‘Unlocking the door to being there’: The contribution of creative facilitators in supporting people living with dementia to engage with heritage settings

Abstract

This article reports findings from the evaluation of ‘Sensory Palaces’, an innovative project developed by the charity Historic Royal Palaces, which looks after six of the United Kingdom’s unoccupied royal palaces. The Sensory Palaces project employs creative facilitators to support people living with dementia and their care partners in engaging with two of these sites; Hampton Court Palace and Kew Palace. This paper focusses on the role and contribution of the creative facilitators in supporting people living with dementia to connect with these heritage spaces. It reports on data collected from facilitator interviews relating to the benefits of engaging together through sensory and creative methods to explore and share experiences of the palaces, drawing out important factors from the design, content and delivery of the sessions.

Keywords

creative facilitators dementia heritage sites sensory arts well-being

Introduction

Creative and arts-based approaches and activities, both participative and non-participative, appear to have much to offer to people experiencing health challenges, and to vulnerable and excluded groups. Artists and creative professionals may be found working on projects with homeless people (e.g. Streetwise Opera, 2018), offenders (e.g. The Koestler Trust) and people with mental health difficulties (e.g. About Face Theatre Company (n.d)); and artists-in-residence have been appointed to work in hospitals, prisons and residential institutions. Such initiatives have also become increasingly common in dementia care in recent years (Bellass et al., 2018; Zeilig, Killick, & Fox, 2014). Creative professionals bring discipline-specific skills in, for example, performance, music and art-making, but also particular perspectives and approaches to the business of making connections between people, places and things, drawing on their own and other people’s experiences and transforming them into something new (Basting & Killick, 2003, p. 8).

Background

Artists for Sensory Palaces

The use of creative and artistic approaches to support experiences of visiting heritage spaces for people living with dementia is a key aspect of the Sensory Palaces (SP) participatory creative workshops programme, which is intended to provide authentic, site-specific and multi-sensory experiences. SP creative facilitators are practising and/or trained artists in their own right. They are employed to facilitate engagement with the historic settings, and to ignite the creativity of the workshop participants, as well as to manage the group format of the SP experience in a safe and enriching way. Their aim is to create a safe environment for people to learn, engage and ‘play’. Experience of having worked with the specific audience, experience of working with groups in heritage/cultural sessions and a distinctive creative practice aligned with the senses were decisive selection criteria for the artists engaged as creative facilitators on the programme.

Although some of the creative facilitators have experience of applying their artistic discipline therapeutically, they are not asked to employ their skills in this way. The sessions do not focus on the individuals and their mental health specifically, neither do they aim to ease or slow down development of dementia symptoms. The focus of the SP programme is to make the royal palaces at Kew and Hampton Court accessible, in all senses of the work for people living with dementia and their care partners, and to support them in engaging with the history and heritage within these sites. This forms part of the wider Learning and Engagement strategy of Historic Royal Palaces (HRP), to create opportunities for everyone to ‘explore the story of how monarchs and people have shaped society, in some of the greatest palaces ever built’ (HRP, n.d.b).

The programme brief requires facilitators to use ‘Three S’s’ in the development and delivery of sessions – engaging participants’ senses and using stories to help them enjoy and relate to the historic spaces in which the programme is delivered. A session template was developed in order to facilitate the three s’s combination in each session. The practitioners responded to this template by locating spaces and stories from Hampton Court and Kew palace and integrating these with participative creative activities drawing on their own artistic practice. The activities are directly linked to the material spaces and social encounters being experienced by participants, and although not directly stated in the HRP literature, this approach appears congruent with observations made by Bellass et al. (2018) who note that viewing the self as a social, relational process may have more to offer in understanding the value of art and creativity to people with dementia than individualised approaches.

Session proposals were reviewed from the logistical, conservation, historical accuracy and accessibility perspective and adapted further. Heritage sites face and present particular challenges in accommodating the requirements of vulnerable groups, including people living with dementia (see the practical guide for dementia-friendly heritage sites produced by HRP, 2017). For example, some sensory materials were replaced for those safe to use in the period rooms, access routes into the period spaces were chosen taking into account potential mobility issues of participants, and historical stories were simplified and underpinned by HRP research (Groom & Prosser, 2006; Worsley & Souden, 2005).

