1.PublicServices:thevalueofcultural commissioning Demonstratingimpactonpublicservice outcomes BelindaSosinowicz,AgeExchangeArts&HealthCoordinator belinda.sosinowicz@ageexchange.org.uk www.ageexchange.org.uk 02083189105

2. Partneringwithacademicinstitutions toevaluateimpact GatheringtheEvidence EvaluationofRADIQLwithRoyal HollowayUniversityLondon:A quantitativeandartsbased/ ethnographicalapproach 3. AgeExchange AgeExchangeworkswitholderpeopletoimprovetheirqualityof lifeby valuingtheirreminiscencesandgivingthemopportunitiestoexpress themselvesinthepresentthroughverbalandnon verbal(embodied) ways: Multiartformandperformanceartsprojects intergenerationalprojects exhibitions publications documentaryfilm With30yearsworkinginthisfieldAgeexchange isrecognisedinternationallyasbeingtheleading practitioners,consultantsandsourcesof Informationaboutreminiscence. 4. OurOutreachServices Reminiscenceartstraining forcarestaffand volunteers Reminiscenceartstraining forpractitioners Deliveryofreminiscence artsprogrammesfor dementiapatientsto improvewellbeing Consultancyonintroducing reminiscenceartsintocare homes 5. Ourobjectives Olderpeopleneedanenvironmentthattheycanshape,thriveand livelifeto thefullforaslongaspossible Thosewhosehealthhasbeguntofailalso deservetoenjoylifeasfullyaspossibleandweneedtofindnewwaysto supportthem (AuditCommission,2003) Workinpartnershiptoimprovethequalityofdaytodaylifeof thoseincare settingsthroughtheuseofreminiscencearts. Supportingolderpeoplewhoremainphysicallyandmentallyfitand independentthroughusingreminiscenceskillstocombattheimpactof growingloneliness. Enableolderpeopletorecovertheirselfconfidenceandsenseofselfworth throughtheuseofintergenerationalworkshopsandprovidingvolunteering opportunities. 6. ReminiscenceArts ReminiscenceArts(RA)isatermcoinedbyAgeExchangeTheatreTrusttodescribea uniquemethodofco workingingroupor11sessionswitholderpeople, intergenerationallyandforRADIQLwithpeopleaffectedbydementia. AgeExchangehasbeendeveloping,runningandtraininginthismethodofworking forthelast30years. ReminiscenceArtspracticeevokesandinspires participants memoryandimaginationthrough activities,techniquesandknowledgederiving Fromdance/movement,visualarts,theatre, handling,literatureandmusicpractices. Itisamethodologythatcanbeusedtolearn aboutandfromtheperson,informartisticpractice andtheexperienceofthepersoninthepresent. Itutilisescompassionandrelationship centredEngagementandagenuinedesire tolearnabouteachotheratitsheart. 7. ReminiscenceArtsandDementia ImpactonQualityofLife(RADIQL) Changingtheenvironmentandcultureofcareshiftinthewaywethink aboutolderpeople,fromdependencyanddeficittowardsindependence andwellbeing(AuditCommission,2003) 3 yearresearchprogramme todevelopanasset basedmodelofexcellenceintheprovisionof Personcentred(Kitwood,1997) creativecareforolderpeopleinSouth London Seekstoimprovethequalityoflife andwellbeing fortheolderpeople whoparticipateintheprogramme,specificallythosewithdementia improvemoodandselfesteem, reducelevelsofisolation,unhappiness anddepression,improvesocialinteraction betweenresidentsandcare staff Lessentheuseofanti psychoticdrugsandincreasemeaningfulactivity 8. Fundedwitha595,500grant byGuy'sandStThomas' Charity inlinewiththeir ambitionstosupport innovationinhealthwhich Will improvethehealthand wellbeingofthepopulation ofthetwoLondonBoroughs ofLambethandSouthwark, which mayinfluence