MENTAL HEALTH
The Bradford Saturday Club Ian Mackie and Margaret Fox describe a successful joint initiative between the probation and health services which has led to an uncommon relationship between young offenders on community sewice ordets and elderly people with dementia.
M
ulti-agency and multidisciplinary approaches to community care are being pursued throughout the country. Collaborative working in tire care of elderly mentally ill people or in community service for young offenders remaias unusual. In the Bradford ‘Saturday Club' a joint agency project team has been created which combines care for elderly mental ly ill people (dementia sufferers) with a venue for offenders to serve community service orders. The joint project creates a total therapeutic effect from which both client groups benefit and to which lx>th contribute. In November 1987, Margaret Fox, a pro bation service officer, visited Northern View day hospital for elderly mentally ill people to ask for advice on how to begin a day centre for people suffering from dementia. Following several discussions we felt that the idea of a ‘club’ should lx> followed up together, as a joint health ser vice/probation service project. The aim was for the health service to supply the nursing staff while the proba tion seivice would select offenders to Ire based at the club for the duration of their term. The dementia sufferers would gain a new resource while the offenders would lx able to gain new experiences in caring and taking responsibility for others as they served the sentence of the court. Inevitably, Lite planning and coordina tion time was quite lengthy but in April 1988 the Saturday Club opened. In January 1990, Margaret transferred to Huddersfield and opened a second club in conjunction with Dewsbury Health Authority, now 26
NURSING
THE
called the Kirklees Saturday Club. The Bradford Club operated for three years at a local social services department day cen tre, transferring earlier this year to the day hospital where the nursing staff are based. Both clubs fulfil the original aims. The Bradford Saturday Club was the subject of an evaluation by Bradford Health Author ity from January to August 1990 (1) and since this report it has been possible to review some aspects of the club’s practice. In particular, it showed us the value of compiling a clear policy document. Our feeling is that both clubs have lxen a suc cess, demonstrated by the pride, esteem and motivation shown by all attenders.
Club-like atmosphere The outline plan for the project from its inception was for the provision of a day care resource for dementia sufferers and carers. Care would be provided by nurs ing staff who would supervise the work of offenders on community service (commu nity service workers). The CSWs would lx expected to provide social care for the attenders of the club. The philosophy of the unit was to pro vide a non-institutional club-like atmo sphere in which the normality of the dementia sufferers would be emphasised rather than their impairment. In keeping with the clulr-like pltilosophy, family mem bers, carers and children would be wel come to visit or to remain with the patient for as long as they liked. It had been hoped that allocation of CSWs to sufferers might lx possible on a one-to-one basis, but as the club devel oped and this objective seemed unrealis ELDERLY
JULY/AUGUST
tic, CSWs were allocated to a group of sufferers for all or part of the day. From the beginning of the project, the probation service had undertaken to pro vide the catering for the club. A commu nity service supervisor and a team of CSWs are employed in the kitchen. Those CSWs involved in the care work are supervised by the nurse in charge of the project. The community order supervisor on duty calls at the project each week and will assist if any problems arise with the CSWs. Induction of CSWs is a joint responsi bility between nursing and probation staff. The probation service selects offenders and arranges for an intrcxluction to tlx scheme. Wherever possible, new entrants to the scheme are then interviewed by a member of the nursing staff. The daily programme for the club starts with a 9am meeting of nursing staff and CSWs. During the meeting, activities for the day are discussed and CSWs allocated to groups. During this time new entrants to the scheme are also given some instruction and training on aspects of dementia and social care. Group activities take place from the arrival of the dementia sufferers until lunch, usually a leisurely affair with staff, patients and CSWs all eating togeth er. Alter lunch, a rest period is usually fol lowed by music or singing. The everyday programme is frequently interspersed with outings or ‘celebration’ days when an entertainer might lx booked for the club. The club has had several cabarets, which are greatly enjoyed by everyone. These ‘celebration’ days have shown the ability of even quite severely impaired people to enjoy and take part in 1 9 92
VOL 4
N04