Literature review

There is a developing body of literature evaluating creative and arts-based interventions specifically for people living with dementia, such as singing/music, multi-sensory activities, art making activities and visual art programmes. Studies of such projects suggest that they produce wellbeing benefits for participants such as feelings of being socially included (Osman, Tischler, & Schneider, 2014; Vankova et al., 2014) and the possibility of enjoying life, at least in that moment, in the same way as before the diagnosis of dementia (All-Party Parliamentary Group on Arts, Health and Well-Being, 2017; Sauer, Fopma-Loy, Kinney, & Lokon, 2016). Hong and Choi (2011) and Subramaniam, Woods, and Whitaker (2014) have suggested improvements in cognition over time for people with dementia participating in music activities; and Clair (1996) found that people participating in music activities are more alert during the session than compared to other silent/non-musical art and craft activities.

A number of studies have highlighted the role of the facilitator, as well as the content of sessions, in enhancing the experience of such activities. For example, Billington, Carroll, Davis, Healey, and Kinderman (2013) identified a number of features of effective facilitation, including addressing the participants by their names, maintaining good eye contact during engagement, speaking in a clear and loud but not commanding voice and creating a friendly atmosphere that allows people living with dementia to express themselves. A literature review by Windle et al. (2017) examined studies reporting visual arts programmes for people living with dementia, seeking ‘theoretical clues’ (p. 3) about the features that appear to contribute to the achievement of good outcomes and more positive and engaged experiences. They combined this with a qualitative exploration of stakeholder experiences of participation. They identified two key contextual factors – the role of the artists and facilitators and the provision of provocative and stimulating aesthetic experiences – as important for underpinning effective visual arts programmes in any setting, with positive outcomes influenced by cognitive stimulation, the recognition and promotion of resilience and person-centred approaches.

The focus of the SP programme is to make the royal palaces at Kew and Hampton Court accessible, in all senses of the word, for people living with dementia, and to support them in engaging with the history and heritage within these sites, with the aim of improving their well-being. A search for literature on programmes for people with dementia in heritage settings revealed no examples of peer-reviewed studies evaluating programmes specifically designed for the purpose of enabling engagement with similar sites and their history and heritage. The search identified 19 studies published since 2010 concerning programmes provided by arts and heritage organisations, in the UK and elsewhere, targeting a range of service user groups, which feature the viewing of art works (e.g. Roe et al., 2016); or handling of artefacts and objects (Ander et al., 2013; Smiraglia, 2015; Solway, Thomson, Camic, & Chatterjee, 2015), sometimes associated with participative arts and crafts activities (Camic, Baker, & Tischler, 2015; Camic, Tischler, & Pearman, 2014; Eekelaar, Camic, & Springham, 2012; Flatt, Liptak, Oakly, Varner, & Lingler, 2015). Some of these projects are delivered within museums or galleries (Camic et al., 2014, 2015; Eekelaar et al., 2012; Flatt et al., 2015; Johnson, Culverwell, Hulbert, Robertson, & Camic, 2015; MacPherson, Bird, Anderson, Davis, & Blair, 2009; National Museums Liverpool, 2012; Roberts, Camic, & Springham, 2011; Roe et al., 2016), but with a focus on art works and artefacts rather than on the spaces in which they are housed or displayed.

Nine of these identified the importance of appropriate staffing and facilitation in creating positive experiences for participants, whether people living with dementia, mental health difficulties or life-limiting illness (Camic and Chatterjee, 2013; Camic et al., 2015; Flatt et al., 2015; MacPherson et al., 2009; Mittelman & Epstein, 2009; National Museums Liverpool, 2012; Roberts et al., 2011; Roe et al., 2016). All emphasised that staff and facilitators should be able to support participants according to their needs, e.g. by helping them to navigate the site or providing support in carrying out activities. Four studies stated that staff and facilitators should have specific knowledge and understanding about the needs of people living with dementia (Roberts et al., 2011; Roe et al., 2016; MacPherson et al., 2009; Mittelman & Epstein, 2009). Five highlighted core communication skills, including clear and respectful communication and listening and slowing down if needed during the activity (Camic et al., 2015; MacPherson et al., 2009; Mittelman & Epstein, 2009; National Museums Liverpool, 2012). Four reported that the creation of a safe, warm, positive environment supports enjoyment and participation (Camic & Chatterjee, 2013; Camic et al., 2015; Mittelman & Epstein, 2009; National Museums Liverpool, 2012).

