Wellbeing Dominoes Review

Cartwheel Arts Wellbeing Dominoes Review Independent review by Suzie Poyser July 2016

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Contents 1.0 ExecuGve Summary

4-­‐5

2.0 Background & Context

6-­‐10

3.0 Wellbeing Dominoes -­‐ The Six SePngs

11-­‐23

4.0 Key Insights

24-­‐34

5.0 Case Study

6.0 OpportuniGes

38-­‐39

7.0 Appendices

40-­‐43

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35-­‐37

1.0 ExecuGve Summary

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1.1 ExecuGve Summary Context & Background

Key Insights

Wellbeing Dominoes is a fun, crea8ve game designed to boost wellbeing, developed by Cartwheel Arts, Art for Wellbeing Programme.

The game is based on 5 key principles of wellbeing, as outlined on page 6 of this document. Using crea8ve ac8vity, the game encourages par8cipants to engage with and follow these principles in their artmaking, and daily lives.

The development of the Wellbeing Dominoes was funded by Heywood Middleton and Rochdale Clinical Commission Group, Social Investment Fund.

Cartwheel commissioned an independent review, to iden8fy the challenges, boundaries and poten8al limita8ons of the game in achieving its benefits and outcomes.

The review of Wellbeing Dominoes in different seRngs has highlighted a number of key insights. Each insight has been considered and is presented providing a descrip8on of the insight, lessons learned, and associated recommenda8ons.

The key insights iden8fied are represented within the following domains: • Partner Working / Responsibili8es; • Group Dynamics and Boundaries; • Physical Space; • Clarity Around Purpose; • Game Appropriateness; • Prac88oner Experience; and • Measuring Outcomes

Wellbeing Dominoes -­‐ The Six SePngs Cartwheel chose to pilot and test wellbeing Dominoes (WD) in a variety of seRngs. These were chosen to maximise the genera8on of feedback and insight of the game: • • • • • •

Closed group at Dandelion Create, Rochdale; Drop in group at Sunshine House Wigan; Closed group at Bury Crea8ve Living Centre; Teambuilding sessions with Alive Conference Team and Inspiring Healthy Lifestyles ar8sts team, Wigan; Workshop and Q&A for third sector and health professionals at Cartwheel Arts IMPACT Conference; and Training Day at MMU for third sector professionals.

The report contains a factual outline of each project considering quan8ta8ve data, outcomes, benefits and challenges.

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OpportuniGes

This review has reached a number of recommenda8ons and opportuni8es. . It is this reports conclusion that the detailed recommenda8ons in sec8on 4.2 are implemented. In addi8on to these recommenda8ons, this report has iden8fied two opportuni8es for further considera8on, including ‘increasing par8cipant coverage’ and ‘commercial opportuni8es’.

The benefits of implemen8ng these opportuni8es include expanding the reach of Wellbeing Dominoes as a wellbeing tool and providing an addi8onal revenue stream to Cartwheel Arts which may be used to subsidise delivery of the game into charitable seRngs.

2.0 Background and Context

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2.1 Background & Context Wellbeing Dominoes -­‐ Outline A game that sets the dominoes of wellbeing in mo8on. Wellbeing Dominoes is a fun, crea8ve game designed to boost wellbeing, developed by Cartwheel Arts, Art for Wellbeing Programme.

The development of the resource was funded by Heywood Middleton and Rochdale Clinical Commission Group, Social Investment Fund. Between 2013-­‐14 the resource was developed by Cartwheel Arts and Art for Wellbeing Prac88oners, Ar8st Lisa Risbec and Emo8onal Support Worker Jodie Silverman. A group of 8 adults with mild to mental health experiences worked with Lisa and Jodie to develop the content, process and mechanics of the game.

The game was then trialed at 2 community venues, Crimble Crog Community Centre (Heywood) and the Lighthouse Project (Middleton) where we gathered feedback, adapted the game-­‐play and developed the game instruc8on booklet and facilitator cards.

The finished resource is ideally played in a closed group seRng of up to 10 people, with a trained facilitator. It is suitable for anyone who would benefit from regular crea8ve social contact in a group seRng. The game is based on the following wellbeing principals, using crea8ve ac8vity to encourage par8cipants to engage with and follow these principles in their artmaking, and daily lives: • Create and connect • Play and experiment • No8ce and sense • Nurture and care • Relax and distract

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2.1 Background & Context Wellbeing Dominoes Sessions: During the ini8al development period, 30 delivery sessions took place on Thursdays between 3rd April 2014 and 30th July 2014. Further development sessions took place on 19th November 2014, and 15th May 2014.

