Gill Windle, Kat Algar-Skaife, John Killick and Luke Pickering-Jones explain how Creative Conversations have been used for staff development.
How can care staff improve their understanding and enhance their communication with the people they care for?
Rather than helping staff understand how to communicate with people living with dementia, training for care staff in the UK tends to focus on manual handling, fire safety and safeguarding. The Creative Conversations programme aims to develop the skills of dementia care staff using the arts. The programme was developed because we know that when staff have taken part in arts activities for people living with dementia they often reported a deeper understanding of the people they care for, although they were not the target of the activity.
To date, very little work has been done around arts-based programmes to help care staff learn more about dementia. However, the little that has been done has been promising and the Creative Conversations programme was inspired by and builds on these. 1 2
How does it work?
At the heart of the Creative Conversations programme is a remit for developing compassionate communication that goes beyond performing care tasks and deepens the quality of relationships with those they care for. It encourages staff to use these skills in everyday interactions in the care home (rather than a time-limited activity session). A facilitator/artist practitioner delivers the training in ‘creative sessions’ of up to two hours long. In our project, four creative sessions were delivered over 12 weeks.
It is important that the facilitator is knowledgeable about dementia and also understands life in a care facility as it helped staff connect with the facilitator. We found that staff valued and respected this experience and that this enabled the facilitator to shift the perspective of staff members to that of the resident when necessary. It is also important that the sessions are delivered outside of the care home and in an unconventional venue. This immediately made staff curious and engaged them in a way that a traditional classroom setting would not. In our case, the sessions took place in a pub and a cinema.
The sessions explore topics such as seeing people with dementia as individuals and communicating with people with dementia who have lost language through various artistic outlets, including poetry, visual art, film, photography, and music (see example below).
The facilitator’s approach is informal, no facts are given, and activities involve a high degree of sharing. Personhood is asserted throughout without being stated. This format moves away from structured and formal learning to the creative exploration of dementia. Participants felt this engaged them throughout, and enabled them to gain an empathetic manner, rather than just learn facts. One member of staff commented:
“(Creative Conversations) isn’t ‘this is dementia, this is what causes dementia, these are the symptoms.’ It’s personal about the individual, because every individual with dementia is different. Like all of us are different.”
During each session, several activities are suggested for staff to try between sessions while back in the care home setting. In our project, sessions 2-4 had time at the beginning for staff to reflect on how they had implemented the learning from the previous sessions.
Example: Mother Tongue Film
A short film featuring Kitty, who has dementia and has lost her verbal communication, and her daughter Caroline, is shown to the group. The film shows Caroline spending time with her mother in a care facility, as well as talking to the camera. In it, Caroline describes her mother’s communication as ‘Kitty language’ saying:
“Kitty language is unique. Sometimes I’m the only person who understands it. Sometimes I don’t understand it, but it doesn’t matter, but it’s deeply meaningful.”
After watching the moving film, the facilitator asks the group for their reaction and then asks them to reflect whether there are people they know who have developed their own means of communication; as well as whether only a family member can form such a strong relationship with a person with dementia. The group discussions that follow are led by the group. Reflections from this activity included:
“She was actually talking with her eyes and her eyes became her voice”
“We are family. I think we know them (residents) differently. We know them as they are now”
“You learn to understand that person. It’s about trust isn’t it…They are confident in you and when they are comfortable with you…you understand them.”
Staff have responded extremely positively to Creative Conversations. They particularly valued the space to reflect on their own practice. In their busy working lives, this is something they are rarely able to do, so they reported that Creative Conversations helped validate and appreciate their own skills, that sometimes they didn’t realise they had. Staff also felt appreciated by their managers through their support of the programme. Staff welcomed the opportunity for discussion and to learn from staff from other homes as this is again something they rarely had the opportunity to do. They found it interesting to hear how other homes worked and to compare different perspectives. They found the approach of learning through the arts strengthened their understanding of residents and the role of non-verbal communication.
Flintshire Social Services monitoring team have also seen an impact of Creative Conversations in the homes following the sessions. They have noted an increased involvement from the homes with different activities and their communities. They are keen that more homes are offered the Creative Conversations programme and have sought funds to continue it within the region. In the next step you will read about the impact that the programme has had on Flintshire Social Services.
The sessions enabled them to appreciate that the arts can be weaved into everyday interactions without having to lead a formal activity session and they were keen to pass on their new skills to other staff in the homes.
Creative Conversations is a partnership between Bangor University, Dementia Positive, and Flintshire County Council Social Services funded by Health and Care Research Wales and supported by the Centre of Ageing and Dementia Research (CADR) and Created Out of Mind.
Our Creative Conversations programme was developed by John Killick, who was involved in both the Descartes and The Arts and Older People projects.
‘Creative Conversations’ staff development programme is based on and takes its inspiration from two earlier programmes:
- The Descartes project conceived by Hannah Zeilig, (Zeilig, Poland, Killick & Fox. 2015. The arts in Dementia Care Education. Journal of Public Mental Health 14(1) 18-23.) Descartes innovated the use of arts-based material to educate care home staff.
- The Arts and Older People Project and John Killick at The Courtyard, Hereford. This project used poetry to enhance creative conversations and enable compassionate communication. The Arts and Older People Project and Killick, J. (2015). The best words, in the best order: A toolkit for making poems in dementia care settings. The Courtyard Centre for Arts, Hereford.
© UCL/ Created Out of Mind