Shaping our Age Tools and Techniques. Sharing Principles and Practice of an Involvement-led approach to support older people s well-being

Sharing Principles and Practice of an Involvement-led approach to support older people s well-being Diane Hinchliffe and Chiara Vagnarelli Involvement Workers 2012-2013

Contents Acknowledgements 3 Introduction 4 Part 1: Principles of Involvement 5 Part 2: - Ideas and activities 11 Ice Breakers 12 Discussion Group Activities 17 Creative Activities 30 Evaluation 42 Reference List 44 Appendices 45 Tools and techniques 2

Acknowledgements Thank you to the Involvement Workers for sharing the methods of involvement which have worked for them. Thank you to the older people who took the journey of exploration with our Involvement Workers around well-being and involvement and in so doing were willing to try out something new and different. As a result, they have helped to provide practical guidance on some for involvement-led practice which are the subject of this document. We hope this guidance will be useful to others. Sharing Principles and Practice of an Involvement-led approach to support older people s well-being Written by: Diane Hinchliffe and Chiara Vagnarelli Involvement Workers 2012 2013: Diane Hinchliffe: Chiara Vagnarelli: Elizabeth Walthew: Zenia Wainwright-Melnyk: Kirklees and Sheffield Lancing Scottish Borders Thanet

Introduction was a three year Big Lottery Funded action research project: involving older people in improving their well-being. It was a unique partnership project between WRVS, Brunel University ad De Montfort University from 2010 to 2013. The involvement techniques and activities shared in this document were used in the context of involvement work, to engage with older people around issues of interest and concern to them regarding their well-being. In some cases the activities were further developed in response to participants interests of past, present and future and were a way of supporting personal growth and development; developing new skills; increasing confidence and self-esteem and working towards a shared vision and outcome. It is important to note that what we share here are the principles and practice of involvement which have worked for us, and so are examples for others to explore in developing their own repertoire of skills for involvement. What we present as our experience is not the only way of involving older people. This resource has been produced in two parts. Part 1 offers the reader an opportunity to reflect upon some of the techniques used to encourage involvement, whilst Part 2 offers activity ideas as tools for involvement. There is a useful reference list which refers to books which have contributed to the development of ideas and activities in supporting involvement on different levels. The Appendices provide examples of some of the tools used in practice. 4

Part 1: Principles of Involvement This section presents the approach used by one of the Involvement Workers, Chiara Vagnarelli. She presents her own approach which encompasses many of the techniques and principles common to all four Involvement Workers. The context of the approach and practice used and described here acknowledges that older people often feel invisible. The work of the Involvement Workers was to use an involvement-led approach and practice that clearly acknowledged their visibility. It is difficult for people to feel involved and get involved, if they feel invisible and ignored. Outlined below are some key components of the approach which I used during my local work for in which I worked with a group of older people in a community centre to develop a range of activities and to create a Friends group to inform the work of the centre going forward. Actively engaging with individuals about their lives, their views and their concerns in order to discover more of who they are as individuals; as people Facilitating conversations without being judgemental or censorial Building relationships of trust with the facilitator and also with each other in the group; instilling a confidence which flows from involvement in the group setting into one to one relationships Allowing time for the person to emerge 5

Part 1: Principles of Involvement Techniques for Involvement 1. Making Initial Contact and Encouraging Engagement Distributing postcards and information within the local community (see Appendix 1.) Visit existing groups: listen, observe, and join in with practical tasks, e.g. making and serving tea/coffee. Be seen in communal areas. Help existing staff and volunteers with setting up and clearing up activities. Engage individuals in specific conversations about their lives, seeking openings into conversations surface questions initially i.e. how often do you visit the centre/group/activity to more in depth questions what was your job before you retired/ do you work/volunteer now? e.g. find areas of interest to the individual/ shared by group. Respond to questions about your life, within reason. Use your emotional intelligence and observation of body language/eye contact when someone looks like they clearly do not want to continue the conversation, let go. Always acknowledge individuals you have spoken with before. Show your active involvement and genuine interest in the group/activity/centre. 2. Building trust and developing relationships Take the time to have meaningful conversations with individuals and follow up opportunities to carry on the conversations on a regular basis. Show that you enjoy the conversations and that you are open to them. Work on being non-judgemental and challenge your own assumptions. Use active listening skills pay attention to what s being said by giving your full focus to what the other person is saying. If there are distractions around, try and move to where there is less distraction. Listen to the other person s body language. Show you are listening and understand what the other person says through your own body language, through reflecting back what the other person is saying and asking questions to clarify your understanding. If the conversation is taking up too much of the time you have available, be 6

Part 1: Principles of Involvement honest and explain, but suggest another time to continue the conversation. Encourage the individuals who you start to develop relationships with, to use their own skills in building trust and developing relationships with others. Ask individuals for help with what you are doing whether it is in the general context of your role or specific practical tasks, like publicising a meeting or activity, introducing you to some other service users. 3. Organising meetings - take into account individual and group needs Times of meetings People have to travel either by foot, bus or car and it all takes time - to and from the meeting. Some individuals may be carers and have to get another person up and ready in the morning, some individuals may rely on lifts/pre-organised transport to meetings, some individuals may have religious commitments which could impact on their availability at certain times in the day. Consider the afternoon concentration slump before setting late afternoon meetings. Ensure meetings do not exceed two hours and provide half way refreshment breaks. Access Mobility may be an issue so make sure the venue is fully accessible and close to transport links. Ensure other access needs are met: hearing loops/sign language interpreter/ translator/translated documents/other access support. Ensure the room is set up with no obstacles or narrow entrances or chair aisles. Ensure lighting, heating, ventilation, seating are comfortable, adequate and in good working order. Administrating and publicising meetings and involvement Encourage group members to be involved in designing and producing the content of publicity and any other marketing materials. Look within the group for anyone who has skills and/or experience in graphics, producing publicity, or marketing materials and ask for their help or encourage them to take on key tasks. Ensure all publicity, presentations and documents for meetings are in a simple friendly format, using interesting and inclusive images, are short and to the point, in clear large font 14 at least, and that the format is not cluttered with information or images. Information should Invite rather than tell or patronise 7

