Presentation from Belinda Sosinowicz, Age Exchange Arts & Health Coordinator which was part of the Cultural Commissioning National Seminar in London on the 6th June 2014. Find out more about Cultural Commissioning Programme. http://www.ncvo.org.uk/practical-support/public-services/cultural-commissioning-programme

1. 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

2. 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

3. 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.

4. 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

5. 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.

6. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. • 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

17. 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)

18. 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 well‐
being, stress and burnout using measures of
Work Environment Scale, Maslow Burnout Scale and General
Health Questionnaire (GHQ12
RAP Measures
SWL, WEMWBS, ONS

19. 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

20. 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?

21. • 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

22. 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‐

23. 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)

24. 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

25. 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. music‐
you can remember your childhood‐ it goes to your soul”

26. 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”

27. 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”

28. 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

29. 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”

30. 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

31. 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

32. 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