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Winston Churchill Memorial Trust Report 2010

   

“Developing embodied communications in dementia care”

Dr Richard Coaten

Dance Movement Psychotherapist & Churchill Fellow 2010

Experiential Workshop at the Reitman Centre, Toronto

20th September 2010

“We must all be willing to redefine our role in society, seeking new structures and not clinging to the past, but recognizing that the artist is part visionary, part

showman, part educator and part trouble-maker” Adrian Noble, Artistic Director, Royal Shakespeare Company (Observer, 2/1/2000)

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Introduction This report details the main aspects of a month long trip to Canada between September 11th and October 10th, in both Toronto and Vancouver, and a trip to a major arts and health conference in Penticton in the Rockies. It covers what took place and why, some of the people met, the organisations visited including benefits/recommendations for my own community on return. I would like to give everyone I met a mention here however that is not feasible unfortunately. The purpose was to enable me to better understand the use of movement, dance and embodied practices in the care and treatment of people with dementia and their ‘care-givers’ in Canada, bringing lessons learnt back here. This involved a strategy of meeting and shadowing key players in the field in both Toronto and Vancouver and using their connections and local knowledge to extend my original plans. This quest for skills and knowledge was coupled with my intention to disseminate my recently completed doctoral researches through talks and workshops. In brief I work for the South West Yorkshire Partnership NHS Foundation Trust as a Dance Movement Psychotherapist running a Dance Movement Psychotherapy Service in Calderdale. The role involves using movement, dance, music, song and reminiscence techniques to help older people with mental health problems maintain their skills and abilities for as long as possible. The work also helps foster relationships and aims to enable people to continue to live as independently as possible in their own homes.

I would like to thank all those at the WCMT and my colleagues at SWYPFT for giving me an extraordinarily rich opportunity to further develop my work and researches; building new friendships in Canada: extending my knowledge and understanding of the importance of international dialogue, and opening up new career development opportunities. Since returning I have had some very affirming emails, asking if people I met and worked with can come and train with me here in the UK. Surprisingly, during the trip I gradually discovered that through the meetings and 11 workshop/presentations I gave (sharing my work with over 210 participants) what I brought was very new, and I could find little evidence* of movement and dance work happening in Canada with people living with dementia. This meant that the purpose of the Fellowship shifted while there to a focus on dissemination of my own work and researches, which attracted real interest, in part I think, because of its innovative nature.

* This does not mean that it is not happening in Canada, just that I could find little evidence of it unfortunately.

“The multimodal work you shared with us at the conference in Penticton has ignited a desire in us to study your work on a deeper level. Your research and its outcomes resonated with us to our core. We find it imperative to study your research and practices on a deeper level before we can begin to integrate these processes into the broader culture here. Your work resulted in improved well-being, more meaningful and emotionally congruent relationships that were built non-verbally by way of the body, and this is something we want to understand, witness and internalize under your mentoring”. Marti, Pat & Geoff (Portland, Oregon)

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Itinerary

The actual timetable is included below because it contains the details of all that I did, that may in future prove useful to Fellows planning their own travels in relation to the same or similar subject area.

  Dr  R  Coaten   Actual  Timetable   Winston  Churchill  Fellowship  

2010  

Date   Day   AM   PM   Travel  Mode  11th  Sept  2010  

Saturday   Travel  Huddersfield  to  Manchester  11.16am  (arr.  12.12pm)  to  Toronto  Dep.;  15:45      

Arrive  18:30  settle  in  accomm  in  ‘Annex  Guest  House’  Annex  neighbourhood/downtown  

Thomas  Cook  Airlines    

12th  Sept   Sunday   Settling-­‐in  recovery  from  jet  lag  etc  

   

13th  Sept   Monday   Getting  bearings  etc      14th  Sept   Tuesday   12pm  Meet  Music  

Therapist  Amy  Cortes  @  Baycrest  Care  Facility    

Visit  Toronto  Museum  –  View  Photographic  Exhibition  by  Dr  Mark  Nowaczynski  founder  of  ‘House  Calls’  Project  1998  

Bicycle  Hire  

15th  Sept   Wednesday   12.15pm  to  1.30pm  Meet  Amy  Cortes  @  Baycrest  Care  Facility  