Part 1: Principles of Involvement (see Appendix 2). Send meeting reminders to all individuals by post for the first few months and in an invitation or flyer format rather than a formal letter. Poor memory may be an issue as well as observation skills - so telling someone dates and times face to face and putting up posters in regular venues is not enough. Then keep to a regular time of the month and time of day e.g. third Wednesday in the month, 1.30 p.m. Some people with particular memory issues may still need reminders sent to them. Meeting notes can be arduous and boring to read. Consider producing a newsletter, one or two sided, with contained blocks of key information and interesting news. (see Appendix 3) Encourage the group to publicise the meetings by word of mouth as well as via flyers. All these processes can over time be assimilated into the way the group works with each other and others and provide a framework for the group to selforganise. 4. Meeting/group facilitation Allow the group to settle in before commencing on focused discussion, tasks or activity this could include, moving room furniture around to suit new individuals, participants having casual conversations and refreshments. Create a space for the meeting to commence with a welcome followed by an informal review of the last meeting or activity. At the first meeting, invite the group to develop codes of conduct, which may include e.g. listen to each other without interruption, be non-judgemental, be open to new ideas, one conversation at a time, encourage each other to speak up within the group, to respect each other s opinions, even if you do not agree with them. This can be referred to during subsequent discussions to aid facilitation. This activity can be carried out by encouraging participants to work in pairs, use post-it notes to record their suggestions or inviting them to add their ideas to a flip chart. Seek a natural break/lull in conversations to bring group focus into the meeting. As a facilitator act as a guide to help people move through a process together. Draw out opinions and ideas of the group members, rather than give your own opinions. Make sure everyone feels comfortable participating, and allow for people who don t want to join in. Some people like to listen rather than speak, but do pick up 8

Part 1: Principles of Involvement on times when they may want to have their say. Build self-esteem and confidence by positive affirmation of members, praising their involvement and contributions to them personally, within the group and other situations, encouraging them to feel good about their contributions. Encourage a sense of ownership by ensuring that they as individuals and as a group are aware that they are key to the process of decision making, and the role of the facilitator is to support this process. The facilitator should always be aware of the need over time to step back from the facilitator role whilst consistently confirming that the group are the decision makers, and that their decisions count. This enables the group to build trust and confidence in the group as a functioning and successful team and in each other as team members. As a result a sense of ownership and responsibility evolves. Look for natural breaks in the meetings. Where they do not occur ask the group when they want a break. Make time for social chats or activities as part of the meeting e.g. with the Lancing group we created a Living our Lives slot where members of the group related cameo life stories. This was the idea of the members and became an essential part of the meetings. Encourage laughter and celebrate good humour and playfulness. If racist/sexists/homophobic comments are made, briefly explore the context, through neutral, non-threatening, non-aggressive questioning and then draw the discussion to a close. Encourage the group to agree that these meetings are not the place for these kinds of comments, reminding them of the group agreement and re-affirm their understanding of mutual respect and equalities. If in your judgement there is a need to explore these issues further, consider developing an activity that explores equalities in more detail, or seek a trainer/ facilitator who can carry this out. 5. Group/Team Development Create a welcoming and caring atmosphere by example. Encourage all to welcome new people to meetings and keep them company throughout. Encourage mutual support by picking up individual member s qualities of kindness, caring and respect and affirm these by reflecting the same qualities back to them and to others who may need support, e.g. at the Lancing SoA group, one particular member, was always first to help another individual with mobility issues, accompanying them to the toilet and helping them to their seat. On one occasion I took on the role when the helper was not available, and the 9

Part 1: Principles of Involvement following week when a new member with mobility issues joined us, a further helper automatically volunteered their support. Look for opportunities to encourage cooperative activities - giving feedback on a piece of publicity, planning a meeting, making tea and coffee, helping each other through giving advice and support for individual issues that are shared with the group. Let conversations between individuals take place, as long as they do not interrupt an on-going group discussion. Notice individuals and give them attention, it is easy to fall into the habit of treating the group as a homogenous entity. Be aware and alert, observing interactions and general group dynamics and look for ways to facilitate situations and group interactions to get the best out of people. Notice how individuals interact outside of the meetings; are they more animated, more confident, or less likely to interact with others? Consider what factors in the environment outside of the group meetings/inside of the group meetings may have helped or hindered the situation, e.g. people may find it difficult, even overwhelming to be in a large group situation, as in their day to day lives they may live on their own and be isolated, only having an opportunity to meet others at the centre/in the group meeting. As one of the SoA group related to me, I sometimes find it difficult to speak or forget how to have a normal conversation. I spend so much time on my own. In this case I ensured over time that I gave the individual practice in having conversations, prioritising opportunities to speak with him and showing an interest in him, outside of the meetings, building up his confidence and his forgotten vocabulary. Openly praise and celebrate individual group members skills, strengths, and ideas and encourage the rest of group to do the same. There were times at the Lancing group where I would suggest a round of applause for something someone had said or done. Always acknowledge an individual s ideas and suggestions, even if they are not popular with the rest of the group. Hold one off review-celebration sessions where the group achievements are considered and enjoyed. Good food essential, music optional. Encourage the development of mutual trust through providing opportunities for group members to work together on a task/rely on each other for help with a task. Enjoy the process and work with group members to make it enjoyable for all. 10

Practical ideas and activities for encouraging involvement The activities that follow are ideas that have been used in encouraging involvement in different settings and offer brief reflections of how they have worked in practice. 11