Research approach and methodology

Aim

The evaluation of the SP programme aimed to address two questions: the impact of the programme on people living with dementia and their care partners, and the role played by the heritage setting in their experience.

This paper reports findings from data collected from the creative facilitators who designed and led individual SP sessions and offers a contribution to our understanding of how artistic and creative approaches can be used to support people with dementia and their care partners to engage with heritage spaces.

Research design

A mixed-methods research design was adopted for this study, acknowledging the complexity of dementia, which consequently warrants a complex research approach seeking increased understanding of the issues (Robinson et al., 2011). The methods used included observations of SP sessions, and interviews with creative facilitators, and session participants, i.e. people living with dementia and their care partners. Details of participant interviews and findings from this aspect of the study, focussing on participant experiences of the sessions and the impact of attendance, are reported in detail elsewhere.

Data collection

Creative facilitators

Nine different SP sessions took place on at least one occasion during the data collection period, examples of which include ‘The Sensory Postcard’, delivered at Kew Palace, and ‘The Tudor Feast’, delivered at Hampton Court Palace.

The individual sessions were designed and delivered by eight creative facilitators. All eight were invited to participate in the evaluation, but only six were available to contribute to the data collection (Table 1).

Table 1.

Data collection – Creative facilitators.

Creative facilitator	Interview	Focus group
Dance/movement therapist	Yes (telephone)	Yes
Freelance artist/facilitator	Yes (face-to-face)	No
Musician 1	Yes (telephone)	Yes
Musician 2	No	Yes
Sensory sculptor	Yes (telephone)	Yes
Theatre practitioner	No	Yes

Four of the six took part in individual interviews (three by telephone and one in person) following delivery of their session, and five contributed to a focus group discussion, which took place following one of their regular meetings at Hampton Court Palace. The five participants in the group included three of those who had also taken part in an individual interview.

Asked to describe themselves, two said they were musicians, one a sculptor, one a theatre practitioner, one a dance and movement therapist and one a freelance artist and creative facilitator. Facilitator interviews were digitally recorded and lasted approximately one hour, and focussed on:

the facilitator’s area of practice and how they became involved with the programme;

their experience of the programme itself, including how this compared with other similar programmes they had worked on;

the impact of the heritage setting on the planning and delivery of their sessions for SP; and

their impressions of the impact of the session on participants.

The facilitator focus group addressed different aspects of their contribution to the programme, although there was some overlap with the interviews. The session lasted one hour, was digitally recorded, and facilitators were invited to explore how they applied their creative and artistic disciplines to the heritage settings and the impact on participants’ responses and engagement. Areas for discussion were:

what facilitators brought as artists to the use of the heritage spaces at Hampton Court and Kew Palaces;

their views on the impact of the heritage spaces on the participants in the programme;

observations on the wellbeing impact on participants during delivery of the sessions; and

experiences of working in the heritage spaces, including any challenges or barriers.

Unstructured observations

Nine sessions were observed by one member of the research team, from the arrival of the participants through to their departure at the end of the event. The purpose of these unstructured observations was to add depth and detail to our understanding of the delivery of the sessions, to contribute to an understanding of how the creative facilitators made use of the heritage setting and to observe the responses of participants ‘in the moment’. Contemporaneous field notes were made, focussing on the three elements of the session design – Sensory, Story and Spaces. Notes were supplemented by photographs of the spaces, objects and artefacts using an iPad. Analysis of interactions and movement around the site provided supplementary data to add richness and detail to the interview data.

Ethics

Ethical approval for the study was granted by the University of Salford Research Ethics Panel on 12 July 2017 (Ref: HSR1717-134). All participants, including the facilitators, were provided with written information and consent forms, involving the provision of detailed information about the study, and given time to consider participation before making a decision and the opportunity to withdraw consent within a specific time period. These documents were explained in person where necessary and were signed by everyone who took part in the evaluation, including people living with dementia. Conduct of the study took account of the particular needs and characteristics of people living with dementia, adopting an established method of process consent, involving ongoing monitoring of participants’ mood and engagement (Dewing, 2008).

