Tom Kitwood and his PhD student Kathy Bredin developed the original tool through ethological observations of many hours in nursing homes, hospital facilities, and day care facilities in the United Kingdom1. It was designed primarily as a tool to develop personcentred care practice over time with data being fed back to care teams who could then use it to improve their practice. The original development work is not available in the public domain5.

DCM has been through a number of changes since its inception. From 1991 to 1997, the first publically available version, DCM 6th edition, was used. This was revised based on feedback from practitioners in the UK resulting in the 7th edition being launched in 1997. The unexpected death of Tom Kitwood in 1998 created a need to have more formalized structures around DCM. The role of strategic lead for DCM was created at the University of Bradford in 2001 which the author fulfilled until 2009. The formal network of DCM trainers and the DCM International Implementation Group had their inaugural meetings in 2001 and 2002 respectively. DCM underwent a further major revision 2002-2004 drawing on the international perspectives. In 2005 DCM 8 was launched. The revised tool (DCM 8) was validated against DCM 7th edition6.

The DCM tool is only available through undertaking a registered courses delivered by licensed trainers using standardized training methods. Those undertaking the basic DCM training course (3-4 days duration) do not need any formal qualification although the complexity of the method requires reasonable numeracy and literacy skills. DCM is not aligned to a particular discipline. There are a number of different levels of training that have developed over the years to equip users of DCM at a variety of different levels.

DCM training has been available in the UK since 1991. The worldwide spread of DCM has been remarkable. Tom Kitwood taught the first DCM course outside the United Kingdom in the United States in 1998. In the same year, the materials were translated into German and training commenced there. Australia ran its first course in 2001. The Danish translation and the first course in Denmark took place in 2002. Training has been available in Switzerland with support from Germany since 2002. The materials were translated into Japanese and the first basic course took place in Japan in 2003. Translation into Korean occurred a couple of years later. Spanish and Catalan translations were completed in 2009. At the time of going into press the translations into Flemish, Dutch and Italian are being done. Strategic partnerships exist between the University of Bradford and organizations in all these countries to ensure that training in DCM adheres to international quality standards. At time of going into press there are approximately 8000 people trained at basic level worldwide.

The DCM International Implementation Group is an association of all those countries where DCM training is offered or who are preparing to offer training. Its purpose is to consider the training, care practice and research associated with DCM drawing on expertise from around the world and ensuring a common set of quality standards.

DCM has grown in popularity over the years. Many practitioners have used DCM in many different situations and continue to do so. This may be because DCM appears to provide a vehicle for those wishing to systematically move dementia care from primarily a custodial and task-focused model into one that focuses on the wellbeing of people living with dementia. There are very few other tools that purport to do this or that have been shown to be effective in this endeavour. Whether it has had a sustained impact on practice is difficult to assess. The investment of time and effort in undertaking training and sustaining mapping cycles can be a barrier in practice. There has been no survey of how many care providers actually use DCM in practice. A survey undertaken some years ago indicated that around 50% of people undertaking the training actually used mapping in practice although many more reported a beneficial impact on their own practice of undertaking the training7.

During a DCM evaluation, an observer (mapper) tracks five people with dementia (participants) continuously over a representative time period. Observation takes place in communal areas of care facilities. Guidelines are provided during training about how to observe in a way that does not increase the ill-being of people with dementia. After each 5-minute period (a time frame) two types of codes are used to record what has happened to each individual. The behavioural category code (BCC) describes one of 23 different domains of participant behaviour that has occurred.

Based on behavioural indicators, a judgement is also made of the relative state of affect and engagement experienced by the person with dementia. This is called a mood/engagement value (ME value) and is rated on a scale ranging from –5 (extreme negative state) to +5 (extreme positive state. ME values are averaged over the mapping period to arrive at a welland ill-being score (WIB score). This provides an index of relative well-being for a particular time period for an individual or a group. Being in a state of well-being is defined as experiencing a preponderance of positive over negative experiences and feelings over a period of time. Therefore, for a person with dementia, experiencing relative well-being would relate to experiencing more of the indicators of well-being over a period of time than the indicators of ill-being.

Personal detractions (PDs) and personal enhancers (PEs) are recorded whenever they occur. PDs are staff behaviours that have the potential to undermine the personhood of those with dementia. These are described and coded according to type and severity. PEs are staff behaviours that are thought to enhance personhood. These are described and coded according to type and the degree to which it is thought they enhance personhood.

From published papers on DCM8 there is consistency of what is reported in DCM data. In long-term care facilities, behaviour codes indicating social interaction, passive watching, and eating and drinking appear as the most frequent codes almost without exception. Codes for walking and sleeping appear as the next most frequently cited. In facilities with lower well-being scores, withdrawn and repetitive behaviours are frequently seen. In facilities with higher wellbeing scores, creative activity, physical exercise and general leisure activities occur more frequently. Generally, a greater diversity of behaviour and higher well-being scores are reported in day-care facilities. These scores both increase generally during periods of therapeutic activity. Higher levels of personal detractions occur in those facilities with the lowest well-being scores.

Most of the published studies here have mapped continuously for 6 hours, although those using DCM for practice-development purposes mapped for longer9-12. It also is evident from practice that useful insights can be gained from mapping for just a couple of hours13. Mapping an individual at a particular time of day may throw light on the causes and triggers of distress behaviours. Length of maps will depend, in part, on the reason for mapping. Sometimes mapping is spread over a couple of days. This can have the advantage of sampling a greater amount of variety of staffing situations but some of the continuity may be lost at an individual participant level. For research purposes, a statistically significant correlation between the hour prior to lunch and a 6-hour map on all their key indicators at the group level has been described14. It is likely that there would be more variation for individual level data.