Study Trip to British Columbia

I was fortunate to have the opportunity to travel to British Columbia, Canada in February 2018 for a Study Trip as part of the Scottish Quality & Safety Fellowship.  The aim of the Study Trip is to gain insights from other areas and consider how these can be applied to your own area of practice.  I elected to visit the British Columbia Patient Safety and Quality Council as I was impressed by the ethos of the Organisation.  The Council believes a patient-centred, innovative, and inclusive approach from the province’s health care system is essential to improving quality of care.  Along with two colleagues, I made the journey to Vancouver (which turned out to have less snow than Scotland, in the grip of Storm Emma, which we missed the brunt of)!

We received fantastic hospitality during our trip with numerous experiences demonstrating how The Council are supporting Patient Safety and Quality Improvement.  You can see from the map that British Columbia (outlined in blue) is huge geographically.  In the interests of not making my Blog too huge, I wanted to share a selection of my learning experiences!

Blog1

Health Design Lab – Emily Carr University

This is a research and design lab where faculty and students work collaboratively on projects with industry and community partners to address complex challenges in health and healthcare.  Emphasis is placed on participatory design research and the involvement of patients, caregivers and healthcare staff throughout the design process.  A range of methods are utilized in order to co-create outcomes and proposed solutions with the ultimate aim of ensuring that those whose health needs are being addressed have a voice in the process.

We were involved in an interactive co-design workshop with members of the Patient Voices Network (who are a community of patients, families and caregivers working with health care partners to improve the health care system).  We participated in various activities in order to create a series of ideas and recommendations to inform future designs of the new St Paul’s Hospital entry and visitor experience.  ‘Personas’ (which are a description of typical and atypical service users, with specific thoughts and needs) were also used in order to broaden the range of experience in the room.

Projects that the Health Design Lab have also been involved in include a digital therapeutic device for delirium and dementia and lighting for residential care.  Further information can be found:

www.healthdesignlab.ca

We were impressed by the energy and creativity brought to the projects by the students from the Health Design Lab.  There is great value in working in partnership with others who can bring a strong design skill set to the process.

Blog3Blog2

Residential Care Units

I had the opportunity to visit several Residential Care Units, which were focusing on Staff training, environment and improved care for individuals with behavioural and psychological symptoms of dementia.  One of the sites we visited at Youville (Providence Health Care) had been involved in co-design work with the Health Design Lab whilst undergoing a process of “Megamorphosis”.  This is an innovation and improvement project to understand the residential care experience for residents, family and staff.  Building on the insights gathered, the next phase is to rapidly test ideas from residents, family and staff.  Ideas being tested included lighting, resident doorways and work around finding out how residents want to spend their day (residents were provided with cameras in order to take photos of what is meaningful to them).  The work is approached with these 3 themes:

  • Emotional connections matter most
  • Residents direct each moment
  • Home is not a place, it is a feeling

Further information can be found:

http://www.providencehealthcare.org/health-services/seniors-services/residential-care-me/our-journey-so-far/megamorphosis

I was impressed by the level of buy in to the Quality Improvement work and the willingness to try new ideas.  There was a real emphasis on ensuring that residents and families are partners in the process.

Peer Advisors

We spent a morning with a GP (originally from Scotland) in Downtown Eastside, which is notorious for its levels of drug use, poverty, mental health, homelessness, and crime.  It is also known for its strong community resilience and history of social activism.  We heard about the work being carried out in primary care around Peer Advisors.  These are people with lived experience of Downtown Eastside who have used Services.  One peer advisor described the role as being like “interpreters in a foreign land”.

We were struck by the ability of the peer advisors to reach the people who needed support and the value that their experience and understanding can bring to Services.  This can be transferred across settings and consolidates the belief that people are the real experts in their care.

I hope you have found this selection of learning experiences interesting and am happy to be contacted for any further information.  I would hope to share additional experiences in a future Blog, including time with the Patient Voices Network and learning from the BC Quality Council around culture change.  I would like to thank everyone involved in the Study Trip for such great hospitality and willingness to share.  Vancouver is a beautiful, friendly city and I hope to return.