Ice Breakers Purpose: Bringing a new group together Getting to know names of group members Building relationships Encouraging participation Providing a safe space for all voices to be included Bringing focus to the start of a session To bring laughter and enjoyment into a session Ice breakers can be an important foundation for the future development of a group. Group Size: Any Time: Time taken will depend upon the ice breaker activity, group size, how well people know each other, different ways of communicating within the group, levels of ability of participants. Facilitator role: To be alongside the group and get involved, modelling the activity to encourage involvement To observe what is happening in the group who participates, who needs more encouragement and respond appropriately Be prepared to be flexible to move an activity on / change an activity To get to know individual needs within the group to support future planning To encourage leaders to come forward and share responsibility 12

Ice Breaker Idea 1: My turn to speak! Having fun with introductions The idea: To get to know the names of all group members To give people a space to be involved To encourage all members to have their voice heard in the group Benefits of this activity: Using an object as a prop for my turn to speak encourages group members to listen and respect the voice of other members. Individuals can, on receiving the object, choose to share or pass whilst still participating in the group activity. Useful for encouraging participation of quieter members of a group. Particularly useful in groups where there are difficulties in knowing when to speak and when to allow others the opportunity to speak, encouraging learning of social skills in respecting the voice of others. Resources required: An object e.g. soft toy, stick, ball Instructions for Group members sit together in a circle the activity: The facilitator models the instructions for the activity and holding the object, shares their name and one thing they would like the group to know about them this could be a favourite colour, a pet they have, favourite food. After sharing the object is passed to the next person Encourage the group to decide which way the object will move around the circle clockwise / anticlockwise Other uses: Discussion activities, debates, big questions Activity in This activity was used in a first session in which three groups came 13

practice: together to form one group. Some people knew each other, some did not. Some people in the group had dementia. A soft toy was used as the object around the circle, Henry the Hedgehog, creating space for my turn to speak. This was a valuable tool as it helped to contain the group and stay on task, ensuring that everybody had an opportunity to have their voice heard and become part of the group. The activity introduced laughter, although some people were uncomfortable with the idea of speaking out and passed Henry on after sharing their name. Having a choice of how much to say was important to the process and eventually in developing individuals confidence in speaking out. It was observed that for some people it was an opportunity to have some physical contact through cuddling Henry and could be said to contribute to individual well-being through a sense of pleasure in contact with the softness. Henry became a future part of the group and was always present whether used or not. 14

Ice Breaker Idea 2: The Raccoon Circle The idea: A circle is suggested as a symbolic representation of unity, community, and connectedness. The creation of group circles are said to support personal growth and development. The raccoon circle offers a visual and physical opportunity to bring people together through the creation of a group circle held together by the raccoon. The basic raccoon circle is created from a 12 15 foot length of 1 tubular webbing, knotted into a loop of 4 feet diameter (Climbing rope is also an option). Benefits of this activity: Used at the start of each session, gives a feeling of connection with others in a group, creating a sense of community and belonging; bringing a group to focus on the session ahead. Adaptable and can be used in different ways, for exploration of many different themes and topics. Raccoons can be made up of different sized circles for different group sizes. Resources required: Raccoon Circle Instructions for Choose a theme for the purpose of the circle e.g. the activity: introductions, what I hope to get from this session, letting go of the events of the day Group members, standing or sitting, hold on to the raccoon circle. Members are invited to share as they wish, in their own time The raccoon can be moved around the circle and the knot holding the circle together can be used as the point from which to speak and share Other uses: Bringing a group back together for ending of a session: 15

creating a space for informal reflection / evaluation of the session sharing information / instructions for the next session checking out - leaving behind final thoughts, questions in preparing people to depart to their home / next setting See: The Book of Raccoon Circles by Dr Jim Cain & Dr Tom Smith Activity in practice: The raccoon circle was introduced to a group in their second session and became an essential part of the start of each session, bringing the group together and giving some focus to the session ahead. Generally the focus would be the question: what do you want to achieve from this session? Initially the raccoon circle was simply held, with people who wanted to, taking the opportunity to share something. Eventually the group decided to start working with the movement of the knot around the circle, so that everybody was involved in sharing something. The group moved on to using the raccoon circle again at the end of each session as a closing reflection of how people felt, what had been achieved. The philosophy of the circle as a symbol of unity and connectedness has been borne out with this group. On one session where the raccoon circle was not available the group decided, in maintaining their usual coming together at the start of the session that they would join hands. One member of the group, a lady with dementia, was particularly impacted by the physical contact with other people, stating that it s not very often someone holds her hand. The group have adopted the idea of the raccoon circle and are considering how to use this in future in groups they might lead. 16

Discussion Group Activities Purpose: To invite participation and involvement of individuals in exploring key and relevant themes to the group Group Size: A group of 6-10 people is a good size for widening the discussion, whilst still manageable and allowing opportunity for all members to participate. If working with larger groups e.g. up to 20 people it would be beneficial to introduce some activities which can be completed in pairs and or small groups of up to five people, who then report back findings to the large group to encourage a wider discussion. Time: 45 minutes to one hour is a useful time limit for discussion based activities. However, this will be very much dependent upon the activity focus, the size of the group and the participants engaging with the activity. Facilitator role: To introduce the theme and instructions for the session It is useful at the beginning of discussion group sessions to agree ground rules with the group, in creating a safe and inclusive environment for participation and discussion e.g. allowing people to speak, respect that others might have different opinions, listening when others are speaking To observe involvement levels and encourage quieter members to participate e.g. inviting them into the discussion by their name and asking what they think, whether they have anything further to add what do you think about that Suzy? Be sensitive to individuals who have difficulty talking in large groups try not to put people on the spot whilst inviting them to join in. Encouraging participation in pairs work and small group discussions would be a good starting point Be creative in finding ways to involve those people who are quieter in a group setting maybe invite them to write the flip chart, or read a question out again be sensitive to people who 17

might struggle to read or write. What other tasks might people be able to support in encouraging their involvement? Use open questions: why, what, when, who, where, how, and follow on questions: can you say more about I m wondering how you felt when and then what happened to develop the conversation and / or encourage individuals to share more of their viewpoint / story. 18

