Rachel’s Blog

This video is not directly relevant to my work, but I love this video and the ideas it expresses… Enjoy!

A couple of Fridays ago I visited the Singing for the Brain group in Old Basing – led by Sue, an experienced singing facilitator. It was a good opportunity to see some best practice in action in the area of singing with people living with dementia.

The group was quite large – over thirty, including visiting facilitators like me, carers, volunteers and Alzheimer’s Society employees. I particularly enjoyed the feeling of ‘expansiveness’ that the facilitator created; it was a space where anything was possible – and yet it was a safe space too. This is something I am looking to better achieve in my practice, and I think it will come as I gain in confidence and clarity.

Singing for the Brain is an idea which many facilitators and local Alzheimer’s Society branches have picked up and run with. It’s been so successful it is now becoming a core service of the charity and a new specification has been written to help guide the groups to have the most positive effect, leaving enough flexibility to take into account each groups’ uniqueness.

The main message I took from discussion with other facilitators is what Singing for the Brain is not: it’s not a sing-a-long! Trying to uncover what it actually is is more challenging as the framework has been developed through years of practice and research and includes complex ideas about emotional memory and something called neuroplasticity (I’ll let you know when I know!). At the simplest level, Singing for the Brain sessions must have a beginning, a middle and an end – this might sound obvious, but finding a good song to end on, or a way of rounding of or cooling down a session can be trickier than it first seems.  It is important to use movement, for a variety of reasons: for gentle aerobic exercise, and to keep joints moving, to help participants remember words, and evoke feelings and memories, and to encourage connections between both sides of the brain by using movements which cross the central line of the body – for example at Old Basing, the facilitator used small beanbags which the participants passed from hand to hand in time to a pulse.

Obviously singing is the central part of the session, and the majority of the time is taken up singing songs, either from memory or from song sheets, and also incorporating harmony through part-songs, rounds and partner songs (2 songs sung on top of each other). There is also a strong sense of pulse running throughout, which helps connect people (this makes me think about entrainment theory) and gives a backdrop to activities such as tongue-twisters and rhythmic ditties such as Hickory Dickory Dock.

I’m really excited about the possibilities of Singing for the Brain because of the improved social, physical and mental health of people living with dementia, a disease for which a medical cure seems a long way off, but for which social coping strategies are being put in place by the fantastic work of The Alzheimer’s Society.

If you want to join in the conversation about singing with people living with dementia please leave a comment or join the wellsing network where there is a new discussion thread on this topic.

I’m really keen on reflective practice – that reflecting and thinking about what I’ve already done impacts, and hopefully improves what I will do in the future. This falls into the lovely messiness of action research/action learning, it’s difficult to know which questions you are going to need to ask until you’re in the thick of it. This can be difficult sometimes, it’s not about being prepared or unprepared, but when in practice, unexpected things happen, which requires the practitioner to be flexible, but also to think about it all afterwards.

That’s what I want to do now (the Christmas break and the New Year seem a good time for reflection and resolution).

I have some questions about my practice. I’ve worked with a wide variety of groups, from tiny (just a couple of people) to large groups of over 50 people, and everything in between. Most of the time it’s in the 12-20 number range. Some groups are more diverse than others; some groups meld together well, and others don’t, or is it simply that some groups include people who find it harder to relate to others socially?  One of the fantastic things about group singing is it is very inclusive and is an activity that different people can share.

The facilitation of a singing group is very important to ensure everyone does feel included.

How do I feel about using the guitar? Does it get in the way?

How could I change my introductions/patter etc? Can I be clearer when giving instructions. I have an invitational style, and perhaps people need something more directive.

How do existing members of the group react to larger numbers? Generally people like being in a larger group if they are not confident singers, but in some settings, it can put people at a distance which limits the connection I can have with each person.

I spend a lot of time seated, especially when working with the older old who are often less able to stand up (I think it’s important to be on the same level, and not looking down on / talking down to participants) and I think this can give me a sense of being rooted to the spot (not in a good way!). How can I vary this?

How do I combine leadership with joint exploration of a song? I want participants to interpret the songs and music in their own way – I don’t have strongly developed ideas of exactly how I want something to sound. Perhaps I should develop this more!

I feel most comfortable when facilitating unaccompanied singing. I think it’s time to write arrangements of my own to cater to this need. Interestingly, the unaccompanied, harmony songs seem to be the most popular, the ones we keep coming back to, as opposed to the guitar-accompanied songs in strophic form.