Age Groups: Our youngest par8cipant was 20, our oldest par8cipant was over 65.

Monitoring Methods: We used Mental Health Recovery Star Assessments and ac8on planning to assess par8cipants wellbeing.

Staff and PracGGoners Roles: Our Emo8onal Support Worker (ESW) took weekly notes and provided a summa8ve report at the end of the project. Our lead ar8st took registers, completed regular Ar8st Evalua8ons and recorded the project photographically and archived on: flickr hkps://www.flickr.com/photos/cartwheelarts/sets/72157650826458576/ 2 case studies for the trial groups and 1 case study for the development group was were produced for the funders.

Our project coordinator produced regular reports and posted pictures and the progress of the project on our blog: hkps://arlorwellbeing.wordpress.com/2015/01/12/wellbeing-­‐dominoes-­‐an-­‐ending-­‐and-­‐a-­‐beginning/ Volunteers: Ashleigh Chaffey, our Arts Administra8on Appren8ce supported a number of Wellbeing Dominoes sessions and completed project administra8on tasks.

Training / New Skills: Ashleigh worked on a Bronze Arts Award, interviewing Lisa Risbec (Wellbeing Dominoes Ar8st) as part of her training.

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2.2 Background & Context Wellbeing Dominoes -­‐ Outcomes Our ini8al development found that playing the game has many benefits. These range from helping to aid relaxa8on and reduce stress, increasing the ability to focus, helping to distract from difficult thoughts and feelings as well as helping to develop social skills and increasing social inclusion.

The crea8ve tasks can ogen spark ideas for future art works, helping people to find out what parts of making art they enjoy and can help to develop their own ar8s8c style.

ParGcipant Session EvaluaGons: Following Wellbeing Dominoes Trial courses in 2014 we conducted a par8cipant focus group to discuss the course, delivery and what the group would be interested in in the future. 90% of people expressed an interest in further projects and 80% expressed an interest seRng up user led, crea8ve groups.

Evalua8on ques8onnaire responses evidence that 93.9% deem the workshop, materials, workshop leader and venue of excellent or good quality. 85% or people surveyed enjoyed Art for Wellbeing Workshops. 89.4% felt more confident ager engaging in workshops.

ParGcipant Wellbeing Assessments: Of the 26 people assessed through the Mental Health Recovery Star, at the start and end of courses, General Mental Wellbeing increases by 14.5%. When looking specifically at the indicators we focus on (managing mental health/social networks/self esteem and iden8ty) this rises to an increase of 20.4% AddiGonal Outcomes: We were able to engage The Owl and The Coconut, a network of Art Therapists in Manchester are interested in running a Wellbeing Dominoes training course for their network. Through this connec8on and before game produc8on, an Art Therapist, un-­‐associated with the project, evaluated the therapeu8c aspect of the game to ensure that the game would be bounderied and safe for par8cipants. This consulta8on helped us to develop the resource so it was based on present themes rather than exploring past issues or future worries.

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2.2 Background & Context Wellbeing Dominoes -­‐ Review Following the produc8on of Wellbeing Dominoes we delivered the resource as courses in 6 seRngs. The resource was iden8fied as a poten8al income stream. The resource worked in different ways in different seRngs and we were keen to commission an independent review, to iden8fy the challenges, boundaries, poten8al and limita8ons of the use of the resource.

We commissioned Suzie Poyser to conduct this review. Suzie was an ideal choice as she was soon to be working as part of our Art for Wellbeing prac88oner team. This review both allowed for an independent interpreta8on of the Wellbeing Dominoes delivery in the six seRngs and provided Suzie with a grounding in the delivery and ethos of Cartwheel Arts, Art for Wellbeing work.

Suzie is a qualified person-­‐centred counsellor, registered with the BACP, with over 1000 hours of post qualifica8on counselling experience and over 8 years of experience in suppor8ng adults and young people with a broad range of issues and challenges. Suzie was recently commissioned by Henshaws Society for Blind People to design and deliver a 4 month counselling pilot for service users. Providing counselling to Henshaws clients and providing a detailed evalua8on and analysis of the pilot, which helped Henshaws success in being awarded funding from the Big Lokery Fund, to provide a full 8me in-­‐house counselling provision.