Blog6

Contributor:

Blog7

Alison McKean, AHP Post Diagnostic Lead, Alzheimer Scotland

Advertisements

Art Psychotherapy with people living with dementia

Introduction

Art therapy is understood to have positive effects for people living with dementia for example, the importance place on emotional and self-expression and provision of a safe place to explore feelings.

Authors have identified positive outcomes from art therapy in dementia care. In a systematic literature review of the efficacy of creative art therapy in treatment of Alzheimer’s disease and dementia, Cowl & Gaugler (2014) conclude that art therapy is an effective treatment for behavioural and emotional challenges of the disease. For example, participation in art therapy can facilitate mental stimulation and a personal sense of control through exploration and use of materials. Participation in art therapy group can present an opportunity for social support and formation of significant relationships

Anticipated treatment aims & objectives of art therapy intervention with people living with dementia

  • Enable positive changes in mood & sociability (Rusted et al. 2002; Cowl et al. 2014)
  • Develop a sense of self and empowerment
  • Counteract feelings of loss of control
  • Provide psychological support when the person with dementia may be experiencing a sense of fragmentation

People living with dementia comments on their experience of coming to art therapy (selected to maintain anonymity and preserve confidentiality)

On the experience of coming for art therapy:

On looking at the artwork that they made:

I had a student placement with Alzheimer Scotland in 2017-2018. I found it to be a very valuable and enlightening experience with many opportunities to learn from people living with dementia, their carers and staff.  The above information is informed by my placement experience. I will graduate in 2018.

Contributor

Blog10

Jocelyn Gray

Currently trainee member of British Association of Arts Therapists (BAAT) and seeking full membership on graduation

References

COWL, A. L., and GAUGLER, J. E., 2014. Efficacy of Creative Arts Therapy in Treatment of Alzheimer’s Disease and Dementia: A systematic Literature Review. Activities, Adaptation & Aging. December, vol.38, no.4, pp.281-330.

RUSTED, J., SHEPPARD L. and WALLER, D., 2006. A Multi-centre randomised Control Group Trail in the Use of Art Therapy for Older People with Dementia. Group Analysis. vol 39, no.4, pp.515-536.

Client images are private and confidential and therefore do not appear in this blog

                                                                                 

Alzheimer Scotland occupational therapy interns Summer 2018

Blog1

Ciara Felle – MSc Occupational Therapy Student

Hello! My name is Ciara Felle, I am originally from Ireland but am currently completing my master’s degree in Occupational Therapy at Queen Margaret University. My undergraduate degree is a BA (Honours) in Psychology and Sociology from the University College Cork, Ireland. I was delighted to be accepted as one of the two occupational therapy interns with Alzheimer’s Scotland, Queen Margaret University and Santander Universities UK, this year. I am looking forward to working with Sarah and the Scottish Dementia Working Group throughout the internship to collaboratively aim to challenge the stigma regarding dementia. Throughout this internship I also hope to provide insight into the value of occupational therapy in dementia care and the importance of raising awareness of the work of different Allied Health Professionals. I am excited to see what new experiences the next 10 weeks brings for us!


Sarah MacFarlane – MSc Occupational Therapy Student

My name is Sarah MacFarlane and I have also just finished my first year of the MSc Occupational Therapy (Pre-Reg) program at Queen Margaret University. Coming into this degree, I have completed my BA (Honours) in Kinesiology & Physical Education and Master of Kinesiology from Wilfrid Laurier University, Canada. My research topic for my Master’s thesis explored the lived experiences of daughters providing informal care to their mothers with dementia. My own personal experience with my grandmother, as well as the conversations I got to have with carers for my research, are what ignited my passion for working with individuals with dementia and their families. I believe there is a strong role for occupational therapy and allied health professionals within this area, and cannot wait to help explore both the power of occupation and assist in closing the gap between people and policy. As an international student from Canada I have fallen in love with Scotland and am thrilled to be able to give back to a community that now feels like home.

