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Cultural Commissioning: Year 1 Case Studies

Introduction

Reading’s Great Place Scheme, “Reading, Place of Culture”, includes a Cultural Commissioning Programme which is focused on supporting local organisations to develop cross-sector partnerships in order to engage the community’s most marginalised and hard-to-reach groups, and to provide genuine social, health and well-being impacts.

Three exciting programmes were funded in year 1, taking place between July 2018-2019. Each programme followed its own timeline, based on bespoke participant, partner and evaluation needs. They all began with an Action Research and Story of Change session. In addition, all three projects developed a joint Action Research question to explore during the course of their funding. This was:

“How can partnerships with arts, culture and heritage enhance existing services for disadvantaged participants?”

The Cultural Development officer managing the Cultural Commissioning Programme facilitated quarterly action research meetings, which culminated in the below case studies. In keeping with the principles of Action Research, the aim was to change practice by learning through experimentation, and to value participation, self-determination, empowerment through knowledge and change. The regular meetings took place in order to continually reflect on observations, implement change, and track what works and what doesn’t. Action Research reframes failure as an integral part of change and aims to improve professional practice through continual learning and progressive problem solving.

This document contains three programme snap shots to showcase the work and what has been learnt.

Background

Reading Borough Council, Reading UK CIC and Reading University are jointly leading on Reading’s ‘Great Places Scheme’, an initiative that links several national funders, to promote a significant improvement of arts, culture and heritage activity in a specific location.

Reading’s project ‘Reading, Place of Culture’ works across three main strands, aiming to make Reading a better place to live, work and visit, through high quality arts, culture and heritage activities across the Borough.

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Reading Place of Culture has finished its first year of activity and with three key strands each working in different ways to ensure that arts, culture and heritage is at the heart of planning and thinking for the town, there have been some fantastic successes. New partnerships have been forged and significant learning has taken place which will inform the project in future years and benefit the wider arts, culture and heritage landscape.

The programme so far has fostered new connections between public, private and voluntary sector organisations, supported existing organisations to increase their capacity, delivered new services and fostered new relationships with funders, partners and other organisations. It has also gathered highly valuable research from local people about their thoughts and feelings, engagement and participation in arts, culture and heritage in their town.

The Reading Cultural Commissioning programme aims to mainstream the commissioning of cultural activities for social outcomes in two ways:

• by making public service commissioners more aware of the potential for arts, culture and heritage organisations to deliver effective interventions around their priority outcomes

• by enabling the arts, culture, heritage and voluntary sectors to better engage with public sector commissioning

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Case study 1: Alana House

Alana House provides an inclusive and non-judgemental space for women. They are supported, and enabled, to address particular behaviours and assess life circumstances that may have put them in a vulnerable position or at risk of offending. Women are offered information and support in line with the nine pathways to reducing re-offending to help empower them to make positive life changes, develop new skills and create new opportunities.

The project aimed to:

• Build self- confidence, self-worth and reduce isolation in beneficiary women.

• Enable participants to process and share their experiences and improve their future safeguarding.

• Provide insight into the women’s experiences to professionals working for PACT – Alana House and wider sector support services.

Its objectives were:

• To enable female offenders and women at risk of offending to represent their experiences and perspectives on the issues through photography and digital storytelling. Then to build self-confidence, self-worth, and insight hence developing future safeguarding through a structured programme of activities.

• To develop confidence and reduce isolation through having a structured space and activities for women to discuss with their peers their thoughts, ideas and experiences about particular relevant themes.

• For the women to learn photographic and digital story-telling skills. • To enable practitioners to have direct insight into the experiences and

issues affecting participants. Thus allowing them to provide better services and support to other people similarly affected.

Conventional research and approaches to offender rehabilitation can fail to prevent the alienation of offenders and those at risk of offending. Traditional methods of practice with vulnerable women are mainly based on interviews and group work. These can be costly techniques which often replicate the authoritarian dynamics which failed to engage these groups either in education or employment. Evidence suggests more creative and artistic approaches can achieve better social

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outcomes including; mental health and wellbeing, educational attainment and skills development, and social cohesion.