Suzie worked closely with our team of prac88oners, had access to par8cipant feedback, Emo8onal Support Worker reports and ar8st evalua8ons to review the delivery of the resource.

This review helps us to outline best prac8ce when using Wellbeing Dominoes and iden8fies the seRngs in which the resource has the strongest impact on wellbeing for par8cipants.

Kerry Bertram Art for Wellbeing Coordinator Cartwheel Arts

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3.0 Well Being Dominoes -­‐ The Six SePngs

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Se#ng 1 Dandelion Create -­‐ Rochdale

“People here really share their experiences, there is great support and there are always people there to talk through ideas”

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3.1 Dandelion Create -­‐ Rochdale Summary Dandelion Create is an NHS funded arts venue, managed by Cartwheel Arts. Par8cipants included exis8ng service

users of Cartwheel projects and new service users, who were recruited either through self referral or local support agencies.

Context • 6 group members, 3 female and 3 male. 3 members from previous Cartwheel projects, 3 new members; • The group met for 7 sessions and played WD for 5 of those sessions; • Group members presented with a range of mental and physical health issues including depression, anxiety, schizophrenia, emo8onally unstable personality disorder, social anxiety, fibromyalgia, arthri8s, type 2 diabetes; • Some group members were socially isolated and some had caring responsibili8es for children with complex needs; • Each par8cipant was assessed using the Mental Health Recovery Star tool.

ParGcipant Outcomes & Feedback • Developed a sense of ownership and pride; Resulted in reduc8on in feelings of social isola8on; Generated opportuni8es for team work and collabora8on; Created improved confidence in artmaking; Enabled gentle challenge of perfec8onism and paranoid thoughts; • Peer emo8onal support was reported; • Expressed desire by par8cipants to engage in future projects.

• • • •

Benefits of SePng

Challenges of SePng

• Delivery of game by experienced facilitators; • Close collabora8on between Cartwheel and referring agencies, CPNs and support workers;

• Fluctua8ng akendance created inconsistency; • Some tension amongst the group at 8mes; • Certain cards triggered feelings of anxiety and / or paranoia within some of the service users.

• Exis8ng group were inclusive of newcomers; • Closed group with formal recruitment meant awareness of par8cipants and their individual needs; • Knowledge of the space meant more control and comfort; 13 of 4a1 • Good ccess to all materials.

Se#ng 2 Sunshine House -­‐ Wigan

“We all have different needs and its nice to have a chat and get stuck in without worrying about the outcome”

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3.2 Sunshine House -­‐ Wigan Summary Sunshine House is a ‘community hub’ and operates as a ‘drop-­‐in’ style service which provides a variety of different groups and ac8vi8es. The group was a pre-­‐exis8ng user-­‐led mental health support group. The game was played with likle structure due to the ‘drop-­‐in’ nature of it.

Context • Akendance fluctuated between 11-­‐19 group members; • 7 sessions held with 6 sessions spent playing WD; • Group members presented with a wide range of mental health issues and physical disabili8es including psychosis, anxiety, depression, OCD, Asperger's syndrome, fibromyalgia, rheumatoid arthri8s, visual Impairment; • Approximately equal ra8o of men to women; • The game play was adapted to fit with the ‘drop in’ nature of the group; • This was the ar8st’s first 8me in delivering the game.

Benefits of SePng • • • • • •

Good collabora8on amongst group and peer support; No pressure and relaxing process; Lots of art work was produced, which par8cipants enjoyed; Par8cipants felt relaxed in their familiar environment; Simplicity of exercises worked for some; Honest feedback was provided, including posi8ves and learning points.

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ParGcipant Outcomes & Feedback • Good engagement from certain members of the group; Generated opportuni8es for team work and collabora8on; Crea8ve play and laughter was facilitated; Created improved confidence in artmaking; Reflec8ve element of game was not incorporated; Feedback sugges8ng that Cartwheel don’t understand the needs of people with mental health issues; • Some exercises were too simplis8c.

• • • • •

Challenges of SePng • Group was too large, 11 – 19 and disjointed; • Drop-­‐in nature of group meant that the forming of group was difficult and chao8c at 8mes; • Support workers at centre didn’t understand objec8ves; • Feedback from par8cipants and staff that the game felt patronising; • Certain cards not appropriate – imagery for people with psychosis; • Ar8st not familiar with the game or with mindfulness.