Discussion Group Activity Idea 1: Three Little Words The idea: An opening activity to encourage early participation and sharing of own ideas Benefits of this activity A simple activity to bring a group together which allows for participation of all group members from the outset and can be kept anonymous. Everybody s thoughts contribute to the whole. Responses shared can be returned to later in a session and used to create further discussion. The idea of asking for three words contains the activity, creates a focus for people s thinking and reduces anxiety / overwhelm for people who struggle to share their thoughts. Resources required: Post-it notes Pens Flip Chart Paper / Lining paper Blue Tack Instructions for Decide on the theme to be explored the activity: Create a heading for the flip chart which is placed around the room (on the wall or on the floor) e.g.: What does well-being mean to you? Give everybody three post-it notes and a pen Ask the group to write three words on separate post-it notes, in response to the theme e.g.: Write one word on each post-it note in response to the word well-being and stick on the flip chart paper. Other uses: Informal evaluation - create headings focused on areas to be evaluated. Ask participants to share three words under each of the headings e.g.: 19

How do you feel now? What have you enjoyed most? What have you learned? What do you need to know now? Words generated around a theme can be a starting point from which to build on through creative activities e.g. create a group poem. Activity in practice: This activity was used as an introduction and starting point of a focus group session exploring well-being using the question: What three activities do you enjoy doing most? The activity brought people into the session, encouraging early involvement, and reflection, and enabled some people in the group who might not usually participate to do so, building confidence for further contributions. From this simple activity the group were able to further develop their ideas and discussion around the theme of well-being. For some individuals in the group, the activity raised their awareness of things they used to do and were no longer involved in. This then encouraged further discussions about why this might be, what were the barriers, what were they doing different / instead of, how might this still be part of their life it they wanted it to be? 20

Discussion Group Activity Idea 2: Ideas Bank a thought shower activity The idea: A session which encourages the development of ideas/suggestions for activities The aim is to derive answers to the following questions: What activities do they enjoy and make them feel good? What other benefits do they gain from taking part in these activities? What activities continue to benefit them? What new activities do they think would benefit them and others? Benefits of this activity: The activity provides a free, friendly, and open environment that encourages everyone to participate. The activity can be used as a starting point for developing a group s time together. It gives an opportunity for all participants to voice what is important to them and encourages negotiation in agreeing a shared plan of action / activities. Taking an active part in the activity can build confidence and ownership in the process and in the group. The activity allows a free flow of creative ideas and solutions, increasing the richness of ideas explored. This is a simple and fun activity, and can help group members to bond as they explore ideas and solutions together. Developing ideas with practical solutions helps to affirm the role and purpose of the group. Resources required: Flip Chart Paper / Pens Depending on negotiation and agreeing methods: Ballot box, pens and slips of paper Flip chart paper with ovals/speech bubbles drawn on to it, 21

Some ideas ready prepared to instigate and warm up discussion if needed. Instructions for Invite the group to work in pairs and share with each other the for the activity activities they enjoy doing and how they think they benefit from doing them. Bring the group together and share the ideas/benefits they have discussed and write to flip chart paper Invite the group to consider which of the activities they think other people would enjoy and benefit from, and to prioritise the ideas they have identified Encourage the group to work together in agreeing the ideas / interests to be adopted by the group. Options for negotiating and agreeing a shared goal might include: a show of hands or a traditional voting ballot method, using slips of paper and a box in the middle of the table. Other uses: Ideas banks are a good tool for developing new groups and for reviewing and agreeing further plans with existing groups in supporting their further development. Activity in practice: One project used this method as a starting point for developing a programme of activities for the group over a number of weeks (see outcome of process at Appendix 4) 22

Discussion Group Activity Idea 3: Big Questions The idea: Named purely for the size of the font on the question, created as individual questions that can be read out by members of a group to encourage involvement (Font Size approx. 36-48). Themes explored using Big Questions : Well-being Getting involved Needs of people in hospital settings Dementia awareness Benefits of this activity: Questions can be read out by different members of the group encouraging different levels of involvement. Subjects can be wide and varied. Encourages group sharing and discussion. Resources required: A set of individual Big Question cards devised around a key theme (font size 48). The number of questions cards created will depend on the size of the group, the time available and the theme to be explored e.g.: Exploring Well-being: What does the term well-being mean to you? What is important to you in your life right now? What do you do that creates a sense of well-being in your life? Flip chart and pens for recording key points from discussions The communication skills of the facilitator are a key resource in helping people to expand on their conversations and generate more discussion within the group e.g. use of open questions, clarifying, and follow on questions. Instructions for Invite participants to volunteer to take a big question and read the activity: out to the group 23

Encourage discussion in exploring the question. Use open questioning, paraphrasing, and clarifying, when necessary in encouraging the conversation to develop and in bringing quieter members of the group into the conversation Write key points on flip chart In closing the session, reflect back the key points discussed Other uses: Focus group discussions Informal review and evaluation discussions after a series of activities to explore the impact of the whole experience upon individuals. Images or symbols can be added to the Big Question card to support communication of people who have difficulty with reading. Big Questions can be used in sessions with groups using themes of interest to them e.g. reminiscence: Let s talk about Christmas Let s talk about bonfires Activity in practice: This activity has been valuable in different settings, exploring different themes. The format has allowed people to feel involved through reading out the questions, or taking notes on behalf of the group, or feeding back the group ideas generated in small group discussions to the bigger group. As a result of involvement in this activity some people have developed more confidence in speaking out in groups. The activity has also been used as a starting point for generating words which are used in a creative activity such as creating a poem. One group used this idea to develop a discussion around dementia in raising awareness of dementia in outreach workshops. They developed four key questions for a Big Questions discussion session of around 45 minutes: What do you think is the potential impact for someone on receiving a diagnosis of dementia? What do you think is the potential impact for a carer when a family member or friend receives a diagnosis of dementia? 24