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social gatherings. The level of sufferers’ social skills can surprise both care givers and nurses. We feel the club’s success is apparent in its continued operation, but what are the benefits of this resource over tradi tional facilities? Dementia sufferers benefit from the care they receive within the pro ject and the increased opportunity to socialise while receiving care. The report compiled for Bradford Health Authority, in which 20 club mem bers were interviewed with their carers, showed that the two most valued aspects of the scheme were activity and stimula tion. This was seen to contrast with the prevailing home situation which might lie isolated and far from stimulating. Care givers valued the scheme for the relief and respite care it could provide. Care givers who attended the scheme felt it gave them a sense of solidarity in knowing there were others in similar situations. Margaret had hoped the project would provide offenders with an opportunity to gain self confidence and esteem, the lack of which may contribute to offending and die inability to resume or take up a posi tive lifestyle. 'Ilie report showed that many CSWs made remarkable and often extreme ly sensitive carers of dementia sufferers. One revelation in both clubs has been the uninhibited rapport of the different generations, with young people, some times extremely extrovert in manner (and appearance) mixing on equal terms with out bias. Tlie CSWs have found that work ing with elderly mentally ill people is an education in itself: the stereotypical sweet elderly person, faculties intact, beloved of television advertisements is a world away from the dementia sufferer who is often (totally out of former character) abusive and cantankerous. The way the two client groups ‘gel’ constantly amazes onlookers, Ixitli professional and otherwise. Attendance of community service work ers on these projects has been better than on many other projects. This could per haps lie attributed to the feeling of worth and the fact that someone needs and relies on them. Most people have the need to be needed. Children who are ignored or neglected often draw attention to them selves by bad behaviour and this may well be carried on into adult life, particularly with high unemployment. Offences often seem to fie committed through boredom
by people with low self esteem. Having a worthwhile aim and being appreciated seems to add discipline to their lives. Of the 14 CSWs interviewed for the evaluation, six stated that although they had never worked with old people before, they would now consider the possibility of doing so. Two CSWs have obtained employment within the care sector. Of equal importance, perhaps, several CSWs reported a change in self perception and attitudes towards disabled people. The scheme was felt by the CSWs to have helped them develop personally. Before the scheme began, we had hoped that staff would benefit from it by working within a less structured and insti tutional environment. Care for elderly mentally ill people can be bound by the
‘The report showed that many community service workers made remarkable and extremely sensitive carers of dementia sufferers’ institutional thinking of staff; it was hoped that staff who spent time working in the club would be able to experience and then develop non-institutional care for elderly mentally ill people. The evaluation showed that staff enjoyed working within the project and subsequently their morale was high. Noone who has worked on the scheme felt that working with CSWs was wrong. Tlie co-working of nurses with proba tion professionals has been fluent and unproblematic. All the nurses who have worked on tlie project feel they have ben efited from tlie experience and the oppor tunity it has given them to extend their role in relation to die supervision of CSWs. Our feeling is that the opportunity to wit ness the spontaneous and natural caring of die CSWs towards the dementia suffer ers has helped to reassert for die nursing
staff the humanity of the patients. This contrasts, perhaps, widi die situation found in institutionalised care where patients can become much more the ‘objects’ of care. We feel the project has demonstrated that a broadly positive experience can occur for divergent groups with different explicit aims within one environment. We think that this may be attributed to the development of a therapeutic milieu with in the project, whereby the interaction between each person is deemed important and potentially therapeutic. Relationships between staff and user groups are characterised by their infor mality and equality. 'Iliis has led to a nat ural and spontaneous role occurring as project workers combine to help one anodier. Relationships between dementia sufferers and others often led die way in diis respect, as they would welcome even the most unlikely looking carers on the basis diat it was apparent to diem that diey were there to help. The project is held in high esteem by the probation service management and full backing and support has been extended to Margaret Fox in die establishment of her second venture into dementia care at Kirklees. Tlie community service arm of die probation service is constandy seeking projects for offenders which give a sense of worth, as diese two clubs do. 'Hie two Saturday clubs cover the low-risk offend er; other less personalised projects cover the middle to high-risk offender in other ‘uncommon relationships’. Perhaps, dien, die project demonstrates that the relationships between people in the club are complementary and can be used positively to assist in the personal development of all concerned. In this respect the Saturday Club may be said to have evolved into an experiential learning centre. The meeting of people who do not usually mix has brought unexpected good results; perhaps other such uncommon relationships could do the same. Ian Mackie RM.N is now Manager, The links Nursing Home, Bradford. Mar garet Fox is Community Service Offi cer, Kirklees Probation Service. Reference
1. Kitwood T. Do you come to this pub often? Unpublished report. Bradford Healtii Authority. 1990.
Downloaded from RCNi.com by ${individualUser.displayName} on Sep 15, 2016. For1992 personal use only. No NO-1 other uses without permission. NURSING THE ELDERLY JUI.Y/AUGtJST VOL4 27 Copyright © 2016 RCNi Ltd. All rights reserved.
