The arts continue to gain recognition as a vital part of society. In particular, there is increasing acknowledgment that the arts can offer practical and innovative ways to impact on the positive factors that nurture health and wellbeing (Seligman, 2011). Matarasso (1997) provides an overview of the social impacts arising from participation in the arts, outlining the demonstrable effects of the use of the arts for improving quality of life, supporting personal development and enhancing social cohesion.
To explore this further, in early 2013 Consilium research (commissioned by Skills for Care, Creative & Cultural Skills and the Baring Foundation) conducted a literature review of available evidence in conjunction with an activity mapping exercise to explore the role of the arts in delivering social care outcomes. The evidence review demonstrates the considerable physical and psychological benefits of supporting people who use services to engage with the arts.
The use of arts to deliver social care overview
- Whilst many of the publications broadly advocate for the use of arts and creative practice a number focus on the use of particular art forms to deliver positive outcomes for recipients of social care. The evidence base also highlights the increased opportunities that the use of arts provides for social interaction.
- The use of art, when delivered effectively, has the power to both facilitate social interaction as well as enabling those in receipt of social care to pursue creative interests. Consequently the ability of recipients of social care to access a range of art activities will enable them to exercise the choice and control that underpins the personalisation agenda.
A range of studies present evidence on the effectiveness of using arts to deliver social, health and well-being benefits. Matarasso (1997) provides a comprehensive overview of the evidence base that describes the social impacts arising from participation in the arts. The report outlines the ability of the arts to support personal development, improve quality of life and contribute to social cohesion.
With specific reference to health and well-being, the report makes a distinction between activities designed to deliver a clear health outcome and activities where health is not the primary outcome but where enjoyment, empowerment, social contact and confidence building are instead the focus.
Both the Arts Council England (2007) and the Health Development Agency (2007) have published reviews of evidence and practice relating to the impact of the arts on health and well-being. The Arts Council England review provides case studies of projects that, for example, improve quality of life for people with dementia, support the management of chronic pain for sufferers of rheumatoid arthritis and contribute to a reduction of instances of self-harm for mental health patients. The publication states that one of the challenges to securing interest and support for the use of arts to deliver health and well-being outcomes is a misconception that there are few scientific studies which demonstrate its positive contribution and impact.
The Health Development Agency concludes that the development of interpersonal skills, opportunities for making friends and increased involvement are among the most important contributions to health and well-being outcomes that arts projects can make. The report also suggests that whilst there has been an increase in the use of the arts to impact on health and well-being, there are no established principles and protocols for evaluating outcomes, assessing the processes by which outcomes are achieved or disseminating recommendations for good practice to the workforce. However, the report also recommends that as many of the best projects are based on intuition, opportunism and personal drive it is important for the field not to become ‘over-professionalised’.
In an earlier review Staricoff (2004) found evidence that participating in arts programmes in care settings can have beneficial impacts on the physical health and psychological well-being of service users. The review reports that anxiety, depression, heart rate, blood pressure and the demand for oxygen therapy were reduced for those participating in arts activities.
Several reviews have focused on the use of arts to support specific conditions or client groups. The Mental Health Foundation (2011) provides an evidence review of the impact of participatory arts on older people. Whilst the review includes 31 studies, most of these were of older people who were in generally good health, although 6 of the studies involved people with dementia, usually in a residential or day care setting.
The review outlines a series of mental and physical well-being outcomes achieved for participants. These include increased confidence and self-esteem, delivering feelings of accomplishment, counterbalancing the mental well-being difficulties associated with periods of loss which can increase the risk of low mood, anxiety and social isolation and improving cardiovascular functioning, joint mobility and breathing control through the use of dance, singing and playing musical instruments. Although this review does not reference any workforce development models to increase the effectiveness of using arts, it does include a recommendation that health and social care planners should recognise the potential of participatory arts and invest in the workforce to grow their ability to reflect on their practice.