Where would you go to get help and information about dementia? How do we help people living with dementia to feel confident and stay active and involved? 25

Discussion Group Activity Idea 4: Quiz Time The idea: To explore a key theme through an interactive method which encourages movement, discussion and opportunity to explore and challenge perceptions and values e.g. dementia Benefits of this activity: A quiz can be as short or as long as is required for the time available and can be used flexibly in response to the needs of the group (see ideas suggested in other uses part of this activity) A quiz can be a starting point for encouraging involvement in wider discussions. Resources required: Quiz questions (and answers!) Materials to support the delivery method e.g. True/False/Don t Know cards; answer sheets; hula hoops Instructions for True/ False Quiz the activity: Introduce the activity and how people will be involved e.g.: The quiz will help to raise awareness of. and help the group to explore together The quiz will involve people moving from one option to another in response to the question true / false / don t know After each question, each group will be able to share with each other and the other groups why they have chosen that response Read out each question and allow time for movement to the chosen response Encourage groups to discuss their chosen response amongst each other and across groups Bring the group back together to share one important message that stands out for them 26

Other uses: Flexible idea to explore any theme. Depending on the group, other options for delivering a True / False Quiz include: Quiz papers completed as an individual or in pairs and then responses shared and discussed with the larger group A gentle seated activity: To hold up True / False / Don t Know cards in response to the question A physical activity: To have hula hoops around the room as True / False / Don t Know areas participants run to get into the hoop which responds to their answer Activity in practice: A True / False quiz was designed by one group as a way of raising awareness of dementia. The activity encouraged discussions and highlighted information not known or considered by some of the participants e.g. the scale of dementia, the impact of dementia on carers. 27

Discussion Group Activity Idea 5: Let s Talk About The idea: To bring older people together in a relaxed environment, encouraging conversation, discussion, and friendship. Benefits of this activity: The activity encourages people to talk to and listen to each other about issues of interest and importance to themselves as individuals and also as a group. A focused activity which can help to build relationships that can continue beyond the discussion setting. Resources required: Prompt questions for agreed theme / topic Memory boxes as relevant to support reminiscence conversations Topic ideas: What is old? 1950s New Technology Seasons of the year e.g. Bonfires, Christmas (see Appendix 5 for suggestions for prompt questions) Instructions for Bring people to sit together in a circle the activity: Set ground rules to create a safe environment for open discussion Introduce the topic for the discussion and set the first question Use open questioning, paraphrasing, and clarifying, when necessary to encourage the conversation to develop and bring quieter members of the group into the conversation. Other uses: As a reminiscence activity this can provide a good starting point for leading groups into more practical activities as they are reminded of things they used to do and would like to do again. 28

Activity in practice: This activity was delivered in one social centre where older people gathered yet rarely came together and spoke with each other. The activity brought together volunteers in the centre and the service users. Those not participating were encouraged to add their views by the service users who had the confidence/interest to contribute. There was considerable affirmation of any given person s view by others. One of the volunteers was a quiet young man with some learning difficulties but the group members were considerate of this and encouraged him to give his view from a different age perspective. The other volunteer was an older person herself and contributed in a way which helped the discussion, and also sensitively challenged some of the older people s views, which meant that the older people had to think more and justify their original statement. This was good for the discussion. After the sessions ended the older people continued to talk quite animatedly about the various topics with each other while they had their tea and waited for their drivers to arrive. Discussion sessions became a regular part of the involvement activities and were a good starting point for developing relationships and reducing isolation amongst the older people during their time at the centre. Through involvement in the discussion activity, some participants grew in confidence. In a sheltered housing setting, a Let s Talk About Christmas session led the group to plan a coffee morning for other residents, with mince pies baked by members of the group. Both these examples evidence how bringing people together to share conversation can reduce isolation, develop confidence and lead groups to develop ideas for other activities they can be involved in. 29

Creative Activities Purpose: Involvement in creative activities can remove barriers and support communication where it might otherwise be difficult. Creative activities can provide a relaxed and therapeutic environment from which to explore deeper feelings about issues of importance to an individual. Creative activities can stimulate thinking and help progression on to other ideas. Creative activities can offer a different dimension to group work and invite shared working, laughter and help build relationships between people. Group Size: Any: 1 to 1; Pairs; Small groups and Large groups Time: Dependent on the activity from 30 minutes to 1 hour of time Facilitator role: To promote and create a safe environment for a can do approach (many people are fearful of creative activities as a result of past understandings about what they can and cannot do e.g.: art, singing, performing) To encourage involvement To participate in modelling participation and being alongside the individual s / group s process To help with ideas by asking open questions about what is being created e.g.: questions which start with why, what, where, how, when To give positive feedback To be non-judgemental 30

Creative Activity Idea 1: Collage The idea: To create a collage to give voice to feelings and ideas in relation to a specific theme. Themes explored through collage: What does well-being mean to you? What is meant by involvement? If my well-being was an image what would it look like? Benefits of this activity: This is a visual activity and brings people s feelings onto paper in front of them which can sometimes support communication. The activity can be a combination of words and images either provided by the facilitator or researched by the participants from available magazines and newspapers. Collage allows creation of a message without participants feeling they need to be able to draw / be good at art, thereby removing barriers to involvement in creative processes. Resources required: Large thick paper drawing / lining paper as the base for the collage Images, words already taken from magazines etc Magazines, newspapers Scissors Glue Thick felt tip pens Crayons Instructions for Invite participants to take the resources they need to create a the activity: collage based on the chosen theme Allocate agreed time to create collage 31