changesinpolicy andpractice morewidelyincarehomesdelivery 9. Partners GuysandStThomassFoundationTrust LeadDementia Nurses SouthLondon&MaudsleyNHSFoundationTrust Older PeoplesCAG Alzheimer'sSociety. KingsCollegePartnership OurAcademicPartner RoyalHollowayUniversity London SocialSciencesandTheatre 10. Participants 12carehomesacrossLambeth&Southwark:NHS& Private 2communityHubs:HealthyAgeingCaf Lambeth& HealthyLivingClub Southwark Carestaff(carestafftraining andcareerdevelopment) Volunteers Familycarers 11. ProjectAims Changingtheenvironmentandcultureofcare DevelopingarobustinterventionbasedonAgeExchangesownReminiscenceArts method Implementingittotestitseffectsinimprovingthewellbeingofpeopleaffectedby dementia(reduceuseofmedication,falls,illhealthetc.) Training&supportingexperiencedpractitionerstodeliverit Trainingstafftoembedtheinterventionanditscorevaluesineverydaycaredelivery Workingwithfamilycarerstoenhancetheirwellbeinganddevelopownskills Improvementsinstaffwellbeingaimingtoreducestaffabsenteeism,presentismand illhealth Testingtheintervention:2newprofessionalrolesofReminiscenceArtpractitioner createdfor1yeartoputintopracticetheinterventionandmethods 12. WorkingwithRoyalHolloway University London HelenNicholson ProfessorofTheatreandPerformance,RHUL DrFrankKeatingSocialSciences Researchers:JayneLloydPHDCandidate& LauraCole,ResearchAssistant Toinvestigatetheimpactoftheintervention UnderstandthenatureoftheRAapproach SeekingNationalandindividualcarehome ethicsapproval Gainingparticipantconsent(orconsultee) Quantitativeandethnographicartsevaluation Verycloseworkingrelationshipco gainingtrust andentryintocarehomes 13. Methods 12highlyskilledandexperiencedReminiscenceArts Practitioners(RAPS)withbackgroundsinvisualarts,dance, music,occupationaltherapy,artstherapy,oralhistory,or communitywork Trainedinreminiscenceanddementiaawarenesspracticeto enrichtheirownspecialism Running,testing,refiningandreflectingonaunique ReminiscenceArtsinterventioninpairs EvaluatedbyateamofresearchersfromRoyalHolloway UniversityandAgeExchange 14. 24weeklygroupsessionsineachcarehome(96residents) 2X10artsbasedpracticeresearchsessionsin2carehomes(16 residents) 150,11sessions(37residents) 24sessionsineachcommunityhub60people) 6Patient/carergroups(60) RAPR&D,resilienceandsupervision(12) Staff(70) Around351directbeneficiaries Around504sessions 15. Design1. Acomparativeandtimeseriesdesigntogatherevidence fromresidentsandstaffincontinuingcarehomesfor peoplewithdementia 12carehomes, 6toreceivetheReminiscence Interventionoverasixmonthperiod,whilethewaitinglist groupreceivesTAUandthentheinterventionafterwards 1. Wellbeingineachcarehomeovertime(T1 T8) 2. Profiling1casestudyovertime(T1 T8) 3. ComparativebetweeninterventionandTAUpopulations 4. Staffimpact(T1T2) 16. DementiaCareMapping Anempirical,robusttool,recognisedforitsvalidityin measuringbehaviourinpeopleaffectedbydementia a)behaviourb)wellbeing/illbeingc)personaldistractions andd)positiveeventse)interactions Recordingcarefromtheclientspointofview Staffmeasures Staffinthecarehomessurveyedtoassesslevelsofwell being,stressandburnoutusingmeasuresof WorkEnvironmentScale,MaslowBurnoutScaleandGeneral HealthQuestionnaire(GHQ12 RAPMeasures SWL,WEMWBS,ONS 17. DCM Eachparticipantisobservedat5minute timeintervals Theyaregivenabehaviourcategorycode of5to+5 Statisticalanalysisfollows comparisonsbetweengroupsandcare homesandwithincarehomes