In the frame

Living Voices

You are here

Living Voices is a national two-year project that is piloting the use of story, poems and song in care home settings across Scotland. It aims to engage and enliven groups of older people through conversation, creative activity and reminiscence.

Living Voices - a positive approach

Funding

The project is funded by the Baring Foundation, Paul Hamlyn Foundation, Creative Scotland and Gannochy Trust. Other partners include: http://www.scottishpoetrylibrary.org.uk/about/projects-partners

Who runs it?

The project has delivered 16 sessions over 18 months across 18 care home settings across Aberdeen City, South Ayrshire and Perth and Kinross. Ten artists (all professionally accredited) facilitate sessions with the help of a volunteer from a team of 12-18. Artists are paired with volunteers to develop a facilitative approach that encourages interaction as opposed to performance.

Volunteers provide support and work one-to-one with the facilitator to develop sessions. The role of the volunteer depends on their confidence and skills. For example, volunteers range from students that offer one-to-one facilitation assistance, such as assisting those who are hard of hearing, to professional storytellers who provide more active supportive roles.

Who are the key partners?

The project is delivered in partnership by the Scottish Poetry Library and the Scottish Storytelling Centre.

How do people hear about it?

Artists visit care homes to give staff and residents information about the sessions. An invite is issued to everyone in the care home, and people choose to go of their own accord or are actively encouraged to attend. On occasion, people are asked to go along, and while this is not ideal, it generally results in good outcomes for the person. For example, the regular social engagement may help them through bereavement or other challenging life circumstances. About 100 service users are involved on a monthly basis.

What are the outcomes?

  1. Facilitates socialisation 
    Living Voices has shown to help new residents adjust to their environment. Being part of the group helps to socialise them and make them feel part of a group.
  2. Promotes health and wellbeing 
    The use of poetry has shown to enrich the lives of people with learning difficulties, long-term conditions and mental health problems. It provides comfort and connectivity in times of need.
  3. Informs person-centred care 
    Staff report that the sessions build an informal, interactive and creative space for participants to speak about their lives. The information that is offered in these sessions is extremely helpful to care staff as they learn more about the person and their life experience and can focus on providing better person-centred care –  care that not only focuses on clinical care and related outcomes, but considers the person in the round.
  4. Fosters learning and development 
    Living Voices has shown to foster learning and development of everyone involved. Care staff are motivated by seeing that they bring their knowledge and understanding of client group to the sessions and also learn from seeing and hearing the person communicate more informally. The sessions have the potential to inform person-centred care.

Living Voices - why it's important

Key messages

How is quality measured?

The question of the artistic quality of the materials used in a session is a tricky one to define.  An artist’s opinion on what ‘quality’ is can be very different to that of social care staff  or residents. For example, choosing the ‘right’ poem, story or song over the ‘quality’ poem, story or song is considered important – the right piece being useful and meaningful to the person in context rather than good ‘literature’.

Overall, the quality of session delivery is measured by enjoyment, well-being and creativity of participants involved. It is important that facilitators working with groups create interesting topics to keep participants engaged and interested. Also, the artists are selected based on their skills and their previous experience of delivering quality work with people in participatory settings.

What are the challenges?

  • Language and communication – artists, volunteers and those working in social care use different language, which can be hard to bridge. It can also be difficult to challenge the artist on their way of working in a care context.
  • Having clear outcomes and plans – as artists generally work in a more exploratory, fluid and less prescriptive way, it is difficult to describe outcomes and plans for reporting and recording purposes.
  • Time and resource – the lack of appropriate physical spaces suitable for non-threatening and less clinical forums can be hard to find. The time of care staff can also be difficult to allocate, and time is also required for the planning of sessions, as well as the learning and development of artists.
  • Sustainability of the model – a pay-for model is not considered feasible. Care homes push for larger numbers of people to attend the groups when the optimal number is between 6-8 per session. The quality of the session can be stifled if too many people attend and it becomes more performance based rather than interactive. This is sometimes misunderstood in care contexts. The small size of groups is less cost effective and pulls more heavily on resources. Sustainability is considered key in the ongoing care of individuals rather than the provision of evidence for effectiveness. Living Voices believe that building a programme that achieves both of these aims is key.

