Public Services: the value of cultural commissioning Demonstrating impact on public service outcomes Belinda Sosinowicz, Age Exchange Arts & Health Coordinator belinda.sosinowicz@age exchange.org.uk www.age exchange.org.uk 020 8318 9105
Partnering with academic institutions to evaluate impact Gathering the Evidence Evaluation of RADIQL with Royal Holloway University London: A quantitative and arts based/ ethnographical approach
Age Exchange Age Exchange works with older people to improve their quality of life by valuing their reminiscences and giving them opportunities to express themselves in the present through verbal and non verbal (embodied) ways: Multi art form and performance arts projects intergenerational projects exhibitions publications documentary film With 30 years working in this field Age exchange is recognised internationally as being the leading practitioners, consultants and sources of Information about reminiscence.
Our Outreach Services Reminiscence arts training for care staff and volunteers Reminiscence arts training for practitioners Delivery of reminiscence arts programmes for dementia patients to improve well being Consultancy on introducing reminiscence arts into care homes
Our objectives Older people need an environment that they can shape, thrive and live life to the full for as long as possible Those whose health has begun to fail also deserve to enjoy life as fully as possible and we need to find new ways to support them (Audit Commission, 2003) Work in partnership to improve the quality of day to day life of those in care settings through the use of reminiscence arts. Supporting older people who remain physically and mentally fit and independent through using reminiscence skills to combat the impact of growing loneliness. Enable older people to recover their self confidence and sense of self worth through the use of inter generational workshops and providing volunteering opportunities.
Reminiscence Arts Reminiscence Arts (RA) is a term coined by Age Exchange Theatre Trust to describe a unique method of co working in group or 1 1 sessions with older people, intergeneration ally and for RADIQL with people affected by dementia. Age Exchange has been developing, running and training in this method of working for the last 30 years. Reminiscence Arts practice evokes and inspires participants memory and imagination through activities, techniques and knowledge deriving From dance/ movement, visual arts, theatre, handling, literature and music practices. It is a methodology that can be used to learn about and from the person, inform artistic practice and the experience of the person in the present. It utilises compassion and relationship centred Engagement and a genuine desire to learn about each other at its heart.
Reminiscence Arts and Dementia Impact on Quality of Life (RADIQL) Changing the environment and culture of care shift in the way we think about older people, from dependency and deficit towards independence and well being (Audit Commission, 2003) 3 year research programme to develop an asset based model of excellence in the provision of Person centred (Kitwood, 1997) creative care for older people in South London Seeks to improve the quality of life and wellbeing for the older people who participate in the programme, specifically those with dementia improve mood and self esteem, reduce levels of isolation, unhappiness and depression, improve social interaction between residents and care staff Lessen the use of anti psychotic drugs and increase meaningful activity
Funded with a 595,500 grant by Guy's and St Thomas' Charity in line with their ambitions to support innovation in health which Will improve the health and wellbeing of the population of the two London Boroughs of Lambeth and Southwark, which may influence changes in policy and practice more widely in care homes delivery
Partners Guy s and St Thomas s Foundation Trust Lead Dementia Nurses South London & Maudsley NHS Foundation Trust Older Peoples CAG Alzheimer's Society. Kings College Partnership Our Academic Partner Royal Holloway University London Social Sciences and Theatre
Participants 12 care homes across Lambeth & Southwark: NHS & Private 2 community Hubs: Healthy Ageing Café Lambeth & Healthy Living Club Southwark Care staff (care staff training and career development) Volunteers Family carers
Project Aims Changing the environment and culture of care Developing a robust intervention based on Age Exchange s own Reminiscence Arts method Implementing it to test its effects in improving the wellbeing of people affected by dementia (reduce use of medication, falls, ill health etc.) Training & supporting experienced practitioners to deliver it Training staff to embed the intervention and its core values in everyday care delivery Working with family carers to enhance their wellbeing and develop own skills Improvements in staff wellbeing aiming to reduce staff absenteeism, presentism and ill health Testing the intervention: 2 new professional roles of Reminiscence Art practitioner created for 1 year to put into practice the intervention and methods