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Reflective practice can be difficult. The questions I ask myself force me to acknowledge the truth of my practice, and sometimes the truth is hard to swallow. The important thing is that I am asking the questions, and if I don’t know the answers, then I am working towards them at least. By blogging them I hope the exploration can be shared with others practicing in these kinds of contexts, and help develop an honest community of (reflective) practice.

On Monday I took one of the community-based singing groups I facilitate into a residential care home. It was a bit of an experiment.

Participatory Singing in Residential Care Homes

I have done a lot of work in care homes. It can be a challenge – more of a challenge than I had expected compared to community-based work. The residents often have high support needs of varying types. For example, there may be people in different stages of dementia, with different physical disabilities and frailty, as well as other factors such as literacy, language (can they speak English?), and other mental health problems such as bi-polar disorder or depression.

Often I am left to lead a participatory singing session with groups like this with no support from care staff. This is, as you can imagine, quite difficult, as participants need help to find page numbers, follow the words and reminders to sing and/or use hand percussion. There may also be disruptive group members who might, for example, sing loudly and completely out of time with the group, which other residents find disruptive and mars their enjoyment, or even participation of the session. This means that sessions can feel a little disjointed as often the groups are as large as 20+.

The Community-Based Singing Group

Having a cup of tea with some of the participants of a community-based group in the autumn, it emerged that they felt they wanted to give something back. They enjoyed singing so much that they wanted to share it with others. After a conversation with the manager of the church centre we use, we got a contact at a local residential care home. This residential care home is brand new and as such has limited local connections. They had been unable to secure any activities or entertainment for Christmas.

The Experiment

Around 12 participants of the community-based group came to a 1.5 hour session (with a break for tea and mince pies) at the resi care home. There were about 12 residents present and I think the enthusiasm of the visitors and the increased numbers of people around them helped them feel able to join in with the singing, especially with the actions. The residents were also assisted by the group to play hand percussion and the group were able to help find page numbers and amplify song requests on behalf of residents sitting near them.

From my point of view, I was able to concentrate on leading the music, secure in the knowledge that everyone was engaged in some way. This led to a more coherent session, with more singing, and smoother transitions between different activities. The increased numbers meant that although I couldn’t distinguish who was singing and who wasn’t from listening, I could relax a little and look around the room and see the different ways in which people were engaging. There was one resident who didn’t join in the singing until we sang Oh When The Saints.

Reflection

Taking the group into the residential care home has made me reflect a lot on my practice in residential settings. Yes it would be great to have enthusiastic singers assisting at a session, and I hope I can develop a regular relationship with this care home, as so many from the group enjoyed the visit. However, it is also helping me rethink the way I work in residential care homes.

• Am I placing too much expectation on the residents to be able to work with my resources? (song book, hand percussion) In some cases yes, in others, no. And usually all in the same room.
• I place a high value on participative sessions, yet many resi care homes describe me as ‘the entertainer’ (”she’s going to sing to you” is how I’m often introduced) – what value is there in performing in residential care homes? Or mixing up the session so there is a combination?
• I want to challenge care home residents to make their own decisions and to take a little responsibility for participating. If I work to the lowest common denominator then will I simply be complicit in the institutionalisation of older people?
• How can I be sure the residents want to be in a singing workshop? The descriptor ‘captive audience’ is sadly no over-statement.
• I want to find ways of encouraging care staff to be involved in participative singing.

It’s been such a long time since I last blogged, I wanted to pull together the many ideas and inspirations and anything else which has caught my attention or fed into my practice over the last few months and place them together in one post.

Telly

The first thing is to comment on the recent surge of interest in older peoples’ issues, for example the recent edition of Wonderland showing how the lives of those living with dementia can be improved through group singing. I have to confess to being frustrated by this programme as I felt they could have shown more of the singing – but could have used fewer clips of people singing ‘It’s a Long Way to Tipperary’. On an occassion when I was volunteering at an Alzheimer’s home we sang this song and a woman commented after the last line (’and my heart’s right there’) “no it’s not, it’s here” whilst pointing to her chest. Always amazed at the humour found within people with this debilitating disease.

Another, two-part programme which has been on the telly (or iplayer in my case) is the Can Gerry Robinson Fix Dementia Care Homes? I really relished watching this programme. I see the inside of residential care homes at least weekly, and I work with older people daily. It was wonderful to see my world on the screen because the media in general doesn’t have much space for older people. It was also inspiring to see examples of good practice that show affordable, excellent dementia care is possible.

