Reinforcement Learning (RL) faces significant challenges in adaptive healthcare interventions, such as dementia care, where data is scarce, decisions require interpretability, and underlying patient-state dynamic are complex and causal in nature. In this work, we present a novel framework called Causal structure-aware Reinforcement Learning (CRL) that explicitly integrates causal discovery and reasoning into policy optimization. This method enables an agent to learn and exploit a directed acyclic graph (DAG) that describes the causal dependencies between human behavioral states and robot actions, facilitating more efficient, interpretable, and robust decision-making. We validate our approach in a simulated robot-assisted cognitive care scenario, where the agent interacts with a virtual patient exhibiting dynamic emotional, cognitive, and engagement states. The experimental results show that CRL agents outperform conventional model-free RL baselines by achieving higher cumulative rewards, maintaining desirable patient states more consistently, and exhibiting interpretable, clinically-aligned behavior. We further demonstrate that CRL's performance advantage remains robust across different weighting strategies and hyperparameter settings. In addition, we demonstrate a lightweight LLM-based deployment: a fixed policy is embedded into a system prompt that maps inferred states to actions, producing consistent, supportive dialogue without LLM finetuning. Our work illustrates the promise of causal reinforcement learning for human-robot interaction applications, where interpretability, adaptiveness, and data efficiency are paramount.

Inspired by the two-way fixed effects regression model widely used in the panel data literature, we propose a two-way unmeasured confounding assumption to model the system dynamics in causal reinforcement learning and develop a two-way deconfounder algorithm that devises a neural tensor network to simultaneously learn both the unmeasured confounders and the system dynamics, based on which a model-based estimator can be constructed for consistent policy value estimation. We illustrate the effectiveness of the proposed estimator through theoretical results and numerical experiments.

Autonomous operations of robots in unknown environments are challenging due to the lack of knowledge of the dynamics of the interactions, such as the objects' movability. This work introduces a novel Causal Reinforcement Learning approach to enhancing robotics operations and applies it to an urban search and rescue (SAR) scenario. Our proposed machine learning architecture enables robots to learn the causal relationships between the visual characteristics of the objects, such as texture and shape, and the objects' dynamics upon interaction, such as their movability, significantly improving their decision-making processes. We conducted causal discovery and RL experiments demonstrating the Causal RL's superior performance, showing a notable reduction in learning times by over 24.5% in complex situations, compared to non-causal models.