PACT’s bid proposed to build on and extend a creative model which they have piloted before. PhotoVoice is proven to work with those with mental health problems and those who are socially isolated. It improves communication skills, creative skills and self-esteem; all essential tools for rehabilitation and reintegration in society. It also highlights participants’ shared experience, which enables them to empathise and identify with one another and their victims. PACT and Alana House see the cultural sector as a pivotal complementary service which can help women move through their supportive services.

The project was run in 6 weekly sessions. A total of 14 participants attended the workshops, and were supported to use participatory photography to explore a sense of community and their role within this. Workshops covered visual literacy, photography techniques, creative expression and captioning. Participants were supported to communicate their experiences and perspectives through photography, subsequently building self-confidence and self-worth, and providing insight into the women’s experiences for PACT and wider sector support services.

The participants, some of whom were new to Alana House, were initially shy within the group and so workshops employed a variety of ice-breaker games and presentation activities. These sought to increase confidence and provide ways for the facilitator and other members to get to know each other. Regular reviews and informal ‘mini’ exhibitions of the work were incorporated into the subsequent sessions. This allowed participants to continue practicing describing their work and intentions, allowing others to provide feedback in a process that built skills alongside self-esteem in a supportive environment.

Over the course of the workshops, a strong group dynamic was formed. Despite some of the participants not knowing each other before the project and the diversity across the group (in terms of age, background and experiences), participants worked well together and supported each other in their ideas and photography work. This diversity and range of experiences also contributed to open and insightful discussions about Reading and the concepts of ‘home’ and what ‘community’ meant to different members.

The final workshop provided the opportunity for participants to show their work and celebrate their achievement in a small closed sharing at Alana House. Each participant exhibited 3 x A3 prints of their work and accompanying captions. All four of the women who had completed the workshops were able to attend; they demonstrated pride at having their work shown and being appreciated by staff and other service users who attended. Participants were awarded with certificates and were given both the A3 prints and some personal photos to take away with them, as a mark of completing the project.

There was a final exhibition of the works created at the Museum of English Rural Life. An opening ceremony saw trusted friends of Alana House come together to celebrate the programme. The core participants attended, and a few presented enthusiastically about how the project had benefited them.

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Partnership

This partnership is particularly interesting as it has been led by the voluntary sector organization. In order to make the programme as sustainable as possible, they are upskilling Alana House staff in creative delivery so there is a consistent offer available when there is not funding to support external artists.

The value of the cultural sector and expertise they bring is not to be underestimated, however and Alana House feel that making their client base more visible to the cultural sector will be beneficial for future partnerships. The staff team does not have additional time for networking, but are open to collaboration.

“Alana House has a strong relationship with the participant group

and it is because of this trust and the safe space that the house

provides to these women that PhotoVoice has been able to

successfully engage with the participants over the course.”

Photovoice Artist

The partners found that running the second project was easier, as the partnership was already established. With a partnership agreement already in place and expectations set, delivery ran smoothly and efficiently. Developing this agreement at the start took additional meetings and time, but was essential to the successful running of the programme. Working with their cultural partners to create clear and mutual benefits for each side was possible because they worked collaboratively to achieve agreed clear set priorities and enabled both the cultural and voluntary sector partners to contribute.

Key Challenges

As is common with programmes engaging hard to reach participants, attendance was a challenge. Time was invested prior to the group starting to ensure participants were fully aware of its purpose and expectations, but due to their complex needs (such as homelessness or being single parents), participants were often not able to overcome other barriers to regular attendance. Previous participants were engaged as ‘peer mentors / encouragers’ for new participants in an effort to provide additional support. The mini exhibition of the first group’s work was also used to show other Alana House service users their photos and therefore engage more participants for the second group.

For the second group, Alana house attempted to over recruit to compensate for likely drop off. The second project still had a smaller than anticipated group, with four women attending all the sessions and fully completing the project. From staff observation, this attendance is in line with general programme completion for this target group and inability to commit to the full duration of the course was not a reflection of the project, but due to other unrelated circumstances. The women that only attended sporadically still produced photography and were able to take this home. Anecdotally, Alana House staff note that programmes which challenge

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the women’s behaviours and coping strategies are often harder to maintain attendance with. Running the programme on the same day and time over the entire year was helpful in terms of encouraging stability and reliability.