The Bradford Saturday Club Ian Mackie and Margaret Fox describe a successful joint initiative between the probation and health services which has led to an uncommon relationship between young offenders on community sewice ordets and elderly people with dementia.
M
ulti-agency and multidisciplinary approaches to community care are being pursued throughout the country. Collaborative working in tire care of elderly mentally ill people or in community service for young offenders remaias unusual. In the Bradford ‘Saturday Club' a joint agency project team has been created which combines care for elderly mental ly ill people (dementia sufferers) with a venue for offenders to serve community service orders. The joint project creates a total therapeutic effect from which both client groups benefit and to which lx>th contribute. In November 1987, Margaret Fox, a pro bation service officer, visited Northern View day hospital for elderly mentally ill people to ask for advice on how to begin a day centre for people suffering from dementia. Following several discussions we felt that the idea of a ‘club’ should lx> followed up together, as a joint health ser vice/probation service project. The aim was for the health service to supply the nursing staff while the proba tion seivice would select offenders to Ire based at the club for the duration of their term. The dementia sufferers would gain a new resource while the offenders would lx able to gain new experiences in caring and taking responsibility for others as they served the sentence of the court. Inevitably, Lite planning and coordina tion time was quite lengthy but in April 1988 the Saturday Club opened. In January 1990, Margaret transferred to Huddersfield and opened a second club in conjunction with Dewsbury Health Authority, now 26
NURSING
THE
called the Kirklees Saturday Club. The Bradford Club operated for three years at a local social services department day cen tre, transferring earlier this year to the day hospital where the nursing staff are based. Both clubs fulfil the original aims. The Bradford Saturday Club was the subject of an evaluation by Bradford Health Author ity from January to August 1990 (1) and since this report it has been possible to review some aspects of the club’s practice. In particular, it showed us the value of compiling a clear policy document. Our feeling is that both clubs have lxen a suc cess, demonstrated by the pride, esteem and motivation shown by all attenders.
Club-like atmosphere The outline plan for the project from its inception was for the provision of a day care resource for dementia sufferers and carers. Care would be provided by nurs ing staff who would supervise the work of offenders on community service (commu nity service workers). The CSWs would lx expected to provide social care for the attenders of the club. The philosophy of the unit was to pro vide a non-institutional club-like atmo sphere in which the normality of the dementia sufferers would be emphasised rather than their impairment. In keeping with the clulr-like pltilosophy, family mem bers, carers and children would be wel come to visit or to remain with the patient for as long as they liked. It had been hoped that allocation of CSWs to sufferers might lx possible on a one-to-one basis, but as the club devel oped and this objective seemed unrealis ELDERLY
JULY/AUGUST
tic, CSWs were allocated to a group of sufferers for all or part of the day. From the beginning of the project, the probation service had undertaken to pro vide the catering for the club. A commu nity service supervisor and a team of CSWs are employed in the kitchen. Those CSWs involved in the care work are supervised by the nurse in charge of the project. The community order supervisor on duty calls at the project each week and will assist if any problems arise with the CSWs. Induction of CSWs is a joint responsi bility between nursing and probation staff. The probation service selects offenders and arranges for an intrcxluction to tlx scheme. Wherever possible, new entrants to the scheme are then interviewed by a member of the nursing staff. The daily programme for the club starts with a 9am meeting of nursing staff and CSWs. During the meeting, activities for the day are discussed and CSWs allocated to groups. During this time new entrants to the scheme are also given some instruction and training on aspects of dementia and social care. Group activities take place from the arrival of the dementia sufferers until lunch, usually a leisurely affair with staff, patients and CSWs all eating togeth er. Alter lunch, a rest period is usually fol lowed by music or singing. The everyday programme is frequently interspersed with outings or ‘celebration’ days when an entertainer might lx booked for the club. The club has had several cabarets, which are greatly enjoyed by everyone. These ‘celebration’ days have shown the ability of even quite severely impaired people to enjoy and take part in 1 9 92
VOL 4
N04