2pm  to  3pm  Meet  Neuroscientist  Dr  Takako  Fujioka  @  Rotman  Brain  Research  Centre/Baycrest  

Bicycle  Hire  

16th  Sept    

Thursday   9am-­‐10am  Meet  Team  &  tour  centre.10.15am  Meet  Molyn  Leszcz,  Chief  Psychiatrist/Toronto  City  11am  Further  Meets  with  Team  till  12pm  Cyril  &  Joel    Reitman  Centre/  Mt  Sinai  Hospital  Meet  Julia  Gray/Catlin  Agla  

2.30pm  Meet  Prof  Stephen  Katz  in  café  downtown.  416-­‐493-­‐5838  (remember  to  call  him)  

Bicycle  Hire  

 17th  Sept    

Friday     Visiting  Bay  Crest  Day  Care  Facility  –  Meet  Faith  Malach  Day  Care  Director  &  tour  centre  

   

 18th  Sept  

Saturday    Day  Off      

19th  Sept    Sunday   Day  off/sightseeing  in  Toronto  

   

20th  Sept   Monday    

3hr  Presentation  at  Reitman  Centre  (Mt  Sinai  Hospital,  60  Murray  Street,  Room  L1-­‐012)  1-­‐4pm  

Educational/community  focus,  talk  to  include  carers.  Nos  =15    

 

21st  Sept   Tuesday   3hr  Presentation  at  Reitman  Centre  (Mt  Sinai  Hospital)  9am  to  12pm  

1pm  to  3.30pm  Attend  Reitman  Centre  Caregiver  support  session.  Staff  =  Jenny  Carr  OT  &  Christina  

 

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Staff    professional  development  focus  inc.  academic/clinical  staff  .    Nos  =8  

Dashko  Chaplain  (I  contribute  to  session  practically)  

22nd  Sept   Wednesday  (Eileen  depart  07.49am)  

1pm  Meet  Dr  Pia  kontos,  Research  Scientist  at  Toronto  Rehab  Institute  (lunch  together  &  meeting)  

Toronto  Rehabilitation  Institute    3-­‐4pm  talk  (Clinical/research  staff  focus)  Lecture  Theatre-­‐University  Centre,  550  University  Ave.  Nos  =  20  

 

23rd  Sept   Thursday   10.30am  to  12pm  Shadowing  Pia  Kontos    at  Toronto  Rehab  Institute  

3pm  to  4pm  Attend  staff  meet  at  Reitman  Centre  to  discuss  my  work  &  approach  in  more  detail.    

End  of  Bicycle  Hire  

24th  Sept*  (Amy  Birthday)  

Friday   Trip  to  Niagara  Falls/’Maid  of  the  Mist’  boat  trip  

Day  off  today   Hire  Car  

25th  Sept   Saturday   Travel  to  Vancouver  12:00hrs  

Arrive  Vancouver:  14:02hrs  Settle  in  accommodation  Vintage  Executive  Hotel,  Howe  Street  

AIR  

26th  Sept   Sunday   Settling  in  Vancouver  day   Sightseeing.  Visit  Vancouver  Aquarium  

 

27th  Sept   Monday   ‘Round  table  discussion’-­‐  Doug  Durand  etc.  Scotiabank  Dance  Centre  Meet  Jill  Marcuse  etc  (Nos  25)  09.30am  to  12.30pm  (Board  Room)  677  Davie  Street,  Vancouver  Nos=  17  

   

28th  Sept   Tuesday   10am  Meet  Dr  Alison  Phinney  &  staff  at  Centre  for  Research  on  Personhood  in  Dementia.  1.30pm  Meet  Jeff  Small  also  from  CRPD  

4-­‐5.30pm  Centre  for  Research  on  Personhood  in  Dementia  45/50  mins  talk  good  mix  of  people.  Talk  –  knowledge  translation  talk.  Nos  =  18    

 

29th  Sept   Wednesday   10am  Meet  Claudia  Jacova  Neuroscientist  –University  of  British  Columbia  Brain  Research  Centre  –  researching  use  of  (f)MRI  scanning  on  music  therapy  &  dementia  patients    