Se#ng 3 Teambuilding Sessions

“I s8ll think about that teambuilding a year on, I have a small child and you helped me unlock my crea8vity, for me not just for him”

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3.3 Team Building Sessions Summary Teambuilding sessions delivered with Alive in Berlin Conference Team, held in London and with Crea8ve Pulse, Inspiring Health Lifestyles Wigan. The aims of these workshops was to create collabora8on in the teams.

Context Alive Berlin • Workshop delivered in London; • 3 hour session; • 8 Par8cipants.

Inspiring Healthy Lifestyles, Wigan • Delivered offsite at Wigan; • Half day session; • 4 Par8cipants.

ParGcipant Outcomes & Feedback • Created space for Relaxa8on and de-­‐stressing; Opportuni8es for mindfulness; Ability to play crea8vely; Ability to create artwork; Learning about benefits and delivery of wellbeing dominoes; Generated opportuni8es for team work and collabora8on with colleagues; • Created improved confidence.

• • • • •

Benefits of SePng

Challenges of SePng

• Using the game in a different way demonstrated versa8lity of game; • Ability to generate revenue for Cartwheel;

Inspiring Healthy Lifestyles, Wigan • Limited numbers of par8cipants; • Disorganised, unstructured organisa8on. i.e. lack of communica8on about venue and numbers.

• Generated opportuni8es for team work and collabora8on; • Generated construc8ve feedback for the game; • Provided opportunity for networking and poten8al future projects for delivery of game.

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Se#ng 4 Crea@ve Living Centre -­‐ Bury

“My husband and family have had a number of health problems recently and I spend a lot of 8me caring. Its nice to have something just for myself to go to for a few hours”

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3.4 CreaGve Living Centre -­‐ Bury Summary The Crea8ve Living Centre in Bury provides people with a holis8c approach to health and well being in a safe and suppor8ve place where people can set their own goals and work at their own pace towards self-­‐empowerment and recovery. The Wellbeing Dominoes project was delivered with a carers group.

Context • Akendance started with 6 par8cipants and ended with one; • 7 sessions were planned, six were carried out as the final session cancelled due to lack of par8cipants; • Group members were carers; • Each par8cipant was assessed using the Mental Health Recovery Star tool.

ParGcipant Outcomes & Feedback • Some par8cipants didn’t understand the purpose of the

sessions; • Some of the exercises felt childlike; • Some reports of lack of clarity around outcomes; • Some par8cipants felt that they didn’t get anything out of the game.

Benefits of SePng • • • • •

Good par8cipa8on by group; Good reflec8ve prac8ces throughout; Giving carers space an 8me for play and self care; Space for sharing and peer to peer support; Specific card – permission slip worked really well.

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Challenges of SePng • Some confusion over boundaries and responsibili8es of partner agency; • Group dynamics were evident – Cliques and group divide; • The environment wasn’t suitable, due to room size, situa8on and privacy; • Par8cipants found it difficult to play and to let go.

Se#ng 5 IMPACT: Generate and Demonstrate -­‐ Manchester

“The Wellbeing Dominoes resource is brilliant -­‐ I can definitely see how this would benefit my organisa8on! It would be great for genera8ng posi8ve ideas and crea8ng a crea8ve way to enhance mental wellbeing ”

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3.5 IMPACT Conference Summary 2 sessions on wellbeing dominoes delivered at the IMPACT: Generate and Demonstrate conference at MMU. The par8cipants were conference delegates from various third sector organisa8ons.

Context Session 1 • Experien8al Workshop; • 11 Par8cipants (Conference delegates); • Delivered by 2 AFWs who had developed the game.

Session 2 • Q&A session; • 6 Par8cipants (Conference delegates); • Delivered by 2 AFWs who had developed the game.

ParGcipant Outcomes & Feedback • Good game format; • • • • •

Well structured and thought out sessions; Experien8al workshop was useful and fun; Therapeu8c benefits clear to some par8cipants; Holis8c nature of the game effec8ve; Provided a good opportunity to learn about the game and it’s benefits.

Benefits of SePng

Challenges of SePng

• Venue was well placed for akendance and plenty of space provided for workshops; • Well structured workshops, providing posi8ve experience; • Opportunity to explain the concept and benefits of the game; • Experience of facilitators provided quality experience for par8cipants .