There were also challenges for the Alana House team’s capacity due to unforeseen pressures. The project started under the assumption that the same staff that had delivered the pilot would work together again, but this wasn’t possible. It was necessary to manage expectations around this and dedicate time to set the relationship up again. In the future, consideration will also be given to who manages the project delivery in-house. If a few hours a week are budgeted for, but a participant comes in with a crisis they need help with, the participant will always be prioritized. If there were a dedicated staff member just for the project this would have been less of a challenge.

Key Successes

Both phases of this project developed a strong group dynamic. Participants did not know each other before the course, yet they were able to form positive relationships and support each other in their work.

For example:

• One participant was particularly motivated to work hard and complete homework, so had been helping other participants less able in caption writing. Providing peer support has helped build her confidence.

• Another participant who was previously agoraphobic built up the confidence to go outside and take photos and as a result is now active in other groups at Alana House. Significantly, her support workers are now also working with her to consider community groups she can attend beyond Alana House.

Photovoice staff noted that the support provided by Alana House staff was key to the overall success of the course. The wrap around support Alana House offer and the fact that they were the lead provider meant that a high level of support was embedded in the programme. Additionally, as PhotoVoice is non-issue specific and works with different participant groups on each project, partnership working is key to the effective, safe and ethical delivery of their projects. The safe and familiar space provided by Alana House, where other staff known to participants were on hand to support, allowed participants to engage with the workshops comfortably with the knowledge that they could step out and talk with a member of staff if needed. On a practical level, for many the workshops were also timed well with other engagements they had at Alana House, meaning that the course was not an additional commitment or ‘burden’ on their time.

When considering how partnerships with arts, culture and heritage can enhance existing services for disadvantaged participants, Alana House believe that this is all about giving women different ways to express themselves. Bringing in different experts, such as Photovoice, enhances their ‘wellbeing’ offer to women. Their hope is that the exhibition will make a case for continuing this sort of work in the future.

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Evaluation

Alana House used both quantitative and qualitative measures to track participants. For example, they have an ‘Empowerment radar’ tool, which tracks the 9 key areas proven to lead to re-offending. Not all areas are relevant to a cultural programme, but they specifically tracked ‘attitudes, thinking and behaviours’ for this. They also used an outcomes star and introduced qualitative questions and the Rosenburg self-esteem scale for additional evaluation. The Rosenberg self-esteem scale is a measure widely used in social-science research. All participants saw improvements in their scores.

All surveys and forms were filled out with a support worker, so that participants were encouraged to be consistent and honest. Using multiple tools enabled Alana House to consider which tools capture the most outcomes and are therefore worthwhile for cultural projects.

Outcomes

On completion of the project, all participants agreed or strongly agreed that they felt more confident using photography and captions to communicate their experiences of ‘community’ and that they felt more confident in sharing their feelings and opinions inside and outside of the workshops.

“I really enjoyed [the project] – I made new friends and it made me

feel confident about taking pictures.”

At the start of the project, the majority of the participants had expressed feelings of anxiety towards meeting new people and joining new groups. Following the projects’ completion all participants agreed that they felt more confident in this area.

All participants stated that the project had enabled them to meet new people and agreed that they felt more confident meeting new people and working in groups, having taken part in the project.

“Working in a group we all became confident and I am grateful to

have discovered a new beginning.”

All participants stated that they would use the skills they had gained through the project in the future and all expressed the desire to continue engaging with future participatory photography workshops and develop their skills further.

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Summary

Key Challenges Key Successes Outcomes

Participant attendance – especially where behaviours are challenged

Developing a strong group dynamic and peer support

Participants were:

— More confident with the new skills learnt

Project team capacity Wrap around support embedded in the programme

— More confident meeting new people and working in groups

Partnership working key to effective, safe and ethical delivery

— Likely to use the skills gained in the future and independently continue with positive activities

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Case study 2: Museum Partnership Reading

The Museum of English Rural Life (The MERL) and Reading Museum formed a consortium in 2018, known as Museums Partnership Reading (MPR). MPR’s Cultural Commission set out to trial and evaluate different forms of cultural projects to improve the health and wellbeing of older people from Reading communities. They sought to assess their impact, including how they contributed to a reduction in loneliness and social isolation for older people in Reading.