A large scale evidence review conducted by Secker et al (2007) focused on participatory arts projects in England for people aged 16-65 with mental health needs. The report presents evidence of gains in mental health, social inclusion and in particular empowerment which, the authors conclude, provides justification to support future arts and mental health work. Drawing on primary research from a sample of case studies, the report highlights three arts projects comprising processes which were important for most participants:
- Getting motivated inspired hope and reduced inactivity, and so improved mental well-being and decreased mental distress;
- Focusing on art providing relaxation and distraction, which again resulted in improved mental well-being and decreased mental distress; and
- Connecting with others in a supportive environment decreased social isolation and increased confidence to relate to others, thus combating social exclusion and mental distress.
A further three processes were reported as being important in some but not all projects:
- Self-expression promoted catharsis and self-acceptance, and provided alternative ways of coping – benefits that decreased mental distress and reduced social exclusion;
- Connecting with abilities gave a sense of pride and achievement, which improved mental health/well-being; and
- Having time out helped alleviate worries and responsibilities, thus decreasing mental distress.
In the context of residential care settings, Swann (2012) outlines the benefits of engaging people with dementia in creative activities. Drawing on the author’s practical experience as an Independent Occupational Therapist the article emphasises that creativity is not just art and crafts, but encompasses a variety of activities including writing, music, dance and drama with each activity having specific benefits which can be enjoyed passively by observing, or through active participation. The article also includes practical learning for care staff on choosing the right activity, encouraging creativity, managing group dynamics and evaluating impact.
Whilst many of the publications broadly advocate for the use of arts and creative practice (Arts Council of Northern Ireland 2011, Art Shape 2000, Devlin 2010, Healing Arts 2010a 2010b, Ni Leime & O’Shea 2012 and the Baring Foundation 2009 & 2011), a number focus on the use of particular art forms to deliver positive outcomes for recipients of social care. The evidence base also highlights the increased opportunities that the use of arts (as with other activities) provides for social interaction.
Elliot et al (2010) provide a practical exploration of the arts in the healthcare of older people based on a small scale project delivered over a six week period. The project involved creative artists working with older people with dementia and staff from two housing centres that were supported by Belfast Health and Social Care Trust. The project incorporated the use of a wide range of art forms to engage the dementia suffers and provided a range of well-being benefits and social engagement benefits.
The research also found that the programme enabled carer participants to see their tenants ‘in a new light’ and was effective in challenging assumptions as well as offering new insights into their interests and personalities. The programme also enabled the development of respectful and creative relationships between tenants, carers and artists.
Although not specifically focused on the use of arts, publications such as Grundy et al (2007) and the Baring Foundation (2012) outline the importance of social interaction for successful ageing. Looking forward in the context of residential care, Mason (2012) suggests that the current generation of 50–60-year-olds who are likely to become care home residents in the next 20 to 30 years will have had a different set of life experiences from the present care home cohort. Future care home residents will want to influence decisions about their care, to continue to lead a ‘good life’ and be able to pursue their interests, dreams and goals.
The use of art, when delivered effectively, has the power to both facilitate social interaction as well as enabling those in receipt of social care to pursue creative interests. Consequently the ability of recipients of social care to access a range of art activities will enable them to exercise the choice and control that underpins the personalisation agenda.
- Music can enable people to participate in activities that are stimulating and personally meaningful. It can provide a source of social cohesion and social contact, give participants a degree of empowerment and control in everyday situations and contribute to a good quality of life.
- In order to be effective, approaches to encourage recipients of social care to participate in arts also have to persuade carers to have an open mind and facilitate access to arts-led activities.
- Professional musicians can assist care staff in their work by offering valuable insight or points of connection with older people for whom communication is difficult.