Again, Ciara and I are both delighted to be working with Alzheimer Scotland this summer as Occupational Therapy Interns. Our roles will continue to adapt and become clearer as the summer progresses and our projects start to develop, however we are keen and excited for what is to come. We will keep you updated on our work this summer through our social media platforms! Please feel free to follow us on twitter @SMacFarlane_OT and @CiaraFelle_OT and Instagram @AHPDementia.

Blog2

Ciara & Sarah

Over the 10 weeks, Ciara & Sarah will be working with the Scottish Dementia Working Group (@S_D_W_G) a national campaigning group, led by people with dementia. The group is the independent voice of people with dementia within Alzheimer Scotland and the group campaign to improve services and challenge stigma.  You can find out more about the group at www.sdwg.org.uk

Woodland Therapy

‘Instinctively Wild’ in partnership with NHS Borders mental health occupational therapy graciously obtained funding from the Life Changes Trust which is funded by the National Lottery. With this funding we sought to provide a group intervention to those living with Dementia. It was aimed at those in the mid to later stage of their journey who require a sensory approach to facilitate meaningful engagement. A gap in the service was identified for individuals living in the Scottish Borders who are at this stage in their Dementia journey. Groups tend to be targeted more towards those in the earlier stages. However as the Dementia journey progresses an individual can find it more difficult to maintain social connections and meaningful activity due to an array of different factors. This is exactly why this is the right time in the journey to intervene and support the continuation of these important aspects of daily life.

Instinctively Wild are an innovative and dynamic third sector organisation that focuses primarily on connecting people through nature. This is such an essential aspect of the culture of many of those living in the Scottish Borders.

What the group is about:

  • Physical activity
    1. Slow paced walk through the woodland, stopping to listen, smell, touch and explore the natural environment.
    2. Picking up materials for activity.Blog1
  • Sensory activities in the woodland environment such as
    1. Making bird feeders/fat balls
    2. Creating creative art work in the form of collages, sculptures and woodland badges
    3. Woodland frames
    4. Colour palates for the seasonBlog2
    5. Crafting musical instruments
    6. Composing poetry
    7. Listening to stories of the woodland
    8. Brewing woodland tea
    9. Campfire baking
    10. Listening to music (harpist)
  • Social interaction
    1. Opportunity for peer support
    2. Opportunity for laugher, fun and enjoyment
    3. Carer peer support

Benefits:

  • Social interaction
  • Confidence building
  • Improving sense of wellbeing
  • Cognitive stimulation
  • Community engagement
  • Physical activity

Group participants ‘golden moments’

  • “It makes me feel free”
  • “It helps when I can’t find the words”

“I have enjoyed meeting new people”

I have observed participants laughing, smiling, chatting and participating keenly in all activities offered. During the musical sessions one participant brought along his accordion to play and another brought along his bass guitar. A carer also brought his harmonica to play. It was a great experience to see everyone get enjoyment and have enthusiasm for a session.

The dynamics of the initial group selected worked very well. Three couples attended; 3 gentlemen with dementia and their wives. The wives would socialise as part of the group obtaining peer support and they would also engage in the activities finding them relaxing and enjoyable. They fed back that this group is just as much for them as it is for their husbands as it is something fun and interactive that they can do together. Two of the participants who have a younger onset diagnosis were supported to attend by NHS staff and they also appeared to get a lot enjoyment from the group as demonstrated by their keen engagement. This group also helped to build confidence in that activities were offered in a way which could facilitate participation and offer an end result.

Blog8

What next:

Woodland therapy is not a new concept to NHS Borders. It has been provided in the past and at that time it was proven to be an effective group and was well regarded by those individuals living with Dementia, their carers and the mental health service. However in this economy funding is always a challenge therefore NHS Borders in partnership with Instinctively Wild are exploring means of sustainability for this dynamic intervention. Funding has been secured for 2 years (2018-2019) which equates to two 8 week groups (sessions are once per week) per year (spring and autumn). Therefore we endeavour to explore alternative routes so this extraordinary group can continue to improve the lives of those living with Dementia in NHS Borders.