The project delivered 44 activities using reminiscence, gardening, dance and knitting, involving 173 participants aged between 52-94. By running well established work (such as reminiscence) and comparing it to new activity (such as dance), the project was able to review and assess their outcomes for participants.

The MERL’s recent redevelopment project, Our Country Lives, or OCL, involved the Museum considering who their audiences are and their future priorities. They used a collaborative process to explore their collections and what they mean for people; a focus on engaging with older adults explicitly came from this. Formative evaluation before the redevelopment appeared to show that the Royal Berkshire Hospital (RBH) represented around 10% of visitors. These potential visitors became an audience target for OCL.

Similarly, the Museum of Reading were keen to use their varied collection and loan boxes to reach more people. The funding from the project enabled greater promotion of this service to local community groups. The Museum had been offering training to care homes and individuals for how to use objects for reminiscence and the commission was a natural extension of this work.

The first half of the Cultural Commission centred on developing evaluation frameworks and establishing academic and health sector partnerships. The programme attracted the support of two academics within the University of Reading (UoR) School of Psychology and Clinical Language Sciences, Professor Margot Gosney & Dr Aileen Ho who supported the evaluation process. As part of their developmental processes, MPR worked with an empowerment group for the Alzheimer’s Society. They became integral members of the Dementia Action

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Alliance and ran training sessions for Royal Berkshire Hospital (RBH) staff. A project officer was appointed in January 2019 and delivery followed on from here.

The reminiscence activities at The MERL promote cognitive stimulation, social interaction and engagement through discussions about past experiences on themed topics. They involve using old photographs, films and artefacts, all of which were used in successful pilots and regular provision during the project, both on and offsite. Sessions were designed and facilitated by The MERL staff (with some volunteer support), either at the museum or in community or hospital settings. Sessions typically lasted 60-90 minutes. Reminiscence was already a well-established activity, but the area of work was extended and evaluated through this project. Fourteen sessions took place at RBH, there were 6 sessions with Younger People with Dementia (YPWD), and one-off events were run with the Alzheimer’s Society, The Grange Memory Café and Alzheimer’s Dementia Support. The project also enabled Reading Museum to showcase their memory box service, promoting it to a broader audience during the Dementia in Action day as well as gaining valuable feedback on the service from two local care homes.

The gardening programme was already part of MERL’s core offer and aimed to promote well-being among older people using the garden for therapeutic activity. The funding allowed this programme to be extended to include table top gardening in a hospital setting. This took place with patients from elderly care wards at RBH. Ten sessions were delivered for 48 participants.

The dance strand was a new activity made possible by the project funding and aimed to strengthen muscles, improve joint mobility, balance, posture and gait, and keep the heart healthy and happy. Sessions were social and inclusive, as well as helping participants maintain mental and cognitive wellbeing through learning and repeating routines and movements. The creative element of dance aimed to help maintain problem solving and decision-making skills and provide participants with a way to express emotions and feelings. The workshops were inspired by the collections and exhibitions of The Museum of English Rural Life and combined dance and live music. A live musician and singing in sessions proved very popular. Eight to thirteen participants joined the sessions each week, with an average age of 74.

Partnerships

MPR worked with local networks and organisations with similar ambitions in order to successfully identify participants. Working in hospital settings enabled them to gain new insights into working with healthcare partners. The partnership between The MERL and RBH was especially positive. The MERL delivered training on facilitating reminiscence groups with RBH’s Care Crew, introducing the practice of object-stimulated reminiscence to upskill staff, which could be applied to other areas of their work. The MERL also facilitated activities on the Care Crew’s team building day.

MPR were able to identify and describe the difference their partnerships made to those involved – to learn jointly and collaboratively and to grow trusting relationships. The next step is to identify drivers and incentives so that partners

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consistently engage with them. As with other funded cultural commissions, utilising partnership agreements would be beneficial. They also plan to engage a more diverse set of partners in the future. To do this, they will demonstrate how their work is successful in positively benefiting a wide range of participants.

Key Challenges

Navigating the ethics of evaluation and monitoring for vulnerable adults was difficult, particularly within clinical settings. This was overcome by focusing the most rigorous evaluation on community settings (such as programmes at The MERL) but also, where possible, interviewing care staff and family members for qualitative data. This does mean, however that full data was not collected on the RBH patients. This represents a wider challenge the cultural sector faces when working with healthcare partners; how do we persuade medical professionals and ethics boards to share their data? Based on MPR learning, the key is in strong long-term partnerships where trust has been developed and in evaluation methodologies being shared and agreed in advance.