Working with Royal Holloway University London Helen Nicholson Professor of Theatre and Performance, RHUL Dr Frank Keating Social Sciences Researchers: Jayne Lloyd PHD Candidate & Laura Cole, Research Assistant To investigate the impact of the intervention Understand the nature of the RA approach Seeking National and individual care home ethics approval Gaining participant consent (or consultee) Quantitative and ethnographic arts evaluation Very close working relationship co gaining trust and entry into care homes
Methods 12 highly skilled and experienced Reminiscence Arts Practitioners (RAPS) with backgrounds in visual arts, dance, music, occupational therapy, arts therapy, oral history, or community work Trained in reminiscence and dementia awareness practice to enrich their own specialism Running, testing, refining and reflecting on a unique Reminiscence Arts intervention in pairs Evaluated by a team of researchers from Royal Holloway University and Age Exchange
24 weekly group sessions in each care home (96 residents) 2 X 10 arts based practice research sessions in 2 care homes (16 residents) 150, 1 1 sessions (37 residents) 24 sessions in each community hub 60 people) 6 Patient/ carer groups (60) RAP R & D, resilience and supervision (12) Staff (70) Around 351 direct beneficiaries Around 504 sessions
Design 1. A comparative and time series design to gather evidence from residents and staff in continuing care homes for people with dementia 12 care homes, 6 to receive the Reminiscence Intervention over a six month period, while the waiting list group receives TAU and then the intervention afterwards 1. Wellbeing in each care home over time (T1 T8) 2. Profiling 1 case study over time (T1 T8) 3. Comparative between intervention and TAU populations 4. Staff impact (T1 T2)
Dementia Care Mapping An empirical, robust tool, recognised for its validity in measuring behaviour in people affected by dementia a) behaviour b) well being/ill being c) personal distractions and d) positive events e) interactions Recording care from the clients point of view Staff measures Staff in the care homes surveyed to assess levels of wellbeing, stress and burnout using measures of Work Environment Scale, Maslow Burnout Scale and General Health Questionnaire (GHQ12 RAP Measures SWL, WEMWBS, ONS
DCM Each participant is observed at 5 minute time intervals They are given a behaviour category code of 5 to +5 Statistical analysis follows comparisons between groups and care homes and within care homes Changes in individuals before, during and after the intervention; longitudinal changes over 25 weeks
Design 2. Arts Based Practice Qualitative Investigation Is helping us define the intervention To understand how and why different reminiscence arts practices can contribute to creative care To identify how the different skills, expertise and experiences of all participants can be brought to reminiscence arts practices To investigate and test new ways of working To locate the RADIQL project within a relational framework for dementia care. Critical dialogue regarding the impact of arts based health research, the quality of the process and outcome What is this melting pot that brings artists working with people to improve wellbeing?
Qualitative evaluation is through an intensive observation (X2 Obs and x2 practice based) practice in: 2 care homes of the first set of 6 homes (currently in operation) 2 in the second set Observations on several 1 1 sessions & community hubs Focus groups and meetings with the RAPS Analysis of RAP reports self initiated studio practice Comparative assessments through visits of comparable organisations
Measuring Cheerfulness Cheerfulness (exhilaration positive affect) is the infectious spread of fun and joy in the now moment the complete opening of oneself to the fun of being alive (Ruch, 1993) Counteracts stress and negative affect Investigating the antecedent to different forms of cheerfulness present in the intervention: Mood, smiling, verbal Reponses, movement, laughing, gesture, motivation How these findings can be used to set The cheer of future groups
RAP as Researcher Provide a strong and supportive foundation R and D Resilience Building Programme (3 days specialist training and 1 day outsourced e.g. circle dancing) Clinical supervision Focus groups to enable reflection on the developing intervention Self Help booklet in resilience building methods and some focus group sessions on applied techniques (e.g. strengths spotting and development) Co working and co counselling Writing weekly reports related to the overall hypothesis (to be analyzed by RHUL and AE)
Initial Results Wellbeing improvements observed through DCM At 24 weeks People s individual scores are going up during the session Staying up after the session Scores showing an overall incline every 3 weeks of measure Staff reporting mood improvements staying up beyond the day