Many thanks for reading!

Contributor

Blog9

Louise Shanks,

Occupational Therapist, NHS Borders

I am an occupational therapist working in NHS Borders as part of the mental health service for older adults. Predominantly I provide a service to those living with dementia helping to adapt current and develop new activities to help retain independence and achieve wellbeing.

Music therapy and dementia Piloting projects in hospital settings

Introduction

This year two music therapy projects have been piloted in dementia-specific healthcare settings in NHS Lothian. The projects took place on both assessment and continuing care hospital wards, aiming to establish music therapy services and gain a greater understanding of how music therapy can be beneficial to patients, staff and carers in the ward environment.

Music therapy and dementia

Music therapy is a psychological intervention centred on the use of music in a therapeutic relationship between the person and the music therapist. The therapy is interactive and dynamic, capable of addressing the emotional, social, cognitive and physical needs of individuals. It is an evidence-based therapy and practitioners in the field are Allied Health Professionals registered with the Health and Care Professions Council*.

The evidence base for music therapy for older people living with dementia is growing, as demonstrated by its inclusion in the Psychological Therapies Matrix (NHS Education for Scotland 2015). This positive impact is well documented over several areas of functioning and engagement, including:

  • Encouraging interpersonal engagement and creativity (Ridder 2011)
  • Improving cognitive skills and language functioning (Carruth 1997; Brotons and Koger 2000)
  • Supporting psychological well-being (Fitzgerald-Cloutier 1993; Groene 1993; Vink 2000; Svansdottir and Snaedal 2006; McDermott et al. 2012)
  • Maintaining connectedness and personal identity (McDermott et al. 2014)

Music therapy is also apt to dementia care in that the therapeutic support can span the duration of the persons’ dementia journey, with the therapist constantly adapting to the clients’ needs (McDermott et al. 2012). Music therapy therefore also has the potential to offer new perspectives to care planning, as well as encouraging positive staff-patient interactions, therefore reflecting progressively on the persons care as a whole (Svansdottir and Snaedal 2006).

Aims of pilot projects

Considering the rationale above and working in collaboration with hospital staff, the following aims were developed:

  • Creating a greater understanding of each persons’ dementia journey
  • Increasing understanding of individual communication abilities of each person
  • Supporting varied emotional states by validating emotional experiences
  • Contributing to holistic care planning
  • Encouraging new pathways of communication between patients and staff
  • Promoting meaningful therapeutic interaction and activity

 Ways of working

Music therapy was offered weekly on the wards in the following formats:

 

Long-term individual sessions Drop in individual sessions Open groups
·Offers a consistent space for patients to engage in therapy weekly

·Working towards individualised aims

·More in-depth understanding of patient needs and ways of communication can be gathered

·Often more appropriate for those in hospital for a shorter period of time

·Provides a ‘taster’ of what music therapy can offer for the individual

·Assessment of individual needs

·Provides an open space for musical engagement between patients, families, the staff team and therapist

·Opportunities for skill sharing

·Handover of musical tools

·Working alongside patients in a group

Outcomes of projects

Staff feedback captured different aspects of the music therapy service, from benefits for patients to the music therapist’s role as a part of the team. Some staff members shared their perceptions of changes in how a person was during or after therapy.  After a patient who had been particularly unwell attended the music therapy group, one staff member commented:

“It is good to see [the patient] being himself and interacting.”

Others commented on the importance of ‘positive emotional memory for some time after’ and sessions providing ‘structure to the day’, describing music therapy as ‘a positive therapy, which most patients seem to respond well to.’ Other responses have been collated in the chart below:

BlogGraph

The therapist’s contribution to the team was also represented in the feedback. It was expressed that the music therapist’s communication as a ‘fully interactive member of the team’, allowed for contributions to ‘distress management’ care planning, as well as creating an understanding of how patients had ‘developed/engaged over time.’

The feedback also reflected the hopes for the music therapy service to continue, in particular emphasising the effect music therapy has on every individual in the ward environment:

“This therapy offers another source of meaningful engagement for patients/family/friends/staff.”