• Short length of 8me didn’t allow for a depth of experien8al learning; • Some delegates reported that there was a need for clearer instruc8on and purpose; • Variety of delegates meant different levels of understanding.

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Se#ng 6 Wellbeing Dominoes Training -­‐ Manchester

“I feel confident in using the resource in my prac8ce and excited about having a go at more of the ac8vi8es myself-­‐ I loved the immersive part of the training, learning by doing is really powerful”

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3.6 Training Day -­‐ MMU Summary Training day delivered by the AFWs who developed the game, for employees from various third sector and public sector organisa8ons to become Wellbeing Dominoes Prac88oners. The training took place at MMU.

Context • • • • • •

10 par8cipants; Training delivered at MMU; 1 full day of training split into 2 sessions; Session 1 – Experien8al Game Play; Session 2 – Q&A/delivery in different seRngs; Delivered by experienced AFWs who developed the game.

ParGcipant Outcomes & Feedback • Feedback very posi8ve on the workshop; • Experien8al element of course was useful; • Well thought out day; • The concept of the game is good, can see how it would fit in with par8cpants; • Feedback that some users have used it with par8cpants; • Clearer instruc8ons needed for the cards and delivery.

Benefits of SePng

Challenges of SePng

• Professional, well placed venue with well laid out room for the course; • Good structure, in terms of balance of experien8al and theore8cal learning opportuni8es; • Delivery of training by experienced facilitators

• Varying level of experience – could see that some par8cipants should not have been passed as prac88oners; • Not all appropriate akendees.

• Time for experien8al game play and Q&A; • Ability to set boundaries around the game.

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4.0 Key Insights

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4.1 Five Principles of Best PracGce Therapeu8c group work has a plethora of benefits and when delivered effec8vely can have posi8ve effects on many aspects of the par8cipants lives. Using art or crea8ve exercises as the focus of group work also has it’s own unique set of benefits on an individual and the group. Cartwheel have clearly defined the benefits and predicted outcomes (Appendix C) of delivering Wellbeing Dominoes as an ‘art for wellbeing’ game for groups.

The concept of group work as a vehicle for therapy is a mature one. There have been many studies conducted in this area which have improved the therapeu8c communi8es understanding and refined the approach to group work to improve efficacy and maximise therapeu8c benefit. The Associa8on for Specialists in Group Work are dedicated to this par8cular field of study and have developed five principles of best prac8ce. This report has developed the key insights through the lens of these five principles (detailed on the next page) when proposing the appropriate recommenda8ons.

AssociaGon for Specialists in Group Work (ASGW) • The ASGW were founded to promote quality in group work training, prac8ce, and research both na8onally and interna8onally.

• The purpose of the Associa8on is to establish standards for professional and ethical prac8ce; to support research and the dissemina8on of knowledge; and to provide professional leadership in the field of group work.

• The Associa8on also seeks to extend counselling through the use of group process; to provide a forum for examining innova8ve and developing concepts in group work; to foster diversity and dignity in our groups; and to promote models of effec8ve group prac8ce.

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4.1 Five Principles of Best PracGce 1. Planning: Considering aspects such as professional context and regulatory requirements, scope of prac8ce and contextual framework, assessment of suitability of facilitators, environment, par8cipants and resources; 2. Group Forming: Considering the dynamics of the group according to the par8cipants individual needs, as well as the needs of the group; 3. Group Performing: Considering aspects such as facilitator involvement, collabora8on, therapeu8c condi8ons and dynamics. Group facilitators to manage the flow of communica8on, addressing safety and pacing of disclosures to protect group members from physical, emo8onal, or psychological trauma; 4. Group Processing: Consider the groups reflec8ve prac8ce and par8cipa8on; and 5. EvaluaGon: Consider the importance of evalua8ng experience of the group from different perspec8ves, including Par8cipant, facilitator, organisa8onal, consulta8on and development of partner agencies.

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4.2 Key Insights The review of Wellbeing Dominoes in different sePngs has highlighted a number of key insights. Each insight has been considered and is presented in the slides below providing a descripGon of the insight, lessons learned and recommendaGons.