Data analysis

Interview data from facilitators and facilitator focus group data were digitally recorded and professionally transcribed. Transcripts were analysed thematically, according to guidelines developed by Braun and Clarke (2006). One member of the evaluation team identified initial codes, based on the words used by participants (e.g. ‘exploring different uses of the senses’; ‘bringing about connections in the mind’ and ‘strengthening bonds between people’) and grouped these into preliminary categories (HS). A second team member (AI) reviewed and confirmed these initial categories, and any changes were discussed and agreed (HS and AI).

Limitations

Not all the creative facilitators involved in the SP programme contributed to the data collection for this study, and it is possible that some perspectives are therefore missing from the findings. Those who did participate had delivered sessions attended by members of the evaluation team, whose own experience of the sessions potentially influenced analysis of the facilitator interviews and focus groups. However, thematic analysis was carried out jointly with a member of the team who had not attended to reduce any bias.

Results

When talking about their overall experience and the content of sessions, participants often mentioned the skills and expertise of the facilitators, in terms of the ways in which the historic settings were used and interpreted, and the creative activities that were included in every session. These factors are important in all of the three themes identified in the analysis of both participant and facilitator data: Enjoyment and Engagement, which is concerned with participants’ immediate experience of attending the sessions; Connecting and Learning, relating to benefits extending beyond the sessions, and Place, Space and Time, which draws out the significance of HRP’s heritage settings and how these enhance and contribute to participants’ experience of the programme.

Findings from the participant interviews and mood questionnaires will be reported separately elsewhere. The focus of this paper is on findings from the facilitator interviews and focus group, aiming to understand the approaches taken by the creative facilitators in interpreting and delivering the SP programme brief, and in particular, their contribution as artists. The findings are presented in relation to each of the three main themes. Quotations are identified by individual facilitator (F1, F2, etc.) and source (I – interview; FG – focus group).

Promoting ‘Enjoyment and Engagement’

A key role for creative facilitators is to deliver SP sessions that provide participants with a positive and engaging experience, taking account of the needs of people living with dementia (HRP, n.d.b).

HRP learning producers and volunteers work with facilitators to create a safe, welcoming and warm environment for SP participants, and the skills and qualities required to achieve this are needed by everyone involved in direct delivery of the programme, including artistic and creative professionals. Participants commented on the friendliness and empathy of all staff and valued their practical support and encouraging but non-patronising approach. Facilitators acknowledged the contribution of other members of the staff team in terms of help with the practical aspects of delivery, and in providing emotional and social support to individual participants and to the group, but were acutely aware of their responsibility to plan appropriate content and to make this work on the day:

I think as a facilitator, you engage with people, you make them feel welcome…First and foremost, you’re the person that’s hanging everything else together (F5:FG)

All facilitators were conscious of the need to have some understanding of the nature of dementia. They recognised that people living with dementia and their care partners might experience anxiety before or during the event, which could impact negatively on their enjoyment and engagement, and which facilitators needed to be sensitive to:

If they’re not feeling stressed, feeling anxious, not feeling like things are out of control for them, then what you’ll see is the engagement (F2:FG)

I notice there are moments throughout my session…where sometimes there’s a freedom that is born through experience, through delivery, which I think is a really nice thing (F3:I)

They talked about the session brief, their approach to session design and the factors that they considered in planning both process and content elements of the event. Sessions had to be flexible enough to meet the needs of people living with dementia, who may be experiencing different symptoms, and be at different points in their dementia journey, in terms of communication, attention span, mobility and ability to participate in activities.

You could be talking to someone who is super-intelligent. They could be there in the room with you. Then you’ve got someone who may be very distant from you now, and not able to engage there at all, but they are still there…do you know what I mean? (F1:I)

You’re dealing with people at different stages of their dementia diagnosis…sometimes you might be working with someone who’s at a much later stage than you bargained for (F3:I)

HRP require facilitators to produce a detailed plan for each session, in which they specify the historical period they are exploring, and explain how they will include and facilitate sensory experiences throughout the session, how historical facts will be integrated into story-telling about a character, event or space and how particular spaces will be used in delivery of the session (Sensory Palaces, n.d). Generally, facilitators said that this worked well, although some suggested that they had found it daunting when first faced with the task of integrating all the required elements into a session plan.