Music: Further detail
A total of 17 studies specifically cover projects that focus on using music (including singing and the use of instruments) to provide quality of life and well-being outcomes for recipients of social care. Hallam et al (2011) present an analysis of the Music for Life project which aimed to explore the way in which participating in creative music making activities can enhance the lives of older people. The project was delivered across three case study sites including The Sage Gateshead, Westminster Adult Education Service and the Connect programme at the Guildhall School of Music & Drama. Using a variety of qualitative and quantitative research methods and including the use of a control group, the study concluded that active musical engagement delivered a range of social, cognitive, emotional and mental health and physical well-being outcomes.
The report emphasises a need for opportunities for active music making to be made available locally and that these need to be open access (i.e. no prior experience required, no auditions) and provide opportunities for progression from beginner to more advanced levels. The report also states that active music making for older people should not be restricted to choirs and opportunities should be available for older people to take part in instrumental groups, making use of a range of wide range of instruments. With regards to practitioners leading the sessions, the report outlines a need for training to include the inappropriateness of holding ‘deficit models’ of aging which can lead them to underestimate the capabilities of older people and not offer them sufficient challenge.
The Sidney De Haan Research Centre for Arts and Health at the University Centre Folkstone has produced a series of publications that highlight the benefits of singing for people with a range of conditions including mental health (Morrison, I. & S. Clift 2012a), chronic obstructive pulmonary disease (Morrison, I. & S. Clift 2012b), dementia (Vella-Burrows 2012) and Parkinson’s (Vella-Burrows & Hancox 2012). These publications also provide practical guidance for practitioners (including those in social care) wanting to set up and use singing groups with people who live with each condition.
Sixsmith and Gibson (2007) present research that outlines the role of music and music-related activities in their everyday lives of people with dementia. The research findings are drawn from the results of qualitative research which was collected during in-depth interviews with 26 people with dementia and their carers who lived either in their own homes or in residential care in different parts of England.
The study concludes that as well as being appreciated in its own right, music can enable people to participate in activities that are stimulating and personally meaningful. It can provide a source of social cohesion and social contact, give participants a degree of empowerment and control in everyday situations and importantly enable people with dementia to enjoy many of the everyday activities that contribute to a good quality of life. The research also illustrates the problems that impede many people with dementia from engagement with music and participation in music related activities, in particular that many of the participants were dependent on others to access music, which had implications for the support and care that they received.
The publication outlines the potential for effectively delivered music-based activities involving care-givers to provide an important emotional bonding experience. As such it emphasises the importance of care givers appreciating the role of music therapy and incorporating music activities in the care provided.
The important role of the care giver (either paid or unpaid) is a recurring theme in the evidence base, in particular as they can strongly influence the choices made by the person/people in their care. Consequently, in order to be effective, approaches to encourage recipients of social care to participate in arts also have to persuade carers to have an open mind and facilitate access to arts-led activities.
Wood (2004) provides a summary of a small scale music therapy project used within a nursing care centre. The article advocates the use of music as an activity to address the social and creative needs of residents. Wood states that activity organisers within care settings do not have to be musicians but rather experts in knowing their residents’ interests and needs to enable them to utilise opportunities for socialising and being creative through the use of recorded music, local musicians and media. The article concludes that within a care setting it is possible to view a resident’s musical experience in a way which can encompass intensive therapy, group opportunities and social leisure time in order to keep each resident at the centre of their care and make the most of the power of music.
The evaluation of Meaningful Moments (Frearson 2009), a programme of live music performances for audiences of older people in nursing and care homes, day centres and other community settings across the UK, delivers a range of learning points for the social care sector. The programme incorporated over 300 interactive music events delivered over a two year period and which reached 2,000 people in 76 residential homes.
The study outlines the contribution of the performances to the well-being of older people, particularly those with severe dementia. It also suggests that regular performances, in contrast to ad hoc or one off activities, demonstrate significant impact on the engagement, memory and vitality of residents with dementia. Importantly the findings state that the performances are most effective when care staff are actively involved as this contributes to the social aspect of the events. The programme also demonstrates the potential for professional musicians to assist care staff in their work by offering valuable insight or points of connection with older people for whom communication is difficult.
