Skills for Care (SfC), The Baring Foundation and Creative and Cultural Skills, commissioned UK-wide research exploring the role of arts in the delivery of adult social care with a particular emphasis of workforce development. We've produced this visual story to give you a flavour of the key messages from the report.
Overall, the reviewed evidence demonstrates the considerable physical and psychological benefits of using arts with people in receipt of social care. The use of arts can also 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.
Rapid evidence assessment Executive summary - Introduction
Consilium Research and Consultancy (Consilium) was commissioned in November 2012 by Skills for Care, in partnership with Skills for Care and Development and Creative and Cultural Skills, to inform future thinking around the role of arts in the delivery of social care and in particular the implications for workforce development. This narrative report provides a summary of the evidence collated and reviewed as part of the evidence review of studies on the role of arts in the delivery of adult social care.
This review is focused on the use of arts in adult social care including activities delivered in a range of social care settings such as residential, day, domiciliary and community care. It also includes activities for adult recipients of care delivered in community settings. The key research questions were: What works? What do you need to make it work? How much does it cost?
In 2010 the Care Quality Commission commissioned the Social Care Institute for Excellence to define what an excellent adult social care service looks like. The report identified four essential elements of excellence, one of which was to provide a service which supports and enables people to engage in activities, pastimes and roles which bring them pleasure and meaning and enhance their quality of life. However, with pressure on funding available to arts organisations across England, there is a need to explore existing and potential models of using arts to deliver social care including the implications for workforce development.
The approach to completing the evidence review has followed Skills for Care's agreed approach (Appendix 1). Having formulated the review questions and developed a conceptual framework (Appendix 2), inclusion and exclusion criteria were agreed and the search strategy implemented. The evidence review was implemented between the 10th December 2012 and 1st February 2013.
The evidence review identified 191 documents that met the search criteria. Each document was screened by a member of the research team and compared against agreed inclusion and exclusion criteria.
The process of initially screening the studies reduced the number of documents to be synthesised to 91. The screening process identified a number of trends in the studies including those presenting evidence on the use of arts in delivering health and social care outcomes but falling short of making a clear distinction between them and publications focusing on the impact of the arts-led activity on the participant/social care recipient but offering limited reflection on the implications for workforce development.
The profile of evidence included:
- 43% of studies were based on primary research, 37% on secondary research and 20% on a combination of primary and secondary research
- 62% of the studies cover multiple social care settings
- 35% of studies were aimed at a variety of service users
- 59% of studies described the use of multi-artform activities with service users
- 51% of studies referenced arts activities delivered in partnership between social care staff/organisations and professional artists/arts organisations
There is considerable variation in the quality and rigor of the evaluation reports identified in the evidence review as well as a lack of consistency regarding the measurement tools used to assess the impact of arts activity on the participants. Indeed, a number of the evaluation studies highlight the need for follow-up research in order to validate any findings arising from pilot studies. It is therefore not possible to make judgements on comparative effectiveness or delivery quality. This review does however identify common themes and learning arising from the evidence base that can inform future approaches to address the needs of the social care workforce to facilitate the use of arts to deliver social care.
Review Results - The use of arts to deliver social care
Evidence on the use of arts to deliver social care has been broadly grouped by artform as the screening process revealed that this was likely to be more productive than grouping by setting or needs of the service users. In many cases the evidence base presents information on programmes that involve the use of more than one artform and participants with different needs.
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.
- 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.
- 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 nonverbal stimulation and communication and simply to provide an enjoyable activity.
- The poetry and creative writing sessions offer patients who find it difficult alternative methods to express themselves.
- 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.
Review Results - 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
Our analysis of the evidence suggests some emerging synthesis across published studies on certain factors and ideas that can support the effective use of arts to deliver social care.
- Hosting taster sessions - this can allow participants and carers to see what they can expect from different activities before committing to 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); and
- 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 and 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;
- For staff to actively participate in the sessions in order to build and strengthen relationships with the people in their care (Jones 2012).
Gaps in the Evidence Base
It is challenging to clearly differentiate between studies that report on the use of arts and those that report on other activities that are outside of the parameters of this review. Moreover, variations across studies mean that it is not possible to compare the impact of different approaches and make judgements on the effectiveness of one approach over another. Whilst acknowledging the limitations of this review, the gaps in evidence include:
- Studies which evidence the longer-term impact of workforce development on the practice of social care staff using arts to support people in their care;
- Detail on the funding models used to deliver arts-led activities in different settings in particular making a distinction between self-funded and funded care recipients;
- Information on the specific skills, knowledge and qualities that social care staff need to deliver different art forms in different settings to people with different needs;
- Discussion on the role of the commissioner or senior managers in providing the necessary organisational context to facilitate and support effective practice;
- Agreement on what constitutes effective practice and how quality of delivery can be measured and assured;
- Existing joint workforce planning to is focused on supporting both artists and social care staff to enhance positive outcomes for adults in receipt of social care;
- Detail on the levels of investment in workforce development by social care employers to support staff to use arts effectively in the delivery of 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. 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 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.
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 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. The evidence base outlines the importance of providing care staff with the confidence to apply any learning and lead sessions themselves as well as highlighting the benefits of enabling care staff to build on any existing creative skills or interests that they have.
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.
However, there are some useful workforce development models that merit further exploration including 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 evidence review also indicated the existence of a number of toolkits and training resources that have been created by arts organisations although it is not possible to determine the extent to which these are actually applied by care staff to support the use of arts in their settings.
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. 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.