1) Partnership Working & ResponsibiliGes Where partner agencies were involved in organising or assis8ng with delivery of the project, issues arose around inter-­‐organisa8onal boundaries. This was mainly evident in Sunshine House, Wigan and Bury Crea8ve Living Centre.

Lesson Learned In order to ensure effecGve delivery of the game within a structured sePng it is of vital importance that partner agencies are consistently consulted and engaged during the planning stage.

RecommendaGons a) Clear Partnership Agreements: Ensure that the pre-­‐signed contracts clearly outline responsibili8es of Cartwheel and those of the partner agency; b) IniGal Project MeeGng & Mid Term Project Review: Akended by Management and facilitators where possible, to clarify responsibili8es and to re-­‐iterate at mid review point; c)

ResponsibiliGes Agreement: A clear and concise document outlining responsibili8es to be circulated to AFWs and support workers involved at partner agencies.

d) Responsibility: Partner agencies to take full responsibility for delivery of workshops with their service users, upon successful comple8on of the Cartwheel Prac88oner training for Wellbeing Dominoes.

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4.2 Key Insights 2) Group Dynamics & Boundaries In any group-­‐work seRng, group dynamics will come in to play. Where WD was delivered in external seRngs the challenges were greater around managing the group dynamics and boundaries. This is in part due to the lack of prior interac8on, assessment or knowledge of the par8cipants by the facilitators and in part because of the issues around partner working.

At Sunshine house the dynamic was chao8c due to ‘drop in’ nature, making it difficult to form a cohesive group. At Dandelion Create the group was closed, with 6 regular par8cipants making group forming more effec8ve. Also, at Dandelion, par8cipants had been assessed by the ESW, meaning that there was a greater understanding of each individuals support needs and how this might impact on the group.

Lesson Learned In order to form a group which can work effecGvely, it is important for the facilitator to have a prior understanding of the needs of the individuals and the group as a whole. This knowledge and understanding can then inform the facilitator in any adaptaGons that may be needed in delivery of the game.

RecommendaGons a) Assessments: Individual assessments to be carried out by ESW whether delivered onsite or externally; b) IniGal Briefing: Ini8al briefing/handover mee8ng with partner agency employees involved in suppor8ng the par8cipants; c)

Icebreaker Session: First session with the group to be focused on group forming through icebreaker ac8vi8es, introduc8ons of par8cipants, facilitators and the project purpose;

d) Responsibility: Partner agencies to take full responsibility for delivery of workshops with their service users, upon successful comple8on of the Cartwheel Prac88oner training for Wellbeing Dominoes.

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4.2 Key Insights 3) Physical Space Where delivered externally, the logis8cs of using another space was reported as an issue. From not having control of the space (i.e. who came in and out during sessions) and the physical space not being adequate (i.e. tables, size of room). Feedback from the AFWs suggests that the space at Dandelion Create is ideal as it is a familiar seRng, the room is a good size and layout for the groups, and all art materials are easily available.

Lesson Learned

LogisGcs needs to be pre-­‐planned and organised effecGvely to ensure smooth delivery of game.

RecommendaGons

a) Clear Partnership Agreements: Ensure that the pre-­‐signed contracts clearly outline clear parameters around the appropriateness of the space; b) Pre-­‐project Visit: Cartwheel manager or AFW to visit to venue of delivery to assess suitability; c)

Cartwheel Delivery: Where possible delivery of projects facilitated by Cartwheel ASWs, to be held at Dandelion Create.

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4.2 Key Insights 4) Clarity Around Purpose Feedback suggested that there was confusion regarding the purpose of the game. Some par8cipants found it patronising, too simple and childlike. In some cases this impacted on engagement in the process. In some seRngs the game was not played in a structured way which seemed to lose the essence of the game. This impacted on the poten8al to achieve the best possible outcomes.

For example at Sunshine house the reflec8ve element was lost, as well as the ability to play the game as intended.

Whilst it is important to retain some flexibility, when the game was played in a structured format, as it was at Dandelion Create, the desired outcomes were more evident.

Lesson Learned In order for the game to be played effecGvely, realising the benefits and predicted outcomes, it is necessary for the facilitators to focus on the purpose of the game and the outcomes. This will provide parGcipants with clarity, focus and insight.