I would say this has been one of the most challenging programmes that I’ve worked in anywhere. You certainly have to put a lot of effort and thinking into getting your pitch and your subject matter and your session right (F3:I)

The ‘thought and effort’ needed to design a successful session was referred to throughout the interviews and focus group, suggesting that the SP brief provided a stimulus for facilitators’ creative capacities and required them to think carefully about how to integrate their individual artistic and creative approaches, values and beliefs with the requirements of the programme:

Sometimes I feel there’s a little bit of pressure on the ‘doing’ part for the participants. And with my work it’s very much about being (F4:I)

The programme brief (see p. 2 above) prompted them to think about what their particular discipline and area of expertise might bring to participants’ enjoyment and engagement. They considered how to apply their creative skills to support participants to see, feel and connect with the spaces in ways that they might not do if they visited the sites independently, or as part of a standard guided tour. Examples of this include enabling participants to access areas not usually open to the public; or carry out activities, such as music making, in public spaces:

We’re offering different ways of engagement, different ways to engage with the spaces, to experience them and to express responses (F6:FG)

They also talked about how the need to balance delivery within the required format with sensitivity to the responses of the group, suggesting that high levels of skill were involved in delivering successful sessions:

It’s about allowing [the session] to unfold in its own way…you’ve got to let go of the structure, but have it (F6:FG)

People naturally gravitate towards areas of interest, if they see a portrait, if they see a view from a window, they are taken on a sense-led journey I think. And that’s very much part of our ethos, to allow that to happen, because that is a really important part of the session (F3:I)

Although the format of the sessions presented some challenges, most of the creative facilitators found it supported their work, stimulated their creativity and helped them to deliver engaging and enjoyable sessions:

I was definitely helped by the format, there is a format that they like the workshop to be presented in…it did help me really to think about each element alongside the other (F2:I)

… the workshops I do here are completely different to work I do anywhere else because you’ve got different parameters to inspire the art you’re making…so that’s always really interesting as an artist…what grows from that (F5:FG)

Supporting ‘Connecting and Learning’

In interpreting the brief, developing a story or theme for the session, and designing a sensory activity, creative facilitators drew upon their experience and skill in their specific discipline, and on a confidence in the possibilities of artistic and creative approaches to help people connect and communicate.

During the focus group, the facilitators talked about what art and artists brought to the SP programme. They identified the potential of art to offer ways of communicating for people whose ability to use language may be restricted or changed by their dementia, or who may be struggling to maintain and express a sense of self:

…language capabilities can be impaired by dementia, so [art] is another way in, another vehicle, another form of communication (F5:FG)

Some talked about their work in ways that suggested that they were not afraid to engage with potentially difficult and upsetting feelings and memories, which are likely to be experienced by many people living with dementia and their care partners. This acknowledgement of the range of human emotions and the rights of people to experience them was largely unspoken, but seemed to underlie some of the comments made in the interviews and focus group.

It’s hard to express, [it’s] something about connection, and something about people accessing their own identity, and being able to express that…and communicate it to somebody else (F6:FG)

It’s not always about happy emotions…it’s mostly about some kind of response…. I’m always looking for how they’re connecting on a mind and body level (F4:I)

Creative facilitators designed sensory activities relevant to the subject of the session, such as making a salt dough decoration; shared music making; tasting or smelling foodstuffs; or creating a sensory postcard, or symbolic Tudor calling card. Although the activities were intended to be enjoyable, light and accessible at different levels of engagement, observations of the sessions and data from the participant interviews suggest that such activities can be powerful not only in supporting connection and communication, but in accessing feelings. For example, in a session involving a visit to the Hampton Court Great Vine,¹ participants created a ‘vine timeline’, adding significant dates from their own lives to a visual representation of the 250-year-old history of the vine. Observation of this session suggested that retrieving shared memories was simultaneously enjoyable and poignant for some participant couples. One participant, whose spoken language was compromised as the consequence of stroke as well as dementia, spoke at length to the group about the importance to him of the event he had added to the timeline, in a way that he rarely did in other situations, to the delight of his care partner.

In another example, a facilitator drew on the dance of the period in exploring part of Hampton Court Palace and included some gentle movement to music in the activity that followed the site visit. On this occasion, a person living with dementia, who according to his care partner, often seemed low in mood, and had not appeared to be engaged at all, stood and responded to the music. Such ‘mini successes’ (F3:I) can be extremely important for care partners to see and share, and are welcomed by facilitators and other staff members.