MPR also found that the scoping and planning stage (along with the establishment of the evaluation framework) took more time than anticipated, but the extra time enabled them to embed partner relationships deeply into their programme and helped create a robust evaluation process. The length of the programme limited the amount of data which could be collected but it has set MPR up with measurement and evaluation systems which they can use in the future and given them a better understanding of which tools work for which programmes and settings.

There were the additional standard challenges, such as staff turnover and changes in personnel. This was overcome by having a dedicated Cultural Commissioning Project Coordinator who took ownership of the project.

Key Successes

A kick off meeting with partners and stakeholders demonstrated a real interest in developing and delivering more social outcomes work. It enabled more professionals to feed into the project.

Professor Margot Gosney, with significant NHS experience, became a critical friend and engaged a group of older people in consultations for their input. They met to look at and provide feedback on the reminiscence boxes put together by Reading Museum. The Professor wrote an abstract based on the discussion and this resulted in an invitation to provide a poster display at the spring conference of the British Geriatrics Society in Cardiff. Attending the event provided new exposure for the museums’ programmes. It also enabled useful discussions with doctors and pharmaceutical companies.

The museums felt that one of the greatest benefits of this programme was the new network they became part of. They now take part in Reading’s Older People’s week, are active members of the Dementia Action Alliance, and regularly attend events which can bring new partners together.

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Evaluation

This programme did provide evidence to support the overall Cultural Commissioning action research question and proposition that the arts, culture and heritage can successfully engage people to enhance health and wellbeing. For The MERL in particular, it further evidenced their approach to community engagement in particular that their activities do not have to take place in the museum, but can engage people in other premises, such as at the hospital. Additionally, MPR have positioned themselves as more than just museums, but as activity hubs. This reinvigorates how participants see the space and encourages them to return to different activities.

The Cultural Commissioning programme builds on the museum partnership’s existing work and new programmes with a range of methods for evaluation. The evaluation framework around wellbeing outcomes and measuring impact developed by Dr Aileen Ho, based on the Warwick-Edinburgh Mental Wellbeing Scale (WEMWEBS), was appropriate for older, independent people, including those who took part in the dance Programme. In circumstances where older people were more vulnerable, evidence had to be collected through carers and support workers using other methods.

The Cultural Commissioning project provided the opportunity to formally gather evidence on the impact of the existing reminiscence and gardening programmes, whilst assessing the value of the new dance programme and table top gardening initiative. The complexities of the audience meant that a single framework could not be identified which was suitable in all situations. However, The MERL staff now have a greater understanding of which tools best fit for each type of delivery.

Developing the academic partnerships and subsequent questionnaires took some time, which is why it was built into this action research programme. In order to capture learning in the interim, observations, interviews with support staff and interviews with family members were conducted with YPWD. This was in order to understand what participants are like before and after sessions. Feedback would suggest that the wellbeing developed through the sessions has a halo effect, with participants more alert and engaged throughout the day.

Outcomes

The qualitative data from interviews was coded against the ‘Five Ways to Wellbeing’ framework (Connect, Be Active, Take Notice, Keep Learning & Give). A total of 114 statements were extracted and categorised from 18 sources (10 care workers; 8 participants) who took part in the

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Reminiscence, Garden or Dance activities. Analysing each category enabled MPR to identify the percentage of statements relating to activities within each Wellbeing outcome:

• Connect: 72% Reminiscence 17% Garden 9% Dance • Be active: Dance 60%, Garden 40% • Take Notice: Garden 67%, Reminiscence 33% • Keep Learning: Dance 48%, Reminiscence 39% Garden 13% • Give: 100% Garden

Qualitative feedback from partners and participants was one of the greatest

successes of this commission. At RBH, for instance, Care Crew staff noted

that patients who had been “wandering” on the wards were able to sit for a

period of time in the group. They engaged patients who did not have regular

visitors, who did not engage in other activities and who talked very little on

the wards.

“It’s been inspiring and motivating to work with the museum. It’s

helped me think differently and now reminiscence is not just a

session, but I find ways to bring it into all the other activities in the

ward.”