Changesinindividualsbefore,duringand aftertheintervention;longitudinalchanges over25weeks 18. Design 2. Arts Based Practice Qualitative Investigation Ishelpingusdefinetheintervention Tounderstandhowandwhydifferentreminiscenceartspracticescancontribute tocreativecare Toidentifyhowthedifferentskills,expertiseandexperiencesofallparticipants canbebroughttoreminiscenceartspractices Toinvestigateandtestnewwaysofworking TolocatetheRADIQLprojectwithinarelationalframeworkfordementiacare. Criticaldialogueregardingtheimpactofartsbasedhealthresearch,thequalityof theprocessandoutcome Whatis thismelting potthatbringsartistsworking withpeopletoimprovewellbeing? 19. Qualitativeevaluation isthroughanintensiveobservation(X2Obsandx2 practicebased)practicein: 2carehomesofthefirstsetof6homes(currentlyinoperation) 2inthesecondset Observationsonseveral11sessions&communityhubs FocusgroupsandmeetingswiththeRAPS AnalysisofRAPreports selfinitiatedstudiopractice Comparativeassessmentsthroughvisitsof comparableorganisations 20. MeasuringCheerfulness Cheerfulness(exhilaration positiveaffect)istheinfectiousspreadoffunand joyinthenowmoment thecompleteopeningofoneselftothefunofbeing alive(Ruch,1993) Counteractsstressandnegativeaffect Investigatingtheantecedenttodifferent formsofcheerfulnesspresentinthe intervention: Mood,smiling,verbal Reponses,movement,laughing,gesture, motivation Howthesefindingscanbeusedtoset Thecheeroffuturegroups 21. RAPasResearcher Provideastrongandsupportivefoundation RandDResilienceBuildingProgramme(3daysspecialisttrainingand1day outsourcede.g.circledancing) Clinicalsupervision Focusgroupstoenablereflectiononthedevelopingintervention SelfHelp bookletinresiliencebuildingmethodsandsomefocusgroupsessions onappliedtechniques(e.g.strengthsspottinganddevelopment) Co workingandco counselling Writingweeklyreportsrelatedtotheoverallhypothesis(tobeanalyzedbyRHUL andAE) 22. InitialResults WellbeingimprovementsobservedthroughDCM At24weeks Peoplesindividualscoresaregoingup duringthesession Stayingupafterthesession Scoresshowinganoverallincline every 3 weeksofmeasure Staffreportingmoodimprovementsstaying upbeyondtheday 23. StaffFeedback Martinisswearinglesswillsingandshoutbutinalessaggressivegetoffme kindofway doesntseemsoangryorlostanymore Johndoesntseemthatlostinthesessionanymore ingeneralheseemsmore playful enjoyingbeingwiththegroupofpeople Margihavinganaudiencehasopenedherup herhumour classclown Ifound shegetsabitofabuzz,shewillrepeatnoisestheatricallyandgiggle Oneparticipantwhowasclimbingandhadtobesectionedduringthefirst sessionin1carehome,isnowgenerallymoretranquilandparticipatingfully. Sheisinteractingwithothersinthegroup Herscoresgofrom3to+5assoonassheentersthegroupandstayupduring theobservationperiodthereafter Enjoyment,cognitiveimprovement,joyandhappinessbecausethey are engagedinsomethingelse engagingspiritually.Whenyouenjoye.g.music youcanrememberyourchildhood itgoestoyoursoul 24. InitialIndicationofCheerfulness Antecedents Highenergycheerfulness engaginginsingingtorecognizedsongs,throwingball toeachotheranddroppingit;taskachievement/goal(opiates) ledtoincreased interaction Marchingsongs Low/Mediumenergycheer focusingonacraft activity(learning;engagement&flow endorphins) Lowlevelenergycheer fullflow& engagement Smoothjazzmusic Mademefeelimportant.IdidntrealiseI wouldenjoyit 25. EmergentQualitativeOutcomes