Offering a different insight, CODA Music Trust (2012) provide a summary of their Music for Health and Well-being Programme which was developed in response to a need for services for individuals who have elected to use personal budgets as part of the roll out of self-directed support in health and social care. The programme included activities for service users with different care needs including Parkinson’s disease and stroke sufferers, adults with learning disabilities, dementia sufferers and people with mental health problems. Activities were delivered in a range of venues including but not restricted to day care centres.
Whilst the programme recorded positive outcomes for participants, the summary report outlines significant challenges in engaging sufficient and consistent numbers of participants at the sessions and charging sufficient fees per head to cover the costs of the music leader, venue hire and organisational overheads. Consequently the cost models used to underpin arts activities are important as these influence the frequency and sustainability of activities.
- The evidence base outlines the positive impact of dance on physical health, particularly in areas such as strength, fitness and balance both among healthy participant groups and those with physical impairments. In terms of psychological status the review highlights the benefits of dance for reducing loneliness and alleviating depression and anxiety.
- Dance has the ability to promote creativity and social integration, allow non-verbal stimulation and communication and simply provide an enjoyable activity.
Dance: Further detail
The use of dance to engage recipients of adult social care was addressed in six studies. Connolly & Redding (2010) from the Trinity Laban Conservatoire of Music and Dance present a comprehensive literature review of the impact of dance on health and well-being among older people. Dance styles covered included social dance, creative and contemporary dance and traditional dance forms such as Turkish folklore dance, traditional Greek dance and Irish Céildhe dancing. The review concludes that dance can have a positive impact on both the physiological and psychological status of older people. In particular the review outlines the positive impact of dance on physical health, particularly in areas such as strength, fitness and balance both among healthy participant groups and those with physical impairments such as Parkinson’s disease. In terms of psychological status the review highlights the benefits of dance for reducing loneliness and alleviating depression and anxiety.
The report also highlights the ability of dance to promote creativity and social integration, allow non-verbal stimulation and communication and simply to provide an enjoyable activity. The review states that the range of research carried out makes it difficult to draw clear conclusions on the relationship between specific types of dance or facets of dance and the measurable outcomes for groups of older people, or concrete best practice recommendations for appropriate delivery of dance among specific elderly groups within the population. However, it does outline a need for more appropriate activities for residents living in care (including residential care and domiciliary care) and the potential for enhancement of well-being through the provision of physical or stimulating activities. The report does not contain specific discussions or note any recommendations on training or professional development in dance for the adult social care workforce.
Specifically looking at the use of dance as a psychotherapeutic intervention for people with dementia, Hamill, Smith & Rohricht (2011) report on the use of circle dancing with a group of 18 people (11 people with moderate-to-severe dementia and 7 family carers) who participated in 45 minute sessions once a week for 10 weeks). The small scale pilot study completed assessments before and after the group therapy sessions, used weekly progress monitoring sheets and undertook qualitative interviews with participants after the group sessions to obtain their views.
The pilot study found that the use of circle dancing as a therapeutic intervention had a positive impact on participants’ general well-being and mood, including improving people’s concentration and communication with others. A number of carers stated that the group helped them to acknowledge the reality of dementia diagnosis and process their feelings of grief and loss as well as see beyond the diagnosis to the person they cared for. The report also provides an outline of the main stages of each group session and considerations for practitioners interested in providing similar activities.
Houston & McGill (2012) present a mixed method study which examines a 12-week dance project for people with Parkinson’s led by the English National Ballet. The evidence presented is based on findings involving 24 participant-dancers who were aged between 60 and 82 years old and had varying degrees of disease progression from mild to severe. Two of the participant-dancers were wheelchair users and six normally used walking aids. The report concludes that dancing may offer benefit to people with Parkinson’s through its intellectual, artistic, social and physical aspects. In particular, the dance project helped to improve balance and stability for participants. This project was led by professional dance artists with no direct involvement by the social care workforce.