Care Crew, Elderly Care Ward, RBH

“Care Crew were shortlisted for the Chairman’s Award at the RBFT

Staff Excellence Awards this year, which was a great achievement.

The Reminiscence sessions are a big part of what the Care Crew do

and attending the training session last year really gave the team

confidence and skills to structure their own Reminiscence sessions,

which was really valuable. No doubt this contributed to the service

and subsequently their shortlisting.”

Care Crew Manager, RBH

“My group left looking happy and relaxed, radiating a sense of well-

being. Dementia can rob you of your identity. This reminiscence

session enabled each person to express themselves and feel valued,

reinforcing their own identity, in a world where they may feel they

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are insignificant. This session opened the eyes of my team. We

witness the quieter more reserved clients actively participating. The

experience has highlighted the importance of ensuring the more

able to not overshadow the less able. We learn so much at each

session… the more we learn about each client, the more we can

actively engage them”

Alzheimer’s Society staff

“‘It’s always a good day after a session, the rest of the day and into

the evening X stays in a good mood with no anxiety.”

YPWD family member

Summary

Key Challenges Key Successes Outcomes

The ethics of evaluation and monitoring in clinical settings

Setting up the right new evaluation systems

Creating new networks and partnerships

Trialling new programmes of work

Stronger understanding of what evaluation methods suit which activities

Health and VCS sector staff appreciate value of museum activities in caring for older people

Different activities give different wellbeing scores

Positive impacts on those with dementia were observed by staff and family

Partner acknowledgement for the relevance and potential of museum & heritage collections to benefit and support wellbeing.

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Case study 3: Reading Rep

Reading Rep, a theatre company based at Reading College, has been running a series of performing arts workshops to boost self-esteem, provide confidence building and life skills. Their ENGAGE! programme originally set out to work with six different participant groups;

• Older people in care homes • Adults with mental health

illnesses • Young people who are unable to

participate in mainstream education

• People with severe and complex learning disabilities

• Homeless people • Women on parole or release from prison.

The number of partners was reduced, however, for the social outcome focus and evaluation to centre on wellbeing and mental health. Core programme partners were Prospect Park Hospital (PPH), Red Balloon Learners Centre, Purley Park Trust and Abbeyfield Care Home.

Reading Rep have been building these partnerships for years. Their work in hospitals has been growing over the last two and a half years, but this programme provided the opportunity to deepen those partnerships and consider how they could better evaluate and evidence the value of their work.

They started out with term-time weekly sessions at Red Balloon Learner’s Centre, delivering drama activities for 12 young people unable to participate in mainstream education. They worked closely with staff to embed the drama sessions into the wider curriculum – for example, in an anti-bullying project. High level staffing changes halfway through the programme (including the Head and Deputy Head) meant that these sessions were unfortunately not continued. Eleven sessions were run in total.

They also ran drama activities at Purley Park and Abbeyfield residential care homes. They engaged 13 people in 6 sessions at Abbeyfield and 36 people disabilities in 35 sessions at Purley Park.

Delivery at Prospect Park Hospital was weekly throughout the cultural commission and engaged over 246 people over the course of 40 sessions. It took place in the dementia and acute mental health illnesses wards with a variety of art forms offered, as this was felt to be more accessible for participants with high needs. Berkshire Health Care has Quality Improvement Objectives, including ensuring a ‘Good Patient Experience’, and they felt that these sessions fitted under this objective.

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Partnership

Reading Rep’s delivery with Red Balloon Learner’s Centre initially demonstrated strong partnership working and cross-sectoral commitment. Red Balloon Trustees observed sessions and gave positive feedback and the Deputy Head was involved with session planning and delivery.

The sudden change of staff and therefore seismic shift in the partnership was unforeseen. The new senior management signed off a new school timetable without consulting partners and therefore Reading Rep’s successful delivery was no longer timetabled.

Reading Rep hope to remain in contact with Red Balloon and develop new relationships with the incoming senior management team. However, situations like this are destabilising for cultural organisations as well as the young people, particularly vulnerable young people where relationship building, and trust takes time. This does beg the wider question of how cultural organisations can enhance services when partnerships are constantly at risk.