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social gatherings. The level of sufferers’ social skills can surprise both care givers and nurses. We feel the club’s success is apparent in its continued operation, but what are the benefits of this resource over tradi tional facilities? Dementia sufferers benefit from the care they receive within the pro ject and the increased opportunity to socialise while receiving care. The report compiled for Bradford Health Authority, in which 20 club mem bers were interviewed with their carers, showed that the two most valued aspects of the scheme were activity and stimula tion. This was seen to contrast with the prevailing home situation which might lie isolated and far from stimulating. Care givers valued the scheme for the relief and respite care it could provide. Care givers who attended the scheme felt it gave them a sense of solidarity in knowing there were others in similar situations. Margaret had hoped the project would provide offenders with an opportunity to gain self confidence and esteem, the lack of which may contribute to offending and die inability to resume or take up a posi tive lifestyle. 'Ilie report showed that many CSWs made remarkable and often extreme ly sensitive carers of dementia sufferers. One revelation in both clubs has been the uninhibited rapport of the different generations, with young people, some times extremely extrovert in manner (and appearance) mixing on equal terms with out bias. Tlie CSWs have found that work ing with elderly mentally ill people is an education in itself: the stereotypical sweet elderly person, faculties intact, beloved of television advertisements is a world away from the dementia sufferer who is often (totally out of former character) abusive and cantankerous. The way the two client groups ‘gel’ constantly amazes onlookers, Ixitli professional and otherwise. Attendance of community service work ers on these projects has been better than on many other projects. This could per haps lie attributed to the feeling of worth and the fact that someone needs and relies on them. Most people have the need to be needed. Children who are ignored or neglected often draw attention to them selves by bad behaviour and this may well be carried on into adult life, particularly with high unemployment. Offences often seem to fie committed through boredom
by people with low self esteem. Having a worthwhile aim and being appreciated seems to add discipline to their lives. Of the 14 CSWs interviewed for the evaluation, six stated that although they had never worked with old people before, they would now consider the possibility of doing so. Two CSWs have obtained employment within the care sector. Of equal importance, perhaps, several CSWs reported a change in self perception and attitudes towards disabled people. The scheme was felt by the CSWs to have helped them develop personally. Before the scheme began, we had hoped that staff would benefit from it by working within a less structured and insti tutional environment. Care for elderly mentally ill people can be bound by the
‘The report showed that many community service workers made remarkable and extremely sensitive carers of dementia sufferers’ institutional thinking of staff; it was hoped that staff who spent time working in the club would be able to experience and then develop non-institutional care for elderly mentally ill people. The evaluation showed that staff enjoyed working within the project and subsequently their morale was high. Noone who has worked on the scheme felt that working with CSWs was wrong. Tlie co-working of nurses with proba tion professionals has been fluent and unproblematic. All the nurses who have worked on tlie project feel they have ben efited from tlie experience and the oppor tunity it has given them to extend their role in relation to die supervision of CSWs. Our feeling is that the opportunity to wit ness the spontaneous and natural caring of die CSWs towards the dementia suffer ers has helped to reassert for die nursing
staff the humanity of the patients. This contrasts, perhaps, widi die situation found in institutionalised care where patients can become much more the ‘objects’ of care. We feel the project has demonstrated that a broadly positive experience can occur for divergent groups with different explicit aims within one environment. We think that this may be attributed to the development of a therapeutic milieu with in the project, whereby the interaction between each person is deemed important and potentially therapeutic. Relationships between staff and user groups are characterised by their infor mality and equality. 'Iliis has led to a nat ural and spontaneous role occurring as project workers combine to help one anodier. Relationships between dementia sufferers and others often led die way in diis respect, as they would welcome even the most unlikely looking carers on the basis diat it was apparent to diem that diey were there to help. The project is held in high esteem by the probation service management and full backing and support has been extended to Margaret Fox in die establishment of her second venture into dementia care at Kirklees. Tlie community service arm of die probation service is constandy seeking projects for offenders which give a sense of worth, as diese two clubs do. 'Hie two Saturday clubs cover the low-risk offend er; other less personalised projects cover the middle to high-risk offender in other ‘uncommon relationships’. Perhaps, dien, die project demonstrates that the relationships between people in the club are complementary and can be used positively to assist in the personal development of all concerned. In this respect the Saturday Club may be said to have evolved into an experiential learning centre. The meeting of people who do not usually mix has brought unexpected good results; perhaps other such uncommon relationships could do the same. Ian Mackie RM.N is now Manager, The links Nursing Home, Bradford. Mar garet Fox is Community Service Offi cer, Kirklees Probation Service. Reference
1. Kitwood T. Do you come to this pub often? Unpublished report. Bradford Healtii Authority. 1990.
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