You can feel the strengthening bonds between people, that adds something as a unit, ‘cos it’s something they’ve both enjoyed or found worth in together (F3:I)

The effectiveness of these activities in reaching participants seems to be related to how facilitators connected them to the story and spaces, and how they were presented in the context of the whole session. Some of the contributions to the interviews and focus group discussion try to capture this:

…when the art happens…you make these sort of maybe surreal or unusual connections, or there’s a sort of freedom to be allowed to imagine that you are part of it. Because it’s not exactly what happened in the history, it’s about feeling like you’re in it, and it all becomes more like now, you know (F1:FG)

I think that when you are working with dementia, you’re stimulating memory, and things that are familiar and that stick to their own history is also bringing about connections in the mind…[but]…I also work on the basis that memory is not just stored in the mind, it’s stored in the body (F4:I)

HRP learning producers are committed to providing an experience that acknowledges that people living with dementia have the potential to learn and to enjoy new experiences, even if only ‘in the moment’, rather than being focussed on retrieving memories and reminiscence, although this may occur naturally during the sessions. Creative facilitators do not see themselves as educators, but accept that part of what they are doing is helping everyone to ‘explore the story of how monarchs and people have shaped society, in some of the greatest palaces ever built’ (HRP, n.d.a); as such they are promoting learning. Through their interpretation of the session brief and use of the sites, they provided new experiences for participants in the programme, in ways that respected the capacity of people living with dementia to develop and achieve.

Our skillset’s in relating to people and communicating through a creative kind of vehicle, rather than educating them. We’re not trying to educate them, we’re trying to facilitate an experience for them (F2:FG)

I’m able to bring people in, make them feel part of what’s going on and convey information (F3:I)

Working with ‘Place, Space and Time’

As artists rather than historians, some facilitators said that they had found a particularly challenging aspect of the programme was the requirement to produce sessions based upon historical events or characters. Sometimes they felt that they had to adapt their usual approaches in ways that were not entirely comfortable, at least initially:

I have a reluctance to go from A–Z in a very straight way, and the idea of storytelling…I found that slightly constricting, because if you’re on the story, it’s too linear somehow (F1:I)

A lot of the work I do tends to be narrative or possibly fiction based…it’s quite different to know that you are talking about, kind of, fact (F2:I)

They admitted to some initial anxiety about achieving historical accuracy, which for them was less important than finding a point of connection with participants; and two people said that they had been worried that participants might ask them questions that they could not answer.

The challenge of working with a heritage space is knowing that you’ve got the right historical facts. You’re trying to be as authentic as you can be…I feel literally the weight of history (F5:FG)

The hardest part about working for them is actually the story. And trying to, you know, answer questions about it. Because we’re not historians. We’re coming in as artists working with historians (F4:I)

Some facilitators talked about how they came to find a balance between incorporating factual information into the delivery of creative sensory experiences through their detailed planning, and where they delivered more than once, through the experience of running and revising their sessions. Learning producers and/or volunteers were involved in all the sessions and were able to support facilitators in providing answers to participants’ questions about the buildings or historical facts.

Despite reporting some challenges, most facilitators found that working in the heritage setting provided rich material and opportunities to work in new and interesting ways. Constructing sessions around specific spaces, including in parts of the site not normally accessible to the public, and finding ways of making the spaces and stories connect, added another dimension to their practice:

Knowing that you are in that space, doing something that is relevant to that space…there is something kind of powerful about that somehow. And you feel more connected (F2:I)

There’s something very specific around that sense of time that you get being in this kind of context…in other settings you’re trying to bring the extraordinary through the artwork, through yourself and the way you’re delivering it. Whereas here, the extraordinary is all around you… (F5:FG)

They commented on the importance of the setting to participants not only because of their historical significance to the session topics, but because of the grandeur of the sites, and their privileged access as SP participants:

There’s a sense of really enjoying this space, and feeling it’s a privilege to have access to it and to engage with it (F6:FG)

The creative facilitators valued the opportunities given to them to choose the spaces to be visited during the session, and sometimes used as the setting for the sensory activity. This was an important element in constructing and preparing the session:

I could choose wherever I wanted. I went down to the kitchens… talked to the staff about the spaces…and to the guys who were food historian experts…and did some research (F2:I)