Understandingtheenvironmentandhowpersonalhistoriesmap aspacefromthe pastthatdeterminesthebehaviourinthepresent Theuniquenatureofcollaborativework:2artsortherapistsworkingtogetherand thedevelopmentof3 modelsofcoworking;thebreadthofcreativeinputthat helpsperson centereddelivery Relationship centereddelivery,qualityengagement,compassionatecare Non verbalnarrative/embodiedmemory averystrongoutcome ThePracticeoftheintervention Thebreadthofskills,knowledgeandexperiencethattheRAPsbringtothe sessionsmakesthesessionsveryrichandperhapsenablestheRAPstorespondto participantsinterestsmorefullythaniftheywerealltrainedinthesame arts discipline. Theseincludedhumour,play,multisensory,flow,creative, experimentation,sensitivity,responsiveness,empathy andseriousness 26. CareStaffTraining 3tiertraining 1fulldaytrainingwithGSTLeadNursesand AERAPtrainers Experientialinvolvementincarehomes Staffmentoring Cascadelearningandextendtheproject whenwearenotthere sustainability BeSpokeTraining: 1and4 hourinhousetrainingsessions Creativeengagementtools/techniquesanduseofRA Compassionate/empatheticcommunication,transculturalnursinge.g..toneof voice,posture,mannerisms,beliefsandpersonalmodalitiesofbehaviour, culturalbackgrounds,moodmirroring Relationship centreddelivery/dailyengagement Positiveworkplace,e.g..connectingandsocialsupport,rewardandmotivation, meaning,Positiveaffect,mindfulness,appreciation,strengthsbasedapproaches Dementiaawareness 27. StaffResponse staffarereportinghugeimpactsofourtrainingintheintervention methodologyontheirwellbeinganddeliveryofcare Theyarebecomingmoreawareofindividualclientsmood Understandingthatperhapsmorechallengingbehaviourmaybeoriginating fromarememberedsetofactionsembeddedinthepastandrecreatedinthe moment Feelingbetterequippedtomanageandcalmagitation,andcapitaliseon improvedmood Ilearnedusingdifferentculturalandhistoricalmemorytriggerse.g.authentic food WecarryonwiththeactivitiesonthefollowingMonday 28. CommissionersResponse PositiverelationshipwithGSTF partnersSpecialistLeadDementiaService nurseswhohaveco deliveredthereminiscenceanddementiacaretraining forfree Positiverelationshipswith4carehomecompaniessofar(Anchor,Dulwich, SalvationArmy,SanctuaryHomes) scopingupscalingdeliveryinregional carehomes PositiveResponsefromCQC Potentialforextendedwork,SLAM,AgeUK,LewishamCommissioners, AlzheimersSociety ScopingupscalingNationally 29. Summary Positiveworkingrelationshipwithouracademicpartner Willprovidetherobustquantitativeaswellasqualitative outcomesneededtoconvincecommissionersofthevalidityof thisinterventiontocommissionservices Willprovidedatafordevelopingabusinessmodelincludinga fullCostbenefittoenableupscalingtheintervention further enhancingopportunitiesforcommissionandaffectingpolicy ProvideevidencetosupportdevelopaccreditationoftheRAP practice Providepeer reviewedpapersforjoournals Raisetheprofileoftheworkandreminiscenceasartform Independentobjectiveevaluation hugelybeneficialin reflectingonthepracticeandthelearningexperience 30. Alotofplacesmayprovidecontainment ratherthan care. DrFrankKeating(RHULPI,2014)saysofthepotentialof scalingup: Havinglookedattheinitialresults,this(project)has thepotentialtochangethecultureofcare.Wewould liketosaythatwhenpeopleareengaged theirlevelof wellbeingshootsup (Weshouldbe)Embeddingthis wayofworkinginthecultureofcare. Ouracademicpartnerisprovidinguswithvalidationof thewayweknowworks www.ageexchange.org.uk