Travel  to  Okanagan  Valley  Stay  Penticton  (Venue  &  Accomm:  Lakeside  Resort  Hotel)  

Avis  Car  Hire  Pick-­‐up  12pm  

30th  Sept   Thursday   Attend  Pre-­‐Conference   CECD  Conf.   CAR  

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Workshops  (Songwriting  Wksop  all  morning  Judith  Kate-­‐Friedman  

David  Barnet  /  Drama  &  Storytelling  Wkshop  all  afternoon  (Venue  &  Accomm:  Lakeside  Resort  Hotel)  

1st  Oct   Friday   Attend  CECD  Conference   Penticton  (present  researches/      

CAR  

2nd  Oct   Saturday   Attend  CECD  Conference   Present  researches  etc  RC  presenting  today  4.10pm  to  5pm  Member  of  expert  panel  to  take  questions  

 

3rd  Oct   Sunday   Visit  Kelowna  with  Kay  Wells  another  Churchill  Fellow  

 Sightseeing  Kelowna  &  walk  (Accomm:  Lakeside  Resort  Hotel  last  night)  

CAR  

4th  Oct   Monday   Travel  to  Kamloops  (3hrs)      

Meet  Wendy  Hulko  &  Gwen  McArthur  Aboriginal  Cultural  Education  Co-­‐ordinator.  3-­‐4.30pm  Exp.  Wkshop  Nos  =14  

CARAccommodated  Thompson  Rivers  University  

5th  Oct   Tuesday   Return  to  Vancouver   Follow  up  links  made  at  conference  

Car  Hire  return  1.30pm  

6th  Oct   Wednesday   Visit  Granville  Island   1pm  Afternoon  spent  with  Alison  Phinney  at  UBC  Dinner  at  her  house  

 

7th  Oct   Thursday   Visit  Vancouver  Anthropology  Museum  (all  day)  

   

8th  Oct   Friday   Morning  spent  with  Alison  Phinney  meeting  at  the  Roundhouse  and  looking  at  her  researches/powerpoint  presentation  

As  follow-­‐up  to  Scotiabank  Dance  Centre  Round-­‐Table  Discussion  (27th  Sept)  I  gave  a  further  experiential  workshop.  Nos=12  1.30-­‐4.30pm  

 

9th  Oct   Saturday     Dept  Vancouver  17:25hrs   AIR  10th  Oct   Sunday   Arrive  Manchester  

10:45hrs      

 

Highlights in Toronto

I discovered a new and more fully rounded approach to support for carers of people living with dementia

in the form of the ‘Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer’s Support and

Training’ (www.caregiverMSH.com) based at Mt Sinai Hospital. A privately funded service for

caregivers it includes a fully integrated, comprehensive dementia care program that introduces the

innovative use of standardised patients - actors trained to simulate real-life situations - so that caregivers,

guided by expert clinical coaches, learn how to deal with common challenging situations. The goal is to

enable family caregivers to support their loved ones' ability to successfully age at home as they cope with

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the condition. The staff team ably led by Director Dr Joel Sadavoy, were so generous with their time in

sharing their work and approach, and Catlin Agla arranged a really valuable timetable for my visit. I was

particularly interested in their use of drama techniques, including the use of Video Tape Recording of

sessions with caregivers taking a good look at their coping strategies, and learning in the process how to

develop new ones. I gave several workshops, one with a community focus and the other for clinicians

and left inspired to bring what I had learnt back to the UK. I hope that in future the team builds on their

innovative approaches using the arts, extending the scope and range of their use; which would make their

work quite unique and eminently researchable. I acknowledge their kindness, their generosity and team

spirit and wish them well in their future endeavours with caregivers, currently a high-priority here in the

UK. Their service was much more psychotherapeutically oriented to any I have previously seen in the

UK, and on return I have been disseminating these findings at talks and conference presentations, and

also in meetings with senior staff at my NHS Trust. In response to all the meetings and discussions I had

with my Canadian colleagues I have set-up a database and send articles, relevant papers and information

about the UK dance and dementia community to them all on a regular basis which they can opt-out of at

any time; this helps keep open channels of communication maintaining international relationships with

new friends and colleagues there.