Bring individuals back to the large group to share their collage with others Other uses: Different themes for collage work: This is me My interest and hobbies Hopes and dreams Activity in practice: Collage has been used as part of a focus group, encouraging reflection, and further discussions exploring well-being and involvement. This was a useful activity with people with dementia, enabling them to represent their thoughts on paper to share with others in the group. Participants have undertaken the activity as individuals, in pairs or small groups. Participants have said they enjoyed being creative reminiscing about being creative as a child at home / at school. Most participants found the activity relaxing and helped them feel involved. 32

Creative Activity Idea 2: Metaphor The idea: Using metaphor can be a valuable tool for enabling people to explore their feelings and can be combined with collage, art work or used as a way to give voice to aspects of self which are easier to share if expressed in the third person e.g.: If I was a colour I would be. because stands for.. If my well-being was a colour, a taste, a smell, sound it would be If I was a form of transport I would be Benefits of this activity: Metaphor takes the focus of the discussion outside the person and in doing so can reveal new information for the individual involved. Metaphor explored in small groups, can be a starting point for further discussions in larger groups. Metaphor can be a lead into other creative activities e.g. creating poems, collages, art work. Resources required: Drawing paper of different sizes A6, A4, A3 Selection of coloured pens, crayons, pencils, felt tips, pastels Resources to support explorations using the senses e.g. things that smell, taste, sound, can be felt / touched with texture. Flip chart paper and pens Images Instructions for Introduce the theme for the metaphor the activity: Invite participants to play with the ideas in pairs, in a small group Depending on the format of the session: Invite people to verbally share their metaphor response Invite people to create their metaphor on paper Invite people to write words on paper 33

Other uses: Can be used as a fun ice breaker to start a session e.g. My name is. If I were an animal I would be. because. Can be used at the end of a session to highlight learning achieved or raise awareness to further learning e.g. If I was a form of transport I would be a bus as I feel I am on a journey with lots of other people. Images can be used as metaphors to encourage exploration and conversation in sharing an individual s personal story, feelings, and meanings. Activity in practice: Metaphor has been particularly useful to support the communication of individuals. In one example, working with a person with speech difficulties, they were able to give voice to feelings and response through colour on to paper; focusing on the question If my well-being were a colour what would it be? The focus on the drawing enabled the person to feel less selfconscious with their speech and as a result freed up thinking and the verbal response. The experience also highlighted something for this person which had been unveiled in the process and brought into awareness for reflection. Metaphor proved useful in working with people with visual impairments. The focus of the activity was the senses of smell, touch, and sound in relation to well-being. People worked together in small groups on one sense area. The activity enabled involvement, reminiscence, and awareness raising. A consensus in discussion highlighted that our well-being is impacted by our experiences in our internal and external environment felt through the senses. A poem was created as a further expression from the words generated by the groups. 34

Creative Activity Idea 3: Poetry Creation The idea: To create poems to express key messages in a different way. Sometimes creating messages of power and impact. Benefits of this activity: Can be used in 1 to 1 situations to support communication and be a model of advocacy in raising awareness of a personal message i.e. with people with dementia. A good group activity in producing a shared message and can build confidence in talking in groups, through reading poems together. A powerful way of sharing feelings about an issue of importance to an individual or a group. Resources required: Pens Paper Crayons, felt tips etc. Instructions for Work with the group to decide on the theme for a poem the activity: Decide on the starting point for the generation of words e.g. Three Little words activity, Metaphor, Big questions Working with the group, select the most important words which reflect the message they want to get across Invite support from the group, bring the words together to create a pattern of verse which flows from sentence / word to another Other uses: Sharing poetry: Prior to the session individuals source poems of meaning to them for the group session. Poems are read out by each person to the group which generates a discussion about meaning, feelings, and memories. This introduction to poetry can be a starting point for encouraging the group to create their own poems as individuals, pairs or as a group. 35

Activity in practice: Poetry has been used on several occasions as a creative way of getting a message across: A group of people with dementia were supported to create a poem to highlight what would be important to them if being admitted to hospital. A poem about friendship was created in another setting and displayed on a poster as a way of bringing people together to form a group. A group who are raising awareness of dementia have used poems as a way of expressing their feelings and impact of dementia, as a person living with dementia or as a carer. A group of people with sight impairments shared words to highlight their senses and the impact of these on well-being. A poem was created from these words to review what had been shared and experienced. (See Appendices 6, 7 & 8 for a sample of some of the poems produced by these groups) 36

Creative Activity Idea 4: Creative Thinking The idea: To create a free space to open up thinking in developing new ideas. Benefits of this activity: The free flow thinking process can help participants to bring into consciousness ideas not previously considered. This is an involving relaxed process which in itself can generate more involvement. This can be an activity of different rounds, each of them focusing and refocusing on words to help a group to reach an agreed outcome, e.g. to agree priority areas of interest. Resources required: Flip chart paper and different coloured pens Instructions for Introduce the activity idea and purpose of the activity to the the activity: group: This activity is one way of opening up new ideas and is a model of word association. One person says a word and others follow with whatever words come up for them. This will be an activity in different rounds to focus and refocus on words shared to reach an outcome. It is important that this activity is completed without judgement or analysis of the words being shared. Encourage the group to sit comfortably, invite people to close their eyes if they feel able and create a space in which they feel able to relax: Take some deep breaths and allow your body and mind to relax letting go of everything that comes into your mind Three deep breaths and release Allow your body to relax starting from your feet squeeze each part of your body and release feet, calves, thighs, up the body. tummy, shoulders, neck, arms, hands - notice any tension in your 37

body with every in breath - squeeze it out and relax See if you can imagine a blank piece of paper where you are going to write some words.. Round 1): Once people are relaxed, choose a word to start with e.g. paper, and encourage the group to freely offer the next word that comes to mind. If the word flow stops, allow a short silence to see if something else emerges and then introduce another word into the group. The process continues until the first round of the activity feels exhausted. Round 2): Invite a volunteer from the group to quietly write down words being shared. Start with a word shared in round 1 and continue with the same process. Round 3 / Round 4): In moving to an agreed outcome, use the words already shared and continue with the process this time, reading out each of the words slowly participants respond with Yes, if the word has a sense of importance for them or creates a feeling within them. The person writing underlines each of the Yes words to start the process of filtering out some words and focusing on those of importance. The results of these processes can help formulate ideas for further creative activities. Some starting word suggestions to support this activity: Day Cat Picture People Sharing Bright Dancing Paint 38