Dorset County Council (2011) report on the Dance Generations Project which was delivered between 2006 and 2009 and provided dance activities for 265 people in residential care homes, day care centres, special schools and pre-schools. The project aimed to provide dance and movement opportunities for those who do not usually have access due to age, health conditions, access requirements and/or financial limitations.
A main focus for the Dance Generations Project was to create a lasting legacy by ensuring that dance became part of a programme of care delivery in the centres. A programme of training was delivered to care staff and teachers to increase skills and capacity as well as training to local artists to develop the skill pool. The training was facilitated by a toolkit created by dance artists. The project used artist mentors to work with and support staff (mentees) and to provide them with an opportunity to put into practice their training in a supported and mentored environment. Before each session artists and mentees discussed the session plan, roles and responsibilities, observation or delivery tasks. After each session there was feedback, advice support and suggestions for further planning.
Presenting impact evidence from one residential care home the report states that there was evidence from participants and Activity Officers that the dance sessions had a positive effect on mood. The creative dimension of dance and the particular structure of the sessions encouraged individuals to think and express themselves. This was seen as a distinctive feature of the dance sessions in comparison to exercise or other physical activity classes which are more about following instructions
The structure and training was reported as an effective way of transferring knowledge and skills to enable Activity Officers in a residential home to deliver dance sessions in a creative, imaginative and enthusiastic manner. A bespoke toolkit was created to be used with the training with each including a workbook that the mentee could use to review the training or to plan future sessions. The toolkit also contained information on dance workshops and ideas for creative exercises.
Arts for Health Cornwall and Isles of Scilly (2009) has also produced a toolkit which provides ideas, advice and inspiration to help staff deliver dance sessions in care settings. The toolkit outlines some practical tips on ensuring effective practice, including:
- Providing advance notice to participants so that a potentially new experience is offered in a non-threatening way;
- Giving value to the activity by making the environment special to create the right atmosphere;
- Structuring the time of the session appropriately. 45 minutes is regarded as a good length of time for participants to feel that they have been active without becoming over tired;
- Removing distractions that can break up the flow of the session. Participants may have a regular routine and may become anxious if tea breaks don’t happen at the same time. Pre warning about a change of routine or planning the session times to coincide with the breaks may be wise;
- Ensuring that the sessions are held in an accessible space where people can watch at a distance initially. Playing music before a session can be helpful in getting everyone prepared and in the right mood to dance. Replaying the music used in the sessions during the week can also be helpful;
- The use of props can be effective. Scarves, ribbons, flags, percussion instruments and balloons can all be incorporated into the dance sessions to support spontaneous movement and inclusivity. People with little movement or comprehension can be a valuable part of the group just by holding a ribbon or feather; and
- Ensuring that sufficient staff support is available to assist with the care aspects such as helping participants to join the group, providing refreshments, toileting and other personal needs.
- The poetry and creative writing sessions offer alternative methods to patients who find it difficult to express themselves.
Literature: Further detail
Four reports explore the use of poetry or creative writing as part of adult social care. Hilse, Griffiths & Corr (2007), report on the impact of participating in a poetry workshop for people who had experienced mental health problems in the past. Using in-depth interviews with two people who had experienced mental health problems, the report identifies both positive and negative impacts on mental health through the writing of poetry and sharing it with others. The researchers conclude that poetry writing as a mental action, as well as sharing poetry in a poetry workshop, has both positive and negative effects.
However, they also state that it should not be assumed that writing poetry is beneficial for all people with mental health problems in any circumstances. The report provides insights into the possible risks and benefits that could be considered in relation to using the writing of poetry as a therapeutic intervention. However the very small sample size raises some caution with regards to the reliability of the findings presented.