The dream team (some of) at the Reitman Centre 16/9/10. From l-R. Marci, LJ, Ann-Marie, Teshome, Jenny, Catlin & Joel

Note the biscuits…superb!

Other highlights –

I have become personally and professionally more confident by way of giving presentations, talks and

workshops to different groups in different settings, becoming more imaginative and creative in style,

content and delivery; a real breakthrough for me. I also learnt to present my work more sensorially,

adapting my material on the basis that embodied practices are best understood through presentation in

experiential and embodied ways; otherwise these can remain as cognitive experiences only, and thus not

as long-lasting and interesting as they might otherwise be.

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The Fellowship has given me a better working knowledge and understanding of where Canada sits in

relation to the development of embodied practices. The two main experts I met (Dr Pia Kontos (Toronto)

& Dr Alison Phinney (Vancouver)) were most helpful in sharing their insights and knowledge and in

facilitating the development of my Fellowship; the third, Professor Katz from Toronto, has inspired

further academic development for me in relation to a whole genre of critical gerontology in the social

sciences, about which I was unaware. I was really pleased to meet staff at the Baycrest Facility

particularly music therapist Amy Clements-Cortes and Faith Malach, Director of the social based day

care programme. The facility is an all encompassing approach to living independently, coupled with

provision of incremental support as care needs increase, including access to on-site hospital care if

needed; similar in concept to one’s in the UK run, for example, by Extra-Care Charitable Trust in

Birmingham. Baycrest also houses the Rotman Brain Research Centre, where quite fortuitously I was

able to meet Dr Takako Fujioka a brain researcher doing remarkable work on music and the brain that

was very relevant to my own researches. I consider that the purpose of the Fellowship has been fully

achieved, in relation to my own personal and professional development; in relation to what it gave to

colleagues in Canada and the US (Portland): and in relation to its potential for making a difference to my

life and on-going work in the UK.

Highlights in Vancouver & the Rockies

Meeting and dancing with artists, dancers and creative practitioner’s from the arts and health field in British Columbia was a real highlight. In Toronto area I had met a range of social scientists, academics and clinicians while in Vancouver and the Rockies this was counter-balanced for me with a great deal more contact with artists and dancers, which was very different and valuable. Thanks to much co-ordination on the part of BC Cultural Planner Doug Durand, who was able to bring together a wide cross-section of artists, dancer’s, administrator’s; we had a really fruitful Round-Table discussion at Scotiabank Dance Centre concerning, amongst many other things, how to improve the care of seniors using arts based activities. Following this, a suggestion was made by my wife Mary to try and offer a

Dear  Richard,  We  sincerely  thank  you  for  all  the  knowledge,  technique  and  joy  you  have  brought  to  the  Reitman  Centre,  our  clients,  and  the  larger  Mount  Sinai  Hospital  Community.  Your  dedication,  and  passion  are  inspiring  and  we  have  so  appreciated  the  opportunity  to  learn  and  share  with  you…and  please  keep  in  touch.  The  Reitman  Team  

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practical and experiential session for this community and anyone else interested. Mirna Zagar, Director of the Vancouver Dance Centre thought this a great idea and was instrumental, not only in setting this up at short notice, but also in helping us find accommodation for the latter part of our stay in Vancouver having returned from the Penticton Conference. Meeting staff at the Centre for Research on Personhood and Dementia at the University of British Columbia was also a highlight, as was giving a talk there, that resulted in more very affirming and moving feedback from a participant who came and emailed me this later:

“Firstly, I enjoyed your ease with people, finding your way very welcoming and immediately engaging.

I loved the way you demonstrated how to enroll people of all ages with the simple movements of hands

or ankles. You made everyone feel ‘at home’ with your topic and one another. I am not a student at

the University (of BC)…So I don’t come with an academic interest purely a compassionate one out of

an avid interest in my mother’s Alzheimer condition…Movement is one way to connect with those

struggling to be seen and heard as unique and special even in their differences. The short film clip you

chose demonstrated how responsive some are to simple felt connections. I liked the way you led us to

experience how the senses of hearing, smell and taste illicit memory. As I recalled my mother helping

me clean a basket of dried rosemary, I could feel her wellbeing in remembering a childhood holiday

spot and the warmth of the summer sunshine. For me it was important to check how I am

communicating and create spaciousness for my mother to feel valued and seen…Thanks for your time

here and for responding to my requests to Rodin’s hands. All the best to you, Barb Quinn”.