Yawn-Length Reports (which have lots of useful things in them)

There has been a report published by the Joseph Rowntree Foundation called Older People’s Vision for Long-Term Care. There has also been a large-scale consultation taking place called The Big Care Debate. This has now come to a close, but the goverment published a green paper – and you can listen to Andy Burnham talking about it here. Hopefully the systemic change the Joseph Rowntree Foundation is calling for will be matched in the green paper. But we’ll have to wait and see…

Books

There have been a number of books which have helped me think and reflect on my practice. One is Contented Dementia by Oliver James. I found it an overwhelmingly positive read and it helped me to see beyond the disease when working with people with dementia. Perhaps one criticism might be that it painted a picture that was a little too rosy. But I guess the important point is that just because someone has dementia, doesn’t mean they or their family will never have fun again. People have a right to fulfilling lives.

A few others are The Artist’s Way by Julia Cameron, Well-Tuned Women: Growing Strong Through Voicework by Frankie Armstrong et al and Community Music Therapy by Gary Ansdell et al.

Music

I have found the music of Chris Wood to be particularly inspirational this year. He has such integrity as an artist, telling stories without sentimentality. He has made me think about connection to place, tradition, nationality and community.

Process and Product are two aspects of community arts which are sometimes considered to be opposing, or to a degree mutually exclusive. I was recently reminded of the debates that raged on about the importance of one, or the other, by an email I received from a student of music and community practice asking which, in my work, do I focus on?

First of all I want to think a little about what process and product mean. Put simply, process is the way we do things, and product is the end result, something tangible like a performance or a CD. I’d like to suggest that the boundaries between these are far more blurred, and we need to look more broadly at what constitutes ‘product’ when working in the community development sphere. For example, the special events that have so far been organised in connection with the Age Concern singing programme (see WittFest and SingFest) were important milestones and focal points for the singing groups involved; punctuation for the rest of the term. For groups who aim for largely soft outcomes, a bi-product of the process is the meeting for coffee at another point in the week.

I have recently been trying to explore more challenging repertoire with one of my groups, with limited success on my part, mainly because of my learning curve in guiding groups through more challenging songs, but also, from the groups perspective (I would posit) because learning more challenging material pushes towards a goal (product), and the purpose of the group is to have fun and build relationships and grow social capital. All these things we are doing – until the music started to get harder (albeit for a couple of weeks) which undermined the confidence and therefore enjoyment of the experience. In this case process is far more valuable than any perceptible product. Indeed, the product can sometimes undermine the process.

The process/product argument is a useful stimulus to get the cogs turning about outcomes. By far the most exciting projects I have been involved with in my short career is one in which outcomes (soft and hard, but mainly soft) were discussed at the beginning – we started from the end and worked backwards, which worked wonders for the creative development process as it gave a real freedom of approach. I didn’t start from what I usually do, I started from the most important thing, what the client will get out of this, whether that be through the ‘process’ of the project, or the ‘product’.

The group singing Jerusalem, accompanied by Sally Mears on piano

Today is the UN’s International Day of Older Persons, and to coincide with this it is UK Older People’s Day. This initiative is in its third year and the theme this year is Full of Life. It is a day to celebrate the achievements and aspirations of older people, and their contribution to society . To mark this, together with Sally Mears, I organised a day of singing at the Abingdon Resource and Wellbeing Centre. Groups came from Witney, Abingdon and Dean Court, joining the service users of the day centre.

We sang songs from all over the world including Bella Mamma from the Torres Islands, Viva Viva La Musica from Italy, Mozart’s Alleluia, and an arrangement of Mozart’s most popular tunes ‘A La Kart’. Other favourites including Doe a Deer from ‘The Sound of Music’, and Jerusalem.

A highlight for me was when a participant went and sat down at the piano during the break and played some wonderful classical music. She received a standing ovation!

There were many positive comments throughout the day and everyone left smiling with a sense of achievement. One person said how much she enjoyed listening to the harmonies in the singing, and another said he felt ‘buoyant’ after singing.

Yesterday I spent the day shadowing  a musician working as part of the Arts in Trust programme in Cheltenham General Hospital.

I felt a little apprehensive about the day, as I have been blessed not to have spent a great deal of time in hospital – in fact, the last time I was in hospital for reasons relating to my own health was in my early teens to sort out a fractured finger bone. I have never spent a night in hospital.

After walking through the corridors, looking at the photographic exhibition ‘Air’ created by a local artist, we met with Peter outisde the oncology unit. He had brought minimal kit with him – keyboard, stand, stool and extension lead.

As an observer I felt in the way, and as though I was invading the patients’ privacy, which I was in as much as going into hospital can be incredibly disempowering as you hand over control to your body, and with it your dignity. I think it is interesting that the NHS is organised in ‘Trusts’ as we have often no option but to trust our doctors, nurses and other care staff.