An earlier report by McArdle & Byrt (2001) outlined various ways in which expressive and therapeutic reading, poetry sessions and writing have been used to benefit users of mental health services. The report draws on evidence presented from a wide range of studies. One approach cited in the research is the telling of a story which is added to, in turn, by each participant, until it is completed. This can be a light-hearted activity enjoyed by participants and effective at increasing group cohesion. However, they also highlight that many studies include little or no mention of nurses’ involvement in expressive or therapeutic uses of reading and writing. They cite one exception by Simms (1993) who argues that ‘art adds a dimension in stimulating creative, expressive and imaginative ways of working’, both within individual nurse–patient relationships and the creation of ‘a more accepting, caring culture’.
More recently Haraldsdottir (2011) evaluated the use of poetry and creative writing in day care. Using a case study methodology the project was delivered by two poets who facilitated five poetry reading sessions and seven creative writing sessions in a day care setting. All sessions were co-facilitated by a clinical nurse specialist in palliative care.
A total of 25 patients attended one or more session with volunteers and staff members attending poetry reading sessions. Each session lasted for one and a half hours. The evaluation report concluded that the sessions provided an alternative approach to communication that facilitated social interaction and ‘sharing of stories’ within a day care setting that would otherwise not occur. It provided common ground and a unique way for the patients to connect with each other.
The poetry and creative writing sessions offered patients who found it difficult to express themselves alternative methods. However the evaluation does not outline any learning from the experiences of staff or include details on what, if any, training was provided by the poets to facilitate staff involvement.
- Art workshops provide both carers and participants with an opportunity to ‘feel special’.
- Training can be valuable in enabling some care staff to challenge their preconception that the end product of making art was the most important factor and helping them to realise that there is considerable value in the process of making.
Visual arts: Further detail
Nine studies specifically covered visual arts. Harper & Hamblin (2010) from the Oxford Institute of Ageing discuss the delivery and impact of the Good Times Programme which was delivered at Dulwich Picture Gallery in the London Borough of Southwark. The Programme incorporated gallery tours, gallery creative workshops, outreach creative workshops, celebration events and intergenerational creative workshops.
The Programme, in partnership with local doctors’ surgeries, also incorporated ‘prescription’ for art workshops offered to individual elderly people who may be frail, depressed or lonely. Doctors referred patients to the Gallery to participate in regular creative art classes. Training was also provided for carers in order to develop their skills and build their confidence in continuing the creative processes outside of their contact with the Gallery. As part of its outreach activities the Programme worked in partnership with a range of social care settings including day centres, residential care homes and a local hospice.
Drawing on the first five years of the Programme the report presents qualitative evidence of impact from both carers and participants who noted that the workshops provided them with an opportunity to ‘feel special’. Those taking part were reported to have enjoyed learning new skills and found a new self-belief in their abilities. The workshops were also reported as successful in encouraging staff from a number of organisations to plan activities suitable for day rooms or other community space. In particular the training was stated to be valuable in enabling some staff to challenge their preconception that the end product of making art was the most important factor and helping them to realise that there is considerable value in the process of making.
One of the lessons highlighted in the research was for staff (care staff, activity coordinators or healthcare professionals) not to underestimate the capacity of people in their care to engage in the arts. Indeed the report stated that several care staff were amazed at the concentration, talents and interaction achieved through just one of the creative sessions. Active participation in the sessions and attendance at training enabled the project to overcome any initial wariness and hesitation of staff as well as allowing them to realise the potential enjoyment and insight of working with older people as part of a creative process.
Workforce development models
- The evidence suggests there are limited published examples or detail of workforce development to support the adult social care workforce in using arts effectively as part of a care plan or personal plan.
- Whilst the availability of guidance material, toolkits and practical resources has a role to play in supporting workforce development, it is difficult to ascertain to what extent these are being accessed and used by the adult social care workforce to support the use of arts with recipients of social care.