Action Research discussions centred on partnership agreements and how organisations can mitigate risk within the ever-changing school landscape. Perhaps there is a role for Reading’s Cultural Education Partnership in providing draft partnership agreements for cultural organisations.

Reading Rep’s partnerships within the hospitals were embedded and strong, but there were challenges around high staff turnover and understaffing. The first part of the programme focused on rebuilding relationships and making sure new staff members fully understood and bought into the cultural delivery.

Initially, there were difficulties engaging with Rowan Ward, which is specifically for those with dementia. There was a change of the core Occupational Therapy (OT) team, the rooms used for sessions were changed and the abilities of the participants are severely limited, which makes planning and delivery additionally challenging. However, this learning was taken on board throughout the course of the commission and led to more consistency within the OT team, joint planning for sessions and co-facilitation when needed.

Key Challenges

It can be particularly challenging to plan and run activity groups which are suitable for individuals with varying levels of cognitive ability. Rowan Ward found that patients who were more functionally able could more easily benefit from attending creative workshops. They were more able to engage with discussions in a group setting and understand and follow different instructions.

In order to also engage the patients who were significantly impaired and found it more difficult to engage, the partnership put certain steps in place. The facilitator would contact the OT staff with ideas for potential activities and would receive feedback based on the current mix of patients on the ward and their needs. The hospital staff would also reflect informally with the facilitator after each session.

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One suggestion that came from this was to run two different weekly types of groups targeted at specific levels of cognitive ability. For example, a simple, sensory based activity for patients who are significantly cognitively impaired and a second group for higher functioning patients which could be more complex. Weekly workshops also helped to strengthen the therapeutic relationship between the facilitator and patients.

As noted above, the other key challenges were major changes in partnerships (Red Balloon) and high staff turnover or understaffing (hospitals).

Key Successes

Even though the partnership with Red Balloon did not continue for the duration of the commission, the work accomplished was successful for the young people involved. The partners worked together to create bespoke engagement options so that even the most vulnerable young people were able to participate. For instance, one member who didn’t want to join the rest of the group had one to one sessions with the art teacher during the drama session, they listen to what Reading Rep are working on and create work alongside this. The Reading Rep facilitator then had 1:1 sessions with the participant separately at the end of the session. This led to Further Education support for this participant to visit Reading College, where they are considering continuing their post 16 education. This participant has significant support needs, so it is very positive that the partners were able to work together to engage and support them.

“Students appear more confident and contribute more, they look

forward to the sessions, one student now participates in Reading

Rep’s mainstream youth theatre and former students came back to

visit and wanted to visit during drama session as they miss it.”

Red Balloon Deputy Head teacher

Developments in the programme at PPH were successful in creating an equitable partnership which drew on the strength of both partners. Having the OTs so closely involved means they were able to track the participants’ successes, such as a staying for the entire session or picking up a pencil and putting it to paper. These are achievements that Reading Rep would not necessarily recognise, so the partnership really benefited from the OT expertise. PPH has also now recognised the volatile situations that can be witnessed by Reading Rep staff and is arranging the facilitator to have break away training.

Evaluation

Reading Rep trialled the Warwick-Edinburgh Mental Wellbeing Scales at Red Balloon in practical drama workshops, where participants tracked themselves, their mental health and their progress. The aim was to deliver this at the start of

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term, half term and end of term. Although they were not able to complete the evaluation, they plan to use the model in the future with different groups.

At the initial workshop, it was interesting to note how low the young people scored themselves in terms of mental wellbeing. Further trials would have to be run to see if the young people felt able to accurately represent how they felt in a group setting. Reading Rep are considering running the workshops in smaller focus groups in the future.

The turnover of patients is high at Prospect Park Hospital, which makes data collection and evaluation challenging. Additionally, evaluation work with people with severe dementia needs to be closely delivered in partnership with care staff and with appropriate clinical care setting ethics approvals. Reading Rep were particularly interested in the programme’s impact on staff and how they see their patients, but this was also challenging because of a rise in agency staff and staff shortages.

“With the client group we are working with, they will never get

better. Progress is something which is very hard to track, as people

have good days and bad days. Sometimes the progress is making

eye contact once during the 45 min session. Sometimes it is

someone picking up a pen. It is a lot more complex to track.