Other uses: The activity can help people / groups who are stuck in their thinking about a particular issue or theme, to highlight other ideas. The activity could be a starting point for generating words to a poem. Activity in practice: This activity was used with a group of people who wanted to find different ideas for raising awareness of dementia in their local community. The creative process highlighted the following initial ideas agreed upon to present their vision: Paper aeroplanes with messages on: Hand Prints: Foot Prints: Post cards: Letters: Posters: Poetry From this experience the group developed their ideas further and: created postcards with hand and footprints on along with messages to raise awareness of dementia created poems as messages of the impact and experience of dementia from different perspectives developed a quiz developed a hand painting workshop for others to experience WARNING: This activity can be emotional so be sensitive to what arises for people in this process and be prepared to respond with support. 39

Creative Activity Idea 5: Hand and foot painting The idea: To have fun with paint in creating a picture either as an individual or group, supporting the reflection of everyone being different and unique. Benefits of this activity: This is a fun activity, which is messy and encourages people to play and create together. As adults we often forget to play and can feel uncomfortable with the idea, so this requires a sensitive approach to involvement. Resources required: Paints Brushes Paint Pots Crayons, felt tips Washing up bowl Soap Paper towels / towels A4 Drawing paper Plastic sheets to cover tables Instructions for The instructions for this activity are taken from a workshop which the activity: has a focus on raising awareness of dementia. This activity forms part of a reflection of learning generated through other activities about dementia the idea can be adapted for other themes. Gather people around the activity table Introduce the activity and how people will be involved: The purpose of the hand painting is to remind us that just as every hand print is unique so is an individual s experience of dementia. Each person in the group will create their own picture of their hand print and we invite people to add a comment or a slogan which they feel gets a message across about dementia. To help the group get thinking about their messages, invite discussion around the following questions. 40

Discussion questions: From the activities involved in so far, what have you learnt about dementia? What message would you want to get across to others? Record responses on flip chart to support creation of statements for hand prints. From the recorded responses, encourage the group to identify the most important messages and highlight them. Invite the group to write their chosen statement into the thought bubble - this will be the slogan for their hand print (if preferred people can choose from the samples available). Let s Paint - don t forget to add your slogan to your hand print. Bring the group back together to share their hand prints and messages and a general discussion about their learning / experience. Other uses: This activity is valuable for creating a reflective space for people to consolidate learning and could easily support a theme of selfexploration in building confidence and self-esteem of individuals: e.g. This is me The activity could also be a group exercise as a different way of getting messages around a key theme across to others; this could be further developed by including music, dance, and movement into the creative process. Activity in practice: This activity was designed by a group as a reflective workshop and another way of opening up discussion around dementia. Participants were initially resistant to play but enjoyed it once they got involved. The activity appears to create a safe space in which relaxed discussion can occur to explore the theme. 41

Evaluation Purpose: Voice and influence To seek informal and/or formal feedback from participants in shaping and developing future ideas together. Group Size: Any Time: Dependent on whether an individual activity completing a paper based questionnaire or a group activity open big questions discussion. 10 minutes to 45 minutes Facilitator role: To seek feedback as a way of monitoring the work / the service To process responses with relevant people / managers Feedback to participants on how their evaluation has influenced change Informal Evaluation Ideas Useful at the end of each session to monitor people s experience and to learning about any gaps that could be addressed in future sessions to influence change. See ideas: Racoon Circle See page: 15 Three Little Words See page: 18 Big Questions See page: 22 Bin, Bag, Heart An evaluation method which is informal and allows thinking around 4 key areas: What are my feelings about today s activity? What would I like to know more about / what other activities interest me? 42

What am I taking away from my experience of being involved today? What aspects of the activity today have I not enjoyed and why? This can be completed as an individual worksheet so you would need work sheets and pens for completion (see Appendix 9). Alternatively the 4 questions could be placed individually around the room and people write their responses on flip charts and add to the relevant questions. Formal Evaluation Ideas Formal questionnaires provide both qualitative and quantitative feedback of the experience and in the case of highlighted the impact of involvement upon an individual s wellbeing. Individual activity based questionnaire See Appendix: 10 Impact of group involvement questionnaire See Appendix: 11 43

References References Useful reading for creative involvement ideas Barber, L. (ed.) (2007) Penguins Poems for Life. London: Penguin Books Burns, G.W. (ed.) (2007) Healing with Stories: your casebook collection for using therapeutic metaphors. New jersey: John Wiley & Sons, Inc Cain, J, Ph.D. & Smith, T, Ph.D. (2002) The Book of Raccoon Circles. Oklahoma: Learning Unlimited Cooperation Chia, S.H. et al (2011) Group and Individual Work with Older People. London: Jessica Kingsley Hartley, N. & Payne, M. (ed.) (2008) The Creative Arts in Palliative Care. London: Jessica Kingsley Killick, J. & Craig, C. (2012) Creativity and Communication in Persons with Dementia. London: Jessica Kingsley Macmillan, A. (ed.) (2010) A Little, ALOUD. London: Chatto & Windus Platts, D.E, Ph.D. (1996) Playful Self-Discover. Scotland: Findhorn Press 44