- Generally where examples of art based activities to develop social care skills have been identified it is not always possible to assess their effectiveness in affecting the actual practice of adult social care staff.
- Training can be instrumental in changing some care staff’s attitude towards their job and care for older people. Providing them with the skills and confidence to deliver activities and see the difference it makes to their residents can give them a new perspective of care, an understanding of the importance of activities and an enthusiasm for providing them.
- Due to the variety in tasks and activities associated with the use of arts, care staff can find their job more interesting. Having received training and feeling more equipped and confident to fulfil their role, the use of arts can increase levels of staff job satisfaction.
What do you need to make it work?
- Hosting taster sessions - this can allow participants and carers to see what they can expect from different activities before committing an individual intervention or programme of activities. This can also be used to empower the participants to choose which activity is of most interest to them (Irving 2010 & Coda Music Trust 2012);
- For sessions delivered in a community space (e.g. gallery, museum or community hall) it can be effective to telephone participants the day prior to the activity in order to remind them and thus encourage attendance (Irving 2010);
- Adopting a person-centred approach and being responsive to the needs of individuals; and Using a mixture of approaches that enable participants to be passively or actively involved (Swann 2012).
For care staff
- Providing care staff with an opportunity to share practice and experiences with other staff through informal networking (Wright 2008 & Jones 2012);
- Using artists as mentors to support care staff to lead activities within their setting and enabling them to reflect on sessions (Wright 2008);
- Avoiding preconceptions about the ability of participants to engage in a range of arts activities (i.e. holding ‘deficit models’ which can lead staff to underestimate the capabilities of participants and not offer them sufficient challenge) (Hallam et al 2011);
- Running a longer-term programme of activities in order to build the care recipients confidence and engagement as well as supporting progression where appropriate. At the same time ensuring that the length of the sessions reflects the capacity of the participants and that the number of participants is guided by the capacity available to support their needs;
- Effective preparation and planning in particular with regards to using resources/prompts, transforming the space where the activity will be delivered and ensuring sufficient staff capacity is available to meet the personal needs of participants Swann 2012);
- Ensuring that evaluation methodologies are sensitive and tailored to the needs of the participants and nature of the arts activity; and
- For staff to actively participate in the sessions in order to build and strengthen relationships with the people in their care (Jones 2012).
This evidence review has sought to inform future thinking around the role of arts in the delivery of adult social care and in particular the implications for workforce development. The process of identifying relevant evidence has encountered a number of challenges, most notably the absence of a consistent terminology in terms of the use of ‘arts’ and agreement on how to measure quality and effectiveness. In addition, many publications don’t make a clear distinction between adults in receipt of social care and those that are not, in particular with reference to activities delivered for older people and many publications blur the boundary between health and social care.
Impact on participants
The review evidence demonstrates the considerable physical and psychological benefits of using arts with people in receipt of social care. Whilst the studies vary in terms of the rigour of their assessment, what is clear is that the arts provide an opportunity for people to interact with others in a meaningful and structured social activity. They facilitate creativity and individual expression and promote feelings of well-being. Where used effectively and as part of a longer-term approach, participants can also demonstrate progression in a particular art-form activity which, in turn, can engender a powerful sense of mental well-being.
Although some work has been undertaken to establish a baseline of information regarding the use of arts to deliver social care, this does not provide coverage across a range of settings (i.e. day care, residential, domiciliary or community) or provide detail on the training and professional development provided to support the adult social care workforce.
Consequently further research may be required to obtain a more accurate picture of how arts are used to deliver social care, the level of investment in training and professional development and models of workforce development that have proven effective in using arts effectively. It is evident from the evidence base that the use of a sustained programme of arts activities is desirable to maximise the positive impact on participants. It is possible that longer-term investment in workforce development is likely to provide stronger value for money for social care providers than making funding available on an ad hoc basis.
