe:

A shift from reactive responses to understanding-led care
Greater empathy and psychological curiosity
Improved communication across roles and settings
Increased confidence in managing complexity and uncertainty
A change in culture and the language used to describe changes in behavour

These changes are critical to sustaining improvements over time.

System-level relevance

The 6D Dementia approach is designed to align with wider system priorities commonly identified across health, care and community settings. By strengthening understanding, consistency and confidence in responses to distress, the approach is intended to support:

More appropriate and proportionate responses to distress and escalation
Earlier recognition of vulnerability and emerging crisis
Reduced risk of breakdown in care and support for people to remain in their usual place of care where possible
More thoughtful and informed use of interventions, including medication
Workforce confidence, resilience and retention
Improved experiences for people living with dementia and those who support them

6D Dementia is designed to complement existing pathways and priorities, rather than operate in isolation or replace established systems.

Ongoing evaluation and learning

6D Dementia is committed to continuous learning and evaluation. Ongoing work focuses on:

Tracking longer-term outcomes over time
Understanding impact across different settings
Using feedback to refine delivery and implementation
Supporting evidence-informed commissioning and partnership decisions

Evaluation is approached as a learning process, ensuring the model continues to evolve in response to real-world use.

Led by clinical expertise

6D Dementia is founded and led by Dr Frances Duffy, Consultant Clinical Psychologist and NHS Clinical Entrepreneur Fellow, with over 15 years’ experience in dementia care. The model builds on her previous award-winning work in dementia care and her contributions to national guidance and policy.

Clinical leadership ensures ethical delivery, robust evaluation, and alignment with national guidance.

Achievements

Academic & Professional Qualifications

1988 BSc Honours Psychology

1992 DPhil investigating Memory Deficits in the Early Stages of Alzheimer’s disease

2005 Statement of Equivalence in Clinical Psychology, British Psychological Society

2010 Diploma in Clinical Neuropsychology, University of Glasgow

Employment History

1992-1993 Lecturer in Psychology, University of Bristol

1993-2005 Lecturer in Psychology, University of Glasgow

2005-2008 Clinical Psychologist, Greater Glasgow and Clyde NHS

2005-2008 Clinical Psychologist, Additions Service and Alcohol Related Brain Injury Service, NHS Glasgow

2008-2010 Clinical Psychologist, NHSCT

2010-2012 Specialist Clinical Psychologist, NHSCT

2012 – 2025 Consultant Lead Clinical Psychologist, Psychology of Older People Service, NHSCT

2023 – present Founder & CEO 6D-Dementia Ltd.

Memberships

Membership of Professional Bodies

Registered Clinical Psychologist, Health and Care Professionals Council
Chartered Psychologist, British Psychological Society (BPS)

Committee Membership

Northern Ireland Regional Dementia Improvement Collaborative (2016-18).
British Psychological Society, Dementia Advisory Group (2017-18).
Dementia Analytic Research Users Group (DARUG) (2018-2021).
Committee Member British Psychological Society Faculty of the Psychology of Older People and Workstream Lead for Behaviours that Challenge (2019 – present).
Enhancing Clinical Care Framework Northern Ireland working group (2020 – present).
Committee member N Ireland Division of Clinical Psychology (2022 – 2025).
Committee Member Association of Clinical Psychologists, Psychology of Ageing Network (2024 – present).
Department of Health Dementia Project Board Training working group (2024 – March 2025)

Clinical Innovation

Clinical Innovation

Launched the CLEAR Dementia Care App.
CLEAR Dementia Care Alzheimer Society Dementia Friendly Innovation of the Year 2016.
Developed Dementia Assessment App in collaboration with Nightingale Analytics.
Development of 6D Dementia Online Training Platform.