I came to Hampton Court, looked around and decided that actually, the feeling is out in the garden, and being able to show them the…art of the architecture…was what was needed…so I built the project around that (F4:I)

Facilitators – and some care partners – were explicit in talking about how the setting intensified sensitivities to the nature and significance of time, and to individual and collective histories. The memories of people living with dementia and their care partners about earlier visits to the Palaces were part of their individual stories, but the heritage setting offered the opportunity to locate those stories within a wider story of shared and collective significance:

I suppose it’s about those spaces, obviously very rich with stories, and then that in turn leads to people telling small parts of their own story (F2:I)

Sometimes the activities designed by the creative facilitators, such as the Great Vine example above, particularly highlighted notions of continuity and change. This juxtaposition of fleeting, and for some, soon-forgotten experiences with the historical settings brought about poignant and thoughtful moments for participants and facilitators alike:

Obviously, this place stays the same in a way…there are certain things that are going to be there… The people, they come again and again, and they change, you see them decline unfortunately (F1:I)

Thoughtful and purposeful use of the spaces was something evident in the comments made by all the facilitators, and their appreciation of the centrality of this element in the success of their contribution to the programme is summed up well by F3:

I think the onus on making the stories of the spaces and the spaces integral to the package is [important]…I totally understand why they need to do that, otherwise we could be delivering this session anywhere (F3:I)

Drawing upon their individual artistic perspectives and practices, alongside strong facilitation and ‘people skills’, the creative facilitators were able to connect the spaces and stories of the palaces with sensory activities in ways which supported people living with dementia and their care partners to experience these heritage sites in meaningful and enjoyable ways:

Whether you’re eating a grape, or smelling the flower, or touching something, that’s your key, unlocking the door to being there (F1:FG)

Discussion

The decision of HRP to use facilitators with backgrounds in creative and artistic practice to design and deliver SP sessions was based on a belief that this group of practitioners were well placed to interpret their ‘3 S’s’ approach, particularly with respect to the development of sensory participative activities inspired by the historic spaces. The evaluation of the programme suggests that the approach engages participants and enables them to enjoy the heritage spaces, and that the impact of attendance has clear benefits for participants’ mental wellbeing, at least ‘in the moment’, and for some, beyond the sessions themselves.

Koch (2017), on arts therapy research, has highlighted the absence of a convincing theoretical model to account for the effects of the arts and to identify the active therapeutic factors that bring about change for participants. She suggests that previous models have been deficient in that, for example, approaches from cognitive science have focused on perception rather than production, and aesthetic theory has tended to take an individualised perspective, neglecting social and interactive factors. Huss (2018), exploring the role of arts in social work, has identified the inadequacy of social work theory to account for and justify art’s relevance to vulnerable populations, picking up similar deficiencies in respect of narrative approaches which favour subjective experiences and decontextualise the person from their social context, and on the other hand, critical theory, which she argues tends to leave out the subject. Both Koch (2017) and Huss (2018) argue that an integrative theory is needed, which can accommodate interpersonal and relational as well as individual factors, and bring together understandings of art-making and art perception into a theory of aesthetic experience. They advocate a theory of embodied aesthetics which acknowledges that the body is at the centre of our development, in constant interaction with other people and the environment, including with cultural practices such as art (Huss & Sela-Amitt, 2018; Koch, 2017).

The findings from the SP study suggest that this programme is consistent with the embodied aesthetics theoretical model and with the programme theory revealed by Windle et al.’s (2017) realist review of visual interventions in dementia care. The ‘Three S’s’ approach, as designed by HRP learning producers and interpreted by the SP creative facilitators, delivers arts-based sessions which mobilise the whole system, involve perceptual and cognitive demands and invoke individual autobiographical, cultural and social memories. The notion of ‘embodied aesthetics’ appears to offer a potentially useful theoretical model to account for the generally positive impact of the sessions reported by those taking part. The sessions designed by the creative facilitators engage participants in movement and sensory experiences; introduce information, historical facts and stories through the medium of objects and the physical environment; and offer opportunities for participants to make meaning for themselves via creative activities in the context of social interaction. Such meaning-making may include moments of negative affect, given that participants are to some extent dealing with adversity, and that creative moments in connecting us more meaningfully to our world may not always be wholly pleasurable (Bellass et al., 2018). Part of the skill of the creative facilitators is to allow space for this to happen, but to contain this within the session, so that such emotions can be felt and acknowledged but without disrupting the overall experience of the event.