Impact of social care workforce
The use of arts can deliver profound benefits for the social care workforce, in particular challenging preconceptions on the abilities and talents of people with a range of conditions or needs. For the want of a better word the arts has the ability to ‘rehumanise’ the people in receipt of care and help the social care workforce to establish a stronger bond and relationship with their clients, seeing them as individuals with their own aspirations and interests. For some staff and/or organisations the use of arts can act as a catalyst for change in the workforce culture which in itself can serve to deliver longer-term improvements to the quality of care and experiences of those within the social care system.
6.6 The evidence base outlines the importance of providing care staff with the confidence to apply any learning and lead sessions themselves. Several of the studies also highlight the benefits of enabling care staff to build on any existing creative skills or interests that they have, most notably in terms of job satisfaction.
Commissioners and employers within the social care sector have a clear leadership role to firstly recognise the value of using arts to support their clients and secondly to invest in the development of their workforce to ensure that the use of arts becomes an everyday part of care planning as opposed to ad hoc one off activities.
The majority of the research has focused on the impact of the activity on the participants. Whilst this is understandable, it does nevertheless present difficulties in extrapolating from the evidence the role of the adult social care workforce and in particular identifying the skills, knowledge and qualities that are required to enable similar arts-led activities to be delivered in other settings/for future participants.
The evidence base largely describes activities that have been led by a professional artist rather than a social care professional. Although there are some examples of delivery by the social care workforce, these have tended to be in a supporting as opposed to leading role. As a result there is currently a lack of published evidence that describes the delivery of arts-led activities by the social care workforce and so in turn a lack of detail as to what training and professional development was provided to support this delivery Although the evidence identified a limited number of training programmes that supported social care staff to deliver art activities, there are some useful workforce development models that merit further exploration. In particular approaches that use artist mentors to support care staff to use arts as part of their care plan and those that enable care staff to network and share practice.
The skills required from the adult social care workforce will be strongly influenced by whether the activity is led by a professional artist, co-produced or led by the social care team. As a consequence any future workforce development programme which aims to increase the skills, confidence and capacity of the adult social care workforce to use arts to support the people in their care will need to acknowledge and accommodate this complexity.
The review has revealed considerable breadth in the use of arts and creative approaches. Whilst there are undoubtedly some underpinning skills, knowledge and qualities that the adult social care workforce requires to support the effective use of arts with recipients of social care, it is important not to over-generalise given the necessary wide range of variation in approaches. For example, the skills, knowledge and qualities required to deliver a visual arts project for people with dementia in a residential care setting may differ from those required to deliver a music project for people with mental health issues in a community setting. The process of undertaking the evidence review also indicated the existence of a number of toolkits and training resources that have created by arts organisations. However it is not possible to determine the extent to which these are actually applied by care staff (in particular activity coordinators) to support the use of arts in their settings. Toolkits and resources include videos which give potential participants an idea of different art activities and thus have the potential to inspire and motivate the social care workforce. The activity mapping phase of the research that will follow this evidence review will generate further detail on the resources that are currently in use to support art activities in social care settings.
This review highlights the absence of any longitudinal impact data on the use of arts by social care workers in a range of settings. Although there are a number of examples of workforce development projects that are providing the social care workforce with the skills and confidence to use arts to support people in their care, in most cases there is a lack of follow-up to ascertain the extent to which the training is still in use and importantly whether this is proving effective in delivering quality arts activities. This is likely to be a function of capacity and finance on behalf of the organisation delivering the training.
Further consideration is needed to understand and unravel the specific training approaches that are likely to be the most effective in providing social care staff with the skills, knowledge and qualities to use arts effectively in the delivery of social care. It is likely that a range of different approaches will be required although there is merit in looking at both accredited and non-accredited models as well as those that are classroom-based and those that are distance based. Any discussion on workforce development for the use of arts in the delivery of social care also needs to acknowledge a wider dialogue about professionalisation and progression routes for care staff and the link to improving outcomes for care recipients.