Appendices 45

Appendix 1 Appendix 1: Marketing Tool for Involvement Workers Postcard It was important for the Involvement Workers, in their early profile building and raising awareness of the work of, to have a source of information that would invite attention and provide key contact details for further involvement. It was decided that a Postcard would be an effective tool as it would be able to include a short overview of the work and could be distributed within local community settings in raising awareness. The size of the postcard meant it was more likely to attract attention than a business card. 46

Appendix 2 Appendix 2: Poster advertising a Gentle Exercise Session GENTLE EXERCISE A fun, friendly and relaxed class HAPPY HEART A WEEKLY SESSION with Julia Owen Starting Thursday 16th August 10.30 11.15 a.m. S E A T E D E X E R C I S E F O R A L L Followed by refreshments 3.50 per session. WRVS Chesham House, 124 South Street, Lancing. For more information call : 01903 854 640 WRVS in partnership with Brunel University and De Montfort University 47

Appendix 3 Appendix 3: Project Newsletter DECEMBER 2012 Dear all, Welcome to the Friends of Chesham House newsletter update! At our November and December meetings we chose this title for the group that meets once a month. We also worked on a list of aims for the group. To summarise, the focus of the group will be to steer and support the work of the Chesham House Centre and its role in enhancing the lives of local people. Please see below, a list of dates for December activities. Best wishes, Chiara Lunch Club Christmas Lunch Wednesday 12th December 12.00 1.30 pm Bingo Wednesday 12th December 1.30 pm Reminiscence Group, Friday 14th December 10.30 am 12.30 pm Christmas Mince Pie Morning, Wednesday 19th December 10.00 am - 12.00 pm with raffle draw at 12.00 noon. Please bring a friend or neighbour, it s a chance for them to find out about the Chesham House centre and its activities and services. Self-Help Computing session Wednesday 19th December, 1.30 3.30 pm Gentle Exercise, now every Monday starting at 10.00 am Scrabble, Thursdays & Fridays 2.00 4.00 pm We wish you a Merry Christmas and a Happy New Year. WRVS in partnership with Brunel University and De Montfort University 48

Appendix 4 Appendix 4: Ideas Bank Ideas bank for SoA group June 6, 2012 IDEAS BANK Trips Out Local Outings by bus and mini bus to local towns Singing Group 7 8 Basic Computing Keep Fit 6 Gentle exercise 7 Cross Stitch /Sewing Debating Forum 3 4 Book Club 2 Giving Something Back Volunteering to do something at Chesham House, e.g. tending the garden area. 1 49

Appendix 5 Appendix 5: Let s Talk About Ideas - - Topics and Prompt Questions 1) Topic: 1950s reminiscence Resources: Museum memory box, items and discussion questions including: o An old radio, model Morris Minor, 50s dresses, newspapers, a photo journal and scrapbook, fact sheets 2) Topic: What is old? Prompt questions: At what age do people become old? Is being old a quantity or a quality? Do you prefer to hang out with other older people or with young people? What do you think is the best age to be? Why? Are old people out- - of- - touch? In Russia, China and many other countries, there is a tradition of choosing leaders who are advanced in years. Do you think that older people make better leaders? Are young people generally more selfish than their parents and grandparents? Should people of between 60 and 65 be obliged to retire from their jobs in order to make way for younger workers? Are there many things that the old can teach the young? The part women play in our society has change a lot in your lifetime. What are your views on this? 3) Topic: New Technology Prompt questions: Do you own a mobile phone? If so, what do you use it for and why? Do you own a Computer? If so, what do you use it for and why? What invention do you think has had the greatest impact on society? Why? What do you think of dating people dating over the Internet? What do you think the world will be like a hundred years from now? Do computers save time or do they just make us waste more time? How has the Internet changed the way you live? Are there some things that never should have been invented? What are they and why? How has technology affected the way we fight wars? Do you think it makes war more or less humane? In what ways has technology improved our lives? In what ways has it made life worse? 50

Appendix 6 Appendix 6: Friendship Group Poster Something different to do? Monday Friendship Group! Friendship is Companionship Talking together Being together Sharing a problem together Laughing together Going out together Playing together Friendship is Helping each other Confiding in each other Always there for each other Being available for each other Taking time out for Tea, coffee, cake.. and Friendship Join Diane your Involvement Worker for Kirklees See you in the Lounge at Sycamore Grange Monday 22 October 10:30am to 11:30am Friendship is Doing something different together 51

Appendix 7 Appendix 7: Today I m also me a carers perspective Today I m also me At the time of diagnosis We felt completely all alone No sense of who to turn to or from whom support would come The journey can be challenging Feeling lonely, loss of life Courage required and energy and strength to fight the fight Everday becomes a challenge Different, from one day to the next No one to make decisions with or share your plans ahead A loved one changed by illness No longer known by you A carer needs great patience Someone to understand Someone to sit and talk with Someone to hold your hand It s important as a carer To do the things you want to do To have a little me time and someone to talk with too Someone to meet for coffee To go on outings with To be with friends and family and to share a cup of tea Today I am a carer Today I m also me Kath: Darnall Dementia Awareness Group 2013 52

Appendix 8 Appendix 8: Poem My senses, my well-being, me My well-being, my senses, me My well-being smells like coffee reviving and uplifting me like flowers gently blowing in the summer breeze making me feel better life s worth living The ocean freshly washing around and over me cow muck, nature, grass and trees feeling good, calm, comforted at peace with the world 53

Appendix 9 Appendix 9: Bin, bag, heart evaluation sheet What are my feelings about the activity I have been involved in today? What would I like to know more about / what other activities interest me? What am I taking away from my experience of being involved today? What aspects of the activity today have I not enjoyed and why? SoA Involvement Activity Evaluation Diane Hinchliffe 54