I took every opportunity to meet with people who came recommended by those I was meeting or working with at the time, and to offer opportunities to slot in additional experiential movement and dance based workshops, at the Vancouver Dance Centre for example (see pic below).

Workshop Vancouver Dance Center 8/10/10

This very successful workshop was more experiential and embodied, keeping it in the realm from which it evolved. This was one of my main learning points in relation to understanding the impact of my

Experiential  workshop  for  dancers,  and  those  interested  in  using  movement  and  dance  with  people  with  dementia.  Vancouver  Dance  Centre  8/10/10  

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travels. When disseminating the nature of embodied practices, endeavour to stay as close as possible to the embodied realm (experiential and practical) rather than the disembodied (chalk and talk/powerpoint).

Penticton Conference (30/9 to 2/10) Meeting so many arts and health practitioner’s with a special interest in dementia was very special indeed

and the presentation I gave at the conference was very well received.

“Richard Coaten’s dedication to his craft and the engaging way he conveys his message makes the performance arts accessible to all. Richard’s workshop and comments during the 5th International Conference on Health, Aging and the Creative Arts in Penticton Canada, gave practical demonstration of the limitless possibilities of dance and movement for those living with dementia and further indicates the value and application of a person-centred approach to dementia care”. Julie Gross McAdam MAC.ART Program Director (www.macart.com.au)

Following a presentation of the work of visual artist Jeff Nachtigall, he kindly sent me a copy of the

DVD of his work by the National Film Board of Canada as artist-in-residence at Sherbrooke

Community Centre, a long-term care facility in Saskatoon. The film documents the importance of the

arts and of a care-culture called the ‘Eden Alternative’, or ‘Human-Habitat Model’, which is attracting

significant interest in the care home sector in the UK, where several are already using it. My intention is

to show this 56 minute film in May/June to a specially convened arts and health audience in Stoke-on-

Trent, introducing it and the artist’s work; this followed with an audience discussion about the

implications for care practice in the UK (date TBA). I am also looking at ways of making and singing

newly composed songs in my sessions, in addition to one’s older people are familiar with, as a result of

innovative singing workshops in Penticton with vocalist/songwriter Judith-Kate Friedman

(www.songwritingworks.org).

(Halifax Courier 29/10/10) Travelling on from Penticton to Kamloops to meet Dr Wendy Hulko of Thompson Rivers University and

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Gwen McArthur, Aboriginal Cultural Educational Co-ordinator at Kamloops Hospital was a real treat.

Both are experts in working with traditionally marginalised groups and First Nations elders with

dementia in particular. Of special note I have just found out that in April 2011, Wendy and colleague

Elisabeth Antifeau have been awarded a significant grant to research the experience of First Nations

elders in relation to dementia and how they experience it; this is excellent news. Wendy had organised a

workshop for me at the University and on arrival my family and I were drummed and sung onto the

territory by a Secwepemc family. This was unforgettable for us, as was learning from the elders

afterwards, that dementia for them is about ‘soul-loss’; in response they help to enable ‘soul-return’ by

traditional means using singing, chanting and drumming, invoking spiritual power in the process. Both

Wendy and Gwen are experts in working with aboriginal communities and in learning from them their

traditional ways of life and sustaining values and beliefs. Gwen’s work in the hospital setting helps

mediate the experience of First Nations people when they come into hospital for treatment. This has

value for us in the UK in learning how best, for example, to support BME communities and asylum

seekers in navigating the increasingly complex bureaucracy surrounding the benefits system.