Trying to be discreet was difficult – but I endeavoured to follow the advice of my friend, a nurse who said ‘try not to be embarassed’.

The stroke and rehab department was a wonderful place; light, airy (good air-con) and spacious. Each bay had 4 beds but in a larger space than the oncology ward bays which held 6 beds. A new photographic exhibition was up around the ward, showing pictures of local parks. It was created in conjunction with the physiotherapists to incorporate ‘rest stops’ symbolised by pictures of park benches, every 4-5 metres.

The experience of being in a hospital was an education in itself – getting used to the different sounds, the smells (not always good), and seeing the way in which medical staff work. One of the things that surprised me was how natural it seemed, seeing a musician tucked into the back of a bay – Peter had previously said at the training day that he wanted to blend into the environment, and I think he did that amazingly well – the choice of repertoire certainly helped (a choice of gentle jazz pieces, with continuous flow between different numbers).

Peoples’ responses were mixed but generally positive. Some people applauded, requested particular songs or styles, and nodded/tapped along, sang (or tried to) and thanked Peter at the end. One woman said “you have fed my soul”. On the other hand, some people appeared to ignore what was going on, and in one bay as we walked in, a woman said ‘no, thank you, not interested’ etc – and although others said they wanted to try perhaps just one song, another woman got out of bed to ask us to leave after a few minutes of music. Not so good. This certainly raised questions for me about the ideas of consultation and consent. As I’ve already mentioned, the loss of control on entering hospital is so great, that I wonder if part of the reason for objecting to the music was a desire to exercise control over the environment, especially as there is so much activity and noise in the mornings on a ward, it must be good to finally get some quiet later on in the morning. Do you really want another group of strangers wandering in?

I was sceptical about these concerts when I first heard about them. Will sick people want to be disturbed? Won’t the musician get in the way of important medical procedures? If it’s not participatory will they make any difference?

A few examples of why music on the wards is positive:

1. I saw a man smile and nod along for the duration of the concert in his bay, about 20 minutes

2. The staff appreciated the music, and it became a talking point between staff and patients on the wards

3. A man on the stroke and rehab ward was attempting to sing along – potentially a rehab intervention?

I am really hoping in the future to go and perform for a day in hospital. Certainly it will be the most honest audience I’m ever likely to come across.

I’m trying to get better at logging/blogging learning points from different experiences – Tim Davies of Practical Participation has suggested a technique which is simply to think of ‘5 things I learnt from…’. So that’s what I will be trying to do from now; sharing my learning in a very basic way.

image courtesy of zenera cc

Despite being very behind with my blogging (partly due to house-move/no broadband for 2 weeks) I am really happy that a couple of people stumbled upon my blog and have got in touch, expressing interest in this field of work.

I thought I would write a quick blog post detailing the moves I have made over the last year, which hopefully will give others who are just starting out an idea of the processes and time scales I am working with…

August 2008: Started day job in Oxford. Made email enquiries to arts and health related people – they gave me further contacts… contacted further contacts (Community Development Worker (CDW), Oxfordshire County Council (OCC))

September 2008: International Music and Health Conference

October 2008: Meeting with CDW, OCC – puts me in touch with Age Concern CDW – first booking made for a ‘taster session’ at Age Concern Activity Day – attended Arts and Care Conference

December 2008: Taster Session at Age Concern Activity Day – 8/10 participants say they would like to take part in a singing session again

January 2009: Singing session with an Age Concern supported coffee club – further booking made for July 09

March 2009: Start ‘Singing for Fun’ group in Witney – running weekly for up to 10 weeks as an initial pilot period, supported by Age Concern and the District Council arts funding

April 2009: Business development – spent a day working out a business plan

May 2009: left the day-job! Made contact with CDW in different areas through Oxford Disability Information Fair – wrote to around 20 local residential care homes with ‘marketing materials’

June 2009: Wittfest! – start to pick up extra, one-off sessions in different contexts, some as a result of mail-shot to resi care homes

July 2009: – Conversations with Sing For Your Life about running 4 ‘Roadshow’ Silver Song Clubs in Oxford – more, extra, one-off sessions

August 2009: – Silver Song Club Roadshow – extra, one-off, sessions – discussions begin re event on 1st October UN Day of Older Persons…

That is roughly the journey I’ve taken – a big part of it is staying connected, being willing to do stuff for free/ on the cheap at first and being and staying visible by being responsive and saying ‘yes, no problem’

It would be really good to hear from other freelancers how they started up? What worked for you? What didn’t? Please feel free to use the comments box to share your journey.