Number of people engaging is the best that we can offer. Patients

are not able to provide consent for anything else”

Senior Therapist, Prospect Park

The action research conversations determined that the PPH OT and Reading Rep facilitator could reflect together more formally to assess what went well and what could be improved. This would help to guide the planning of future sessions and provide more data for evaluation.

Paul’s Story

Paul* was a patient on Orchid Ward. He was in his early 70s and had a diagnosis of reactive depression. Paul presented as very low in mood and was very quiet.

Paul found the ward environment extremely restrictive and frustrating. He was also a smoker, and was unable to smoke on the ward due to the smoking ban. Paul attended a lot of activities to pass time but did not engage. His poor vision prevented participation in many groups.

* name has been changed

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Paul attended a drama group on the ward. The theme of the session was memories where a famous world event was pulled out of envelope by each patient in turn to prompt group discussion. One event was World War 2 which prompted Paul to share his experiences and memories, which were very personal and emotive.

After the session, Paul approached staff to report that in the 6 weeks of his admission, that was the first time he had opened up or shared anything, even to the doctors on the ward. He also said it was the first time that he could forget that he was a patient on a psychiatric ward.

Outcomes

Participants at PPH have seemed to enjoy the sessions. OT staff subjectively observed improvements in patients’ moods from participation and pointed to the maintenance of communication, interaction and process skills.

Some participants even recognised the facilitator and said they were looking forward to the group. Some began to talk more during the session and start to make eye contact towards the end of the group.

“Christie is an engaged and enthusiastic group facilitator who is a

welcome addition to the OT team on Rowan ward. As OTs we

encourage and promote engagement in meaningful activity, for the

enhancement of health and wellbeing. Creative workshop helps us

to deliver this aim and combat health inequalities that individuals

with dementia often experience, such as occupational deprivation

and social isolation. The workshop encourages patients to interact

and communicate with each other which helps to maintain these

skills.”

Occupational Therapist, Prospect Park

“The arts give people an avenue to express opinions and emotions

in a different way than they would during 1 to 1’s. They take people

somewhere else, and people may open up more because of the way

these sessions are delivered.”

Senior Therapist, Prospect Park

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“Participants in creative workshop have the opportunity to engage

with an external group facilitator who is enthusiastic and keen to

engage patients in lively discussions whilst delivering creative

activities. The group stimulates discussions between patients who

may not normally engage in conversations with each other. It

promotes a shared sense of purpose in working together to

complete a shared activity.”

Occupational Therapist, Prospect Park

Summary

Key Challenges Key Successes Outcomes

Running groups suitable for individuals with varying levels of cognitive ability

Major changes in partnerships

Staff turnover or understaffing at partner organisations

Patient turnover and ethics approvals in clinical settings can challenge data collection.

Positive outcomes for some of the young people

A sense of an equitable partnership that has benefits for programme planning, delivery and participants

Hospital staff understand and advocate benefits of cultural activity for their patients

Deepening a smaller, more focused number of partnerships

Subjectively observed improvements in patients’ moods

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Conclusion

These three programmes were the first funded by the Cultural Commissioning Programme. They demonstrated the variety and quality of cultural programmes engaging with disadvantaged or at risk people in Reading. They also elucidated difficulties between cross sector partnerships, challenges around collecting robust data and how difficult it is to truly engage the harder to reach members of our society.

Whether through qualitative or quantitative methods, each of the commissions demonstrated that partnerships with arts, culture and heritage can indeed enhance existing services for disadvantaged participants. They do this in a variety of ways; from engaging participants in fun activities without stigma attached to them, to developing skills such as confidence, to enhancing mental health and wellbeing.

The action research meetings and discussions will continue with newly funded commissions in 2019-2020 and external consultants have been contracted to deliver ‘How to Measure Your Social Impact’ workshops and mentoring, which will support the sector in both understanding and communicating their impact.

The Cultural Commissioning Programme still has its work cut out for it in terms of proving how the cultural sector enhances existing services, however. There is the age old innate difficulty in capturing the true value of participating in arts, culture and heritage that cannot be solved by this programme, but we can explore finding a balance between the black and white trajectory of change many commissioners still expect to see, and the soft touch intrinsic argument some cultural organisations still rely on. We will continue to seek the evaluation methodologies that best suit the work delivered, the participants engaged, and the commissioners we seek to influence.