Gwen McArthur in front of 1860 pic of several chiefs from the interior at New Westminster BC

Kamloops Hospital 4/10/10

Dissemination and development

Press releases and blog A number of press releases have been produced and published, one of which appeared above in our local

Halifax Courier and another in the Newsletter ‘Emotion’ Winter 2010 (VolXX No4 p5-6) of the

Association of Dance Movement Psychotherapy UK (http://www.admt.org.uk/). WCMT press office and

my own NHS Trust worked collaboratively to issue a joint press release, which was published in my

Trust’s in-house staff newsletters. I managed to set up a blog for the purposes of people being able to

view what was taking place during my trip. This can still be viewed on

http://dancingdoctorstrip.blogspot.com

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Conferences

I have been able to present my findings briefly at the ‘5th UK Dementia Congress in Bournemouth’

(9th/11th November), where I was responsible for chairing two different sessions: one on ‘Dance and

Movement’ and the other on ‘Creativity and the Arts’. It was a big national and international conference

with over 800 delegates from all sectors of the dementia care field. I have also helped organise

‘Memory: 1st National Conference on Dance & Dementia’ at the Bluecoat Arts Centre in Liverpool

(10th and 11th December), where I was also a keynote speaker on Day 1. As a direct result of attending

the Penticton Conference I realised that in helping organise Liverpool we needed to invite Dr Julia Clark,

a Clinical Neuropsychologist from Scotland (who also came to Penticton), to give her presentation to the

dance and dementia community here in the UK. Dr Clark’s talk was a keynote at the Conference on Day

2 and came as a direct result of meeting her in Penticton.

Key-note at Liverpool 10th December

Publications Robert Mundle, a priest at the Toronto Rehabilitation Institute, (Mount Sinai Hospital) attended my

talk there on 22nd Sept and got in touch via email on my return. Having been introduced to my work and

researches in Toronto, and following my talk, he downloaded a copy of my thesis and via email asked if

he could use examples of my work in relation to his own up-and-coming publication (“The spiritual

strength story in end of life care: two case studies in Palliative and Supportive Care Journal, Dec. 9(4), in

press). I am delighted about this development and have circulated his proposed paper to my UK based

colleagues, currently working spiritually with people with dementia. I am also working up another paper

with a newly qualified Dance Movement Psychotherapist (who attended the Liverpool Conference) about

enabling knowledge and skills transfer from our own profession, to the important dementia care sector,

‘I  found  Richard  particularly  memorable,  because  of  his  willingness  to  be  completely  open  in  a  forum  where  people  would  expect  people  to  communicate  from  behind  a  paper  and  lectern’  Conference  Delegate  

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where our embodied skills and knowledge could really help make a positive difference to people living

with the condition. I have had published in April 2011 a 2 page article in ‘Animated, the Community

Dance Magazine’, called ‘Going by way of the body in dementia care…’. It details important aspects of

what was achieved at the Liverpool Conference and follows developments in my own thinking and

practice following my Canadian experience.

Finally…

And most significantly, the Fellowship has given me the drive and commitment to pursue setting up a

‘Centre of Excellence for Movement, Dance & Dementia’ (title to be confirmed), here in West

Yorkshire and in partnership with my NHS Trust. This proposal has now (April 2011) passed a crucial

first hurdle, and with good support for it locally, I am quietly confident that this idea will convince senior

managers that the business case is sound, and it can move forward to become a reality. From an

international perspective it would aim to attract Canadian, US and others from around the world, all

interested in improving the quality of life for people with dementia and their carers (professional and

lay); using music, movement, song, dance and reminiscence. This is in part a response to the moving

comments by Marti, Pat & Geoff on p.2 of this report that they would travel from Portland, Oregon to

train with me over here in the settings where I work. Initially it was their idea to invite me to Portland to

train them, however this plan has changed to them being invited to come to West Yorkshire. This

followed much debate with my colleagues, as the training is best located and ‘embodied’ here in the

settings where it is best understood in this UK context. It would be up to international visitors to do the

transposing back to their own settings and cultures. The plan would also aim to meet the need for dancers

and artists based here, to have a place for specialist training in this most rewarding of work. The

Fellowship has given me the impetus to pursue this idea and I am really looking forward to developing

what promises to be a significant career development, and an important contribution to improving quality

of life for those living with dementia and their carers here in the UK and abroad.

I await with interest to learn from Dr Phinney, how her researches go into the uses a local care-home has

made of the ‘Portrait of a Life’ multi-media pack which supports individuals, family carers and care staff

to undertake Life-Story work. I took this to her as an example of good practice asking her to review it.

 A mask at the Vancouver Museum of Anthropology (http://www.moa.ubc.ca/collection-online/search) and a

special reminder of the extraordinary trip I had…