A STRENGTHS BASED APPROACH TO COMMUNITY DEMENTIA CARE

A STRENGTHS BASED APPROACH TO COMMUNITY DEMENTIA CARE KATE IRVING, RACHAEL JOYCE, PAULINA PIASEK, PATRICIA MCPARLAND, CATHERINE DALY, LOUISE HOPPER

OBJECTIVES: TO EXPLORE AND DEVELOP A NARRITIVE CARE MODEL TO FOSTER THE STRENGTHS IN THE PERSON WITH DEMENTIA, THEIR VALUED RELATIONSHIPS AND THEIR COMMUNITIES. • WHY? 1. 2. 3. 4. We know some essential conditions of care but these don’t seem to be sufficient Services for people with dementia are under funded and often not fit for purpose Dementia friendly communities movement – what’s it for if not for helping people age in place Strength based models have worked in other disciplines and are in keeping with theoretical constructs of person centred care

REVIEW OF THE LITERATURE • Deficit model very evident • Strength based models – 50 studies only 15 in the elderly and 4 with a focus on dementia Community Friends Family Person

CRES (CARE RECEIVER EFFICACY SCALE) • 5 domains and was found to be consistent and reliable in measuring strengths in youths. • (1) Self-care performances; (2) Relational coping with caregivers; (3) Perceptions of dependence; (4) Performance-related quality of life; and (5) Accepting help. Community Friends Family Person

ANSWERS (ACQUIRING NEW SKILLS WHILE ENHANCING REMAINING STRENGTHS) • Dyadic six 90 -minute guided sessions including education about dementia and memory loss, communication, recognizing emotions and behaviors • Mild to moderate dementia • Very well evaluated (52 dyads) • (Judge, Yarry, & Orsulic. Jeras, 2010) Community Friends Family Person

MODELS TAKING COGNISENCE OF ENVIRONMENT • VIP (Vital Involvement Practice) Strength-based intervention for working with older, frail adults (Kivnick & Stoffel, 2005). • a) systematic identification of individual strengths and assets, including the environment; b) consideration of strengths in relation to individual and environmental challenges. • Functional-age model of intergenerational treatment: Assessment and intervention that focuses on older adult’s functional capacities, the demands of the environment and interdependence between family members (Greene, 2000) Community Friends Family Person

COMMUNITY ASSET MAPPING Capacity-building /assetbased community development; This model recognizes that social capital and networking are important assets within a communty. Allows members of the community to take a participatory approach and ownership of their own development (Chaskin, Brown, Venkatesh, & Vidal, 2001). Community Friends Family Person

ASSUMPTIONS? • In any system there will be strengths • A focus on strengths would contribute positively to quality of life • These strengths may lie to differing extents in the personal qualities of individual, their valued relationships or their community resources • Any potential to improve quality of life only exists if the person with dementia or the carer are motivated to make a change • Any narrative led by the person with dementia and their carer about their day to day life would in time focus on the most important issues for them • Errorless learning is essential in a dementia context

METHODOLOGY • Methods: • Case study with 5 individuals each was paired with a practitioner • We made twice weekly visits over 14 weeks • taking a narrative approach to identifying exisiting or potential strengths of the person with dementia and carer / community • Co-creating a goal / goals to work towards • Taking an intensly reflective style in thining through issues and in clinical supervision was taken seriously

FINDINGS…

1. UNTAPPED POTENTIAL - THERE WAS POTENTIAL IN ALL INSTANCES TO MOVE THE PERSON WITH DEMENTIA OR CARER CLOSER TO A COCREATED GOAL. “Without those strategies, or whatever, I couldn’t make progress. I couldn’t. I just couldn’t, it wasn’t on, because you are the professionals and… it would be different if I’d gone to somebody else, like you know they give… gives these things, or you go to a group. I knew that wasn’t for me at all. At the beginning, I found it quite difficult, I did, but gradually it was the confidence I got more than anything else, that I could do this. I got worried there about the memory thing at one stage, but you can’t do that, you just have to make use of… or improve what you can improve, you have to practise it. Practice is a big thing. ” (Participant 5)

3. LOCI OF STRENGTH: STRENGTH POTENTIAL LAY IN A DIFFERENT LOCATION FOR EACH INDIVIDUAL. Community Family Self

2. GOAL DEFINITION- UNDERSTANDING THE PERSON WELL ENOUGH TO CO-CREATE A GOAL WAS COMPLEX AND DYNAMIC. • …And then realised, in one of those door handle conversations, their marriage fell through ten years ago, it’s just that he can’t remember it. So, you know, I still had to work with the relationship because there was still a relationship there to draw some strength from, and that’s what we did then as best we could with really poor resources. (Practitioner focus group)

4. ETHICAL ISSUES: ENGAGING IN THIS WAY CAUSED ETHICAL DILEMMAS FOR THERAPISTS. • Playing it by ear– were we doing the right thing blurred lines between research and practice • I know I said that [wife] had her own needs, but [pwd] needed to talk about the dog being taken away, and he couldn’t talk about that in front of [wife], and I think if I had gone in and said, ‘This has to be dyadic, ’ [pwd] wouldn’t have got as much from it because he wanted to tell somebody how much that hurt, and it wasn’t something that we were going to resolve so there was no point in the three of us having a conversation about it. • Achieving neutrality in dyads was very complex where dementia is in the mix • Concerned that the participants set too much faith in our ability to fix them

CONCLUSIONS • A strengths based, narritive model gave flexibility for the development of a therapeutic relationship that was in all cases positive for the person with dementia, the carer and therapist. The breadth of the model was a challenge for therapists and gave rise to ethical issues which required group reflection to ensure the approach was appropriate. • We have used the findings to form a reflective educational tool to give confidence to other practitioners in these approaches and to try to contain the breadth of the approach