Staff Feedback Martin is swearing less will sing and shout but in a less aggressive get off me kind of way doesn t seem so angry or lost any more John doesn t seem that lost in the session anymore in general he seems more playful enjoying being with the group of people Margi having an audience has opened her up her humour class clown I found she gets a bit of a buzz, she will repeat noises theatrically and giggle One participant who was climbing and had to be sectioned during the first session in 1 care home, is now generally more tranquil and participating fully. She is interacting with others in the group Her scores go from 3 to +5 as soon as she enters the group and stay up during the observation period thereafter Enjoyment, cognitive improvement, joy and happiness because they are engaged in something else engaging spiritually. When you enjoy e.g. musicyou can remember your childhood it goes to your soul
Initial Indication of Cheerfulness Antecedents High energy cheerfulness engaging in singing to recognized songs, throwing ball to each other and dropping it; task achievement/ goal (opiates) led to increased interaction Marching songs Low/ Medium energy cheer focusing on a craft activity (learning; engagement & flow endorphins) Low level energy cheer full flow & engagement Smooth jazz music Made me feel important. I didn t realise I would enjoy it
Emergent Qualitative Outcomes Understanding the environment and how personal histories map a space from the past that determines the behaviour in the present The unique nature of collaborative work: 2 arts or therapists working together and the development of 3 models of co working; the breadth of creative input that helps person centered delivery Relationship centered delivery, quality engagement, compassionate care Non verbal narrative/ embodied memory a very strong outcome The Practice of the intervention The breadth of skills, knowledge and experience that the RAPs bring to the sessions makes the sessions very rich and perhaps enables the RAPs to respond to participant s interests more fully than if they were all trained in the same arts discipline. These included humour, play, multi sensory, flow, creative, experimentation, sensitivity, responsiveness, empathy and seriousness
Care Staff Training 3 tier training 1 full day training with GST Lead Nurses and AE RAP trainers Experiential involvement in care homes Staff mentoring Cascade learning and extend the project when we are not there sustainability Be Spoke Training: 1 and 4 hour in house training sessions Creative engagement tools/ techniques and use of RA Compassionate/ empathetic communication, transcultural nursing e.g.. tone of voice, posture, mannerisms, beliefs and personal modalities of behaviour, cultural backgrounds, mood mirroring Relationship centred delivery/ daily engagement Positive workplace, e.g.. connecting and social support, reward and motivation, meaning, Positive affect, mindfulness, appreciation, strengths based approaches Dementia awareness
Staff Response staff are reporting huge impacts of our training in the intervention methodology on their wellbeing and delivery of care They are becoming more aware of individual clients mood Understanding that perhaps more challenging behaviour may be originating from a remembered set of actions embedded in the past and re created in the moment Feeling better equipped to manage and calm agitation, and capitalise on improved mood I learned using different cultural and historical memory triggers e.g. authentic food We carry on with the activities on the following Monday
Commissioners Response Positive relationship with GSTF partners Specialist Lead Dementia Service nurses who have co delivered the reminiscence and dementia care training for free Positive relationships with 4 care home companies so far (Anchor, Dulwich, Salvation Army, Sanctuary Homes) scoping up scaling delivery in regional care homes Positive Response from CQC Potential for extended work, SLAM, Age UK, Lewisham Commissioners, Alzheimer s Society Scoping up scaling Nationally
Summary Positive working relationship with our academic partner Will provide the robust quantitative as well as qualitative outcomes needed to convince commissioners of the validity of this intervention to commission services Will provide data for developing a business model including a full Cost benefit to enable up scaling the intervention further enhancing opportunities for commission and affecting policy Provide evidence to support develop accreditation of the RAP practice Provide peer reviewed papers for joournals Raise the profile of the work and reminiscence as art form Independent objective evaluation hugely beneficial in reflecting on the practice and the learning experience
A lot of places may provide containment rather than care. Dr Frank Keating (RHUL PI, 2014) says of the potential of scaling up: Having looked at the initial results, this (project) has the potential to change the culture of care. We would like to say that when people are engaged their level of wellbeing shoots up (We should be) Embedding this way of working in the culture of care. Our academic partner is providing us with validation of the way we know works www.age exchange.org.uk