Publications

Bowie, G., Duffy, F. & Marshall, J. (2019) Do we need Specialist Teams for Behaviours that Challenge in Dementia Care? FPOP Bulletin, 148, 37-42,
British Psychological Society (2017) Psychological dimensions of dementia: Putting the person at the centre of care. (contributing author).
British Psychological Society (2017). Practice Guidelines: Psychological Best Practice in Inpatient Services for Older People. (contributing author).
British Psychological Society (2019). The Neuropsychological Impact of Dementia. (author)
Duffy, F. (2016). ‘Look at all of me’ – a CLEAR model for dementia care, The Journal of Dementia Care, Vol. 24 (3), 27-30.
Duffy, F. (2017). Measuring Outcome in a Dementia Home Support Team, FPOP Bulletin, 139, 67-70.
Duffy, F (2019). CLEAR Dementia Care © A Model to Assess and Address Unmet Need. Jessica Kingsley Publishers.
Duffy, F (2020). Death and grieving in a care home during the COVID-19 pandemic: A guide to supporting staff, residents and their families. Public Health Agency.
Duffy, F. & Ballentine, J (2020) Supporting a person with Dementia following Bereavement during the COVID-19 pandemic, Northern Health and Social Care Trust & NI Hospice.
Duffy, F. Dow, B. & Kaiser, P. (2020) Death and grieving in a care home during Covid-19: The experience of care staff, residents and families. British Psychological Society.
Duffy, F. & Richardson, J (2018). CLEAR Dementia Care ©: Handbook on Implementation with Case Presentations. Northern Health and Social Care Trust.
Fossey, J. & Duffy, F. (2019) Training and coaching of care home staff to develop person-centred skills with people with dementia. FPOP Bulletin, 148, 43 -47.
Gray, K. L., Moniz-Cook, E., Reichelt, K., Duffy, F. & James, I. (2021) Professional perspectives on applying the NICE and British Psychological Society Guidelines for the management of Behaviour that Challenges in dementia care: an e-survey. British Journal of Clinical Psychology. https://pubmed.ncbi.nlm.nih.gov/34156110/
James, I.A., Duffy, F Reichelt, K., Lord, N., Ritchie, M and Moniz-Cook, E. (2024). First Line Psychosocial Alternatives to Psychotropic Medication for Behaviours that Challenge in Dementia Care: A Tool-Kit for Health and Social Care Practitioners. BPS Documents: London.James, I., Reichelt, K., Duffy, F. & Moniz-Cook, E. (2021). Getting our terminology right: the power of language. Journal of Dementia Care, 29(2), 24-27.
James., I, Mahesh, M., Duffy, F. et al. (2020). UK clinicians’ views on the use of formulations for the management of BPSD: a multidisciplinary survey. Ageing and Mental Health https://doi.org/10.1080/13607863.2020.1830944
James, I, Moniz-Cook, E., & Duffy, F. (2019). Editorial of Special Edition on Behaviours that Challenge. Psychology of Older People. The FPOP Bulletin. 148, 3-5.
Potts, C., Richardson J., Bond, R., Price. R., Mulvenna, M., Zvolsky, P., Harvey, M., Hughes, C. & Duffy, F. (2021). Reliability of Addenbrooke’s Cognitive Examination III in differentiating between dementia, mild cognitive impairment and older adults who have not reported cognitive problems. European Journal of Ageing. 2021 Sep 22:1-13. doi: 10.1007/s10433-021-00652-4.
Rooney, N., Chater, A., Dow, B, Duffy, F et al. (2020). Talking about death – End-of-life care guidance for the psychological workforce. British Psychological Society
Rooney, N., Chater, A., Dow, B, Duffy, F et al. (2020). The End of Life Care pathway during the Coronavirus pandemic. British Psychological Society.
Wolverson, E., Birtles, H., Moniz-Cook, E., James, I. Brooker, D., & Duffy, F. (2019). Naming and Framing the Behavioural and Psychological Symptoms of Dementia (BPSD) Paradigm: Professional Stakeholder Perspectives. OBM Geriatrics, 3(4):19;

Grants

Who attends the Memory Service and what is the outcome of their assessment? Duffy, F. (Principal Investigator) and Serplus, M. Dementia eHealth and Analytics Pathfinder Programme with joint funding from Atlantic Philanthropies, The Executive Office and Department of Health, £100,000
Enhanced Decision Support Tool for Timely Diagnosis of Dementia: Price, R (Principal Investigator), Duffy, F., Crossey, B. Casey, S, Dowey, L & Wong-Lin, K. Dementia eHealth and Analytics Pathfinder Programme with joint funding from Atlantic Philanthropies, The Executive Office and Department of Health, £92,051.96
Understanding the Outcome of Memory Service Assessments and the Impact of CLEAR Dementia Care ©: Duffy, F., (Principal Investigator) Serplus, M., Harvey, M., Zvolsky, P., Price, R., Hughes, C., Mulvenna, M. & Bond, R. Dementia eHealth and Analytics Pathfinder Programme with joint funding from Atlantic Philanthropies, The Executive Office and Department of Health, £100,000
Development of a CLEAR Dementia Care © App. Duffy, F. Dementia eHealth and Analytics Pathfinder Programme with joint funding from Atlantic Philanthropies, The Executive Office and Department of Health, £133,000.
Online Decision Support Tool for Accelerated Diagnosis of Dementia: Price, R (principal Investigator) Duffy, F., Crossey, B., Casey, S., Dowey, L. & Wong-Lin; K. Dementia eHealth and Analytics Pathfinder Programme with joint funding from Atlantic Philanthropies, The Executive Office and Department of Health, £37,000.
CLEAR-AI: empowering people living with dementia to maintain independence in daily lives, decisions, social interactions and activities, by managing agitation. Duffy, F (principal investigator), Condell, J., Price, R., Casey, S., Hun, S., McMurray, A. Longitude Prize for Dementia, £80,000
Wireframe for dementia online training platform, Duffy, F. TechStart, £10,000
6D Dementia Training Platform, Innovate UK Launchpad: life & health sciences, Northern Ireland, £99,644.

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