How do you evaluate?

Artists use reflective logs throughout the process and care staff reflect on, observe and feedback how the sessions impact on the participants. Both the participants and care staff are surveyed and interviewed. While immediate feedback after the sessions is attained (observational qualitative evidence via reflection logs completed by artists and observation logs completed by volunteers at each session), with the aim of building a longer term picture longer term qualitative evaluation needs to be considered.

Summary of interim evaluation

Impact for care home residents:

  • Living Voices impacts positively on participants’ mood and level of contentment
  • The sessions help participants to recall and share stories and memories
  • Levels of enjoyment and engagement are high, and where capable, individuals contribute to the sessions
  • The sessions enhance and encourage creativity, such as written poems and songs
  • Interaction and relationships between residents and care home staff develop

“She has to be coaxed out of her room usually and this can cause her stress, but as soon as you tell her it’s Living Voices she smiles and is always willing to come and join in”. (Care home staff member)

“B became a resident just as the group began. She was so shy and she absolutely refused to leave her room and mingle.She feigned illness so as her meals would be served in her room. When we explained what the group wa she tentatively said she would come and see what it was all about. The change in her was so dramatic. She started joining in all our arts activities, quizzes, sing songs…” (Care home staff member)

“I like sharing my stories. I like the poems and some of the stories you tell us are awful good, and I love a sing-song, not that I can sing! {laughter} I love to hear everyone singing, and yes, singing puts me in a good mood, definitely!” (Resident)

“What can I say? I enjoy it all and I look forward to it. I enjoy telling the stories from the past, but I can’t remember all of them now, your stories are good!” (Resident)

Impact for artists (facilitators):

  • Increased skills and confidence in facilitating arts activities and combining art forms

Living Voices - impact of Living Voices on artists

Impact for volunteers:

  • Increased confidence and skills working with older people
  • Increased awareness of the skills and confidence in different art forms
  • Volunteers develop professional connections and opportunities

Impact for care home staff:

  • Increases understanding of the benefits that participating in oral and literary arts can have for older people, sometimes changing the way they work
  • Skills and confidence of care home staff is increased in using various art forms as ways to engage with individuals
  • Improved relationships between staff and individuals and better person-centred care

Living Voices - impact of Living Voices on care home staff

Full Evaluation report

You can find the full evaluation report available here: http://www.scottishpoetrylibrary.org.uk/learn/carers

What are the key characteristics of effective practice?

  • Sessions work best where care staff participate, not to provide care but to use their knowledge and understanding of client group, as well as skills and confidence that artists can learn from. It is a reciprocal learning and development environment.
  • Accredited artists are used and sourced from agencies such as Scottish Book Trust Writer’s Register and Scottish Storytelling Forum Storytellers’ Directory.
  • For the artists, using reflection logs and sharing them with others is extremely valuable at identifying good practice and for improving practice.
  • Group size – quality of interaction is optimum when there are 6-8 participants in the sessions.
  • The collegiate ‘community of practice’ for artists offers a forum to communicate with, and learn from each other and to build ideas for working in challenging environments, such as with people who have dementia. This community also helps build artists’ skills and repertoire in using different art forms such as poetry, music and story.
  • The model should provide opportunities for training and development. While the quality of session content and its structure needs to be of a standard, there is also the need for flexibility in the design and structure of the sessions. Artists should be viewed as experts in their field and valued for the knowledge they bring.

Recommendations

Skills and training

Skills and confidence of all involved (including participants) are required for using arts more effectively in social care. Quality and impact of sessions also need to be measured more effectively.

Co-productive sessions

Such projects should enable participants to set the agenda, making for more bespoke and flexible sessions. Family members were not involved in the pilot session model, although they often do participate in the groups. This is an area that Living Voices are considering developing more formally in the future.  

Get arts onto policy agendas

Health and social care policy agendas should include the arts as a way to influence better care and support.

Further information

Thanks

Many thanks to Emma Faragher who gave her time to be interviewed for this case study. IRISS is very grateful for her input.