The findings reported here relate to a programme that is delivered in two large heritage sites with a variety of indoor and outdoor spaces available to the facilitators, and more research is needed to establish how these approaches could be transferred into more modest heritage settings and less varied environments. However, the contribution of the artistic imagination that creative facilitators bring to the design and delivery of these site-specific sessions cannot be underestimated. These features of the SP programme, combined with a commitment on the part of heritage providers to enable everyone, whatever their individual challenges, to access such settings, provide a model that could be adapted elsewhere.

Conclusion

While SP is not art therapy or arts psychotherapy, the creative facilitators are familiar with the potential of creative and artistic activities to stimulate and engage people, not only due to their experience delivering creative workshops to people living with dementia and other vulnerable groups, but importantly from their own artistic practice. This adds to the programme’s aim for authenticity and distinctiveness as well as quality of the designed activities. It ensures the layers of creative facilitators’ experience are diverse and personal so they can facilitate in return personal creative experiences for the participants. Participants’ experiences of the SP programme are undoubtedly enhanced by the creative backgrounds of the facilitators through their careful preparation and focus on engagement and enjoyment first and foremost, so that needs arising from the participants’ health condition become a secondary consideration in their lived experience of the sessions.

Footnotes

Acknowledgements

The authors would like to acknowledge the support of two Historic Royal Palaces staff who were involved in collecting demographic data for the evaluation during recruitment of participants to the project.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors are grateful for the funding support of Historic Royal Palaces.

Note

Helen Scholar is a lecturer in social work at the University of Salford. She is a registered social worker with a practice background in work with offenders, and in the family courts, and in training and staff development roles. She has worked in social work education for 20 years, initially alongside practice and since 2005 as a permanent member of staff at the University of Salford. She completed a PhD by published works in 2018, and has been involved in research relating to social work education and workforce issues, and service delivery evaluations for a range of service user groups, including children and young people, vulnerable adults and people living with dementia. Current research interests include social work and professional identity; our relationships with the material world and material culture, and the arts and social work.

Anthea Innes became the University of Salford’s first Professor of Dementia in June 2016 and also took on the role of the Coles-Medlock Director of the Salford Institute for Dementia. The Institute brings together innovative research across the University to find ways of helping people live well with the condition. Scottish-born Anthea studied at the University of Stirling before moving to work at the University of Bradford as a Research Project Officer with the Bradford Dementia Group, where she also completed her PhD. She worked as a Research Fellow and then a Senior Lecturer at the University of Stirling where she introduced the first worldwide postgraduate online programme in Dementia Studies. In 2011, she became a Professor at Bournemouth University where she launched and directed the Bournemouth University Dementia Institute (BUDI). Anthea is a renowned leader in rural dementia care research and has led numerous public engagement and dementia awareness projects including the (Don’t) Mention Dementia social art project and the BUDI Orchestra – both of which have been recognised by the Academy of Social Science. She was a member of the Task and Finish groups advising the Prime Minister on rural dementia care and dementia friendly technology and is a member of INTERDEM, a pan-European network of psycho-social dementia researchers, where she co-leads the technology task force; and she is a member of RADAR a Canadian wide team of rural dementia care researchers.

Monika Sharma is a Research Assistant in the Salford Institute for Dementia and has expertise in environmental architecture design quality and its evaluation related to issues that affect and are especially important to older people. She is an Architect and Planner holding a Bachelor’s degree in Architecture, she has a PgDip and MA in Spatial Planning from Birmingham City University and has a Masters in Technology in Urban Planning. Monika’s PhD research into architectural design quality of sheltered housing outputs to date has been judged to be of internationally excellent quality.

Jana Haragalova is Community Outreach Officer at the Leighton House Museum in Kensington, London. She has previously worked as a Learning Producer for Historic Royal Palaces, developing and coordinating the learning and engagement programme Sensory Palaces for people living with dementia and their care partners. Jana has worked for over 10 years in different roles developing and delivering heritage-based informal learning and creative engagement opportunities for people facing barriers in access to cultural heritage (people with disabilities, mental health issues and hard to reach groups). Jana is also a trained and accredited Integrative Arts Psychotherapist working in private practice in London.

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