Conclusions and recommendations

Based on the positive feedback and high levels of attendance throughout the projects, it can be concluded that music therapy was able to offer a number of benefits not only for patients but also the ward environment as a whole, creating opportunities for:

  • Meaningful emotional and social engagement
  • Access to non-verbal psychological therapies
  • Cognitive stimulation
  • A safe space for emotional expression
  • Creating opportunities for sense of achievement and motivation
  • Contributing to a well-rounded understanding of patients’ individualised needs

Though these short-term pilot projects have created an understanding of how music therapy can be valuable in the hospital environment for those on their dementia journey, a greater capacity for change lies in the opportunity to create a permanent music therapy provision within the older people’s mental health service. This would allow for continuity of care and consistent support for patients.

Most importantly, let us hear from the experiences of service users:

‘I like it because when you’re in pain it’s good to have something like this, the singing, to do.’

‘I was singing the songs and it brought me back because that was me and my time, you know, Bob Dylan and the Beatles and them. It brings things back.’

 Thank you for reading my blog and would welcome any comments

Blog2

*There are almost 800 music therapists currently registered in the UK. The title ‘music therapist’ is a protected title by law and only those registered with the HCPC can use it. https://www.bamt.org/music-therapy/what-is-a-music-therapist.html

Contributor

Blog3

Nina Wollersberger

Music Therapist, NHS Lothian

Older People’s Mental Health and Children’s Music Therapy Services

My interest in music therapy and dementia stems from personal experiences with dementia from a young age. Two of my grandparents, one of whom was a musician, lived with dementia for many years. As they both spent much of their dementia journeys outside of their homes, I developed a particular interest in how music therapy can improve quality of life for those living in care and hospital settings.

 

References:

BROTONS, M. and KOGER, S. M., 2000. The impact of music therapy on language functioning in dementia. Journal of Music Therapy. September, vol. 37, no. 3, pp. 183–195.

CARRUTH, E. K., 1997. The effects of singing and the spaced retrieval technique on improving face-name recognition in nursing home residents with memory loss. Journal of Music Therapy. September, vol. 34, no. 3, pp. 165–186.

FITZGERALD-CLOUTIER, M. L., 1993. The use of music therapy to decrease wandering: an alternative to restraints. Music Therapy Perspectives. January, vol. 11, no. 1, pp. 32–36.

GROENE, R. W., 1993. Effectiveness of music therapy 1:1 intervention with individuals having senile dementia of the Alzheimer’s type. Journal of Music Therapy. September, vol. 30, no. 3, pp. 138–157.

MCDERMOTT, O., CRELLIN, N., RIDDER, H. M. and ORRELL, M., 2012. Music therapy in dementia: a narrative synthesis systematic review. International Journal of Geriatric Psychiatry. October, vol. 28, no. 8, pp. 781–794.

MCDERMOTT, O., ORRELL, M. and RIDDER, H. M., 2014. The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists. Aging & Mental Health. January, vol. 18, no. 6, pp. 706–716.

NHS EDUCATION FOR SCOTLAND, 2015. The Matrix: A Guide to Delivering Evidence-Based Psychological Therapies in Scotland, Older Adults Mental Health.

RIDDER, H. M., 2011. How Can Singing in Music Therapy Influence Social Engagement for People with Dementia? Insights from the Polyvagal Theory. In: F. BAKER and S. UHLIG, eds. Voicework in Music Therapy: Research and Practice. London: Jessica Kingsley Publishers, pp. 130-146.

SVANSDOTTIR, H. B. and SNAEDAL, J., 2006. Music therapy in moderate and severe dementia of Alzheimer’s type: a case–control study. International Psychogeriatrics. April, vol. 18, no. 4, p. 613-621.

VINK, A., 2000. The Problem of Agitation in Elderly People and the Potential Benefit of Music Therapy. In: D. ALDRIDGE, ed. Music Therapy in Dementia Care: More New Voices. London: Jessica Kingsley Publishers, pp. 102–118.