RecommendaGons a) Outcomes Document: Clear outcomes document to be produced and circulated to facilitators and partner agencies; b) Icebreaker Session: First session with the group to be focused on group forming through icebreaker ac8vi8es, introduc8ons of par8cipants, facilitators and the project purpose; c)

ReflecGve PracGce: Ensure that a structured and consistent group reflec8on and review are carried out;

d) Category Reminders: Producing and providing an outcomes/categories poster to ensure clarity for par8cipants and partner agencies.

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4.2 Key Insights 5) Game Appropriateness In each seRng feedback suggests that certain cards worked beker than others. Some cards seemed to evoke nega8ve and poten8ally harmful emo8ons in par8cipants, whilst other cards proved to be extremely therapeu8c.

For example, at Dandelion and Sunshine House certain cards invoked paranoia and disturbing imagery for the par8cipants. Whereas in the Carers Group, it was reported by the AFWs that the ‘permission slip’ card worked really well as it gave an opportunity for carers to think about what they might need to give themselves permission for to ensure their own self care.

Lesson Learned

The feedback suggests that certain cards are not appropriate for certain sePngs. It is vital that parGcipants are safeguarded against any detrimental impact on their mental health.

RecommendaGons a) Game AdaptaGon: The game could be tailored for delivery in different seRngs, with certain cards excluded in order to ensure the best possible outcomes for par8cipants. b) Responsibility: Partner agencies to take full responsibility for delivery of workshops with their service users, upon successful comple8on of the Cartwheel Prac88oner training for Wellbeing Dominoes.

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4.2 Key Insights 6) PracGGoner Experience Feedback indicates that it is impera8ve to have a good understanding of the group to which the game is being delivered, but also that the facilitator has a good understanding of the game.

Lesson Learned

In order to play the game effecGvely, it is imperaGve that the facilitator has experience in delivering group sessions and that they have the ability to clearly communicate the outcomes and benefits of the game to parGcipants.

RecommendaGons a) Facilitator Training: All facilitators to akend the Cartwheel Wellbeing Dominoes training course; b) Responsibility: Partner agencies to take full responsibility for delivery of workshops with their service users, upon successful comple8on of the Cartwheel Prac88oner training for Wellbeing Dominoes.

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4.2 Key Insights 7) Measuring Outcomes The review of Wellbeing Dominoes in different seRngs raises a ques8on mark over whether the outcomes have been achieved and therefore whether the projects have been successful. The review is limited due to the inconsistency in the evalua8on reports provided.

Success of a project could be assessed from different perspec8ves, such as par8cipants, Cartwheel, funders and key stakeholders. In order to evaluate the projects with each of these audiences in mind it is vital to have a consistent evalua8on tool.

The predicted outcomes (Appendix C) are outlined in the Instruc8on Booklet for facilitators. However, these outcomes are not currently measured, therefore pilots cannot be effec8vely assessed.

Lesson Learned In order to measure outcomes and efficacy of each project it is vital to have a structured evaluaGon process in place.

RecommendaGons a) Outcomes Form: Outcomes form to be developed specifically for WD, to be completed by par8cipants at the beginning and comple8on of the project. b) EvaluaGon Process: Create a structured evalua8on process for Wellbeing Dominoes, using standardised forms for AFWs or facilitators.

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4.3 Game Structure -­‐ ObservaGons The report has also considered the instrucGons / structure for playing Wellbeing Dominoes through the lens of parGcipant feedback and the reviewers insights. The observaGons are provided below for consideraGon. InstrucGon Booklet: This is a well produced document which gives clear instruc8on to a facilitator of the game. There are certain aspects of the booklet that could be developed, in order that the game be played effec8vely and the best possible outcomes can be realised.

Ground Rules: The example ground rules sheet appears quite basic, with certain key aspects missing. Confiden8ality within the group is vital. It may also be beneficial to clearly define what “treat with respect” means. For example, allowing everyone the chance to par8cipate, listening when another par8cipant is talking, being sensi8ve to difficult feelings that might come up.

Outcomes & Benefits: The book does not highlight the importance of clearly defining the purpose of the game. It would be useful to include this in the ‘playing the game’ sec8on. Providing a clear introduc8on to the game could help with group forming and framing of the project.

CerGficate: The cer8ficate of par8cipa8on could be perceived as patronising. Feedback suggests that many par8cipants found the game childlike. This could leave par8cipants feeling disempowered. As an alterna8ve par8cipants could produce a final piece of work which incorporates or consolidates the work that has been completed over the course of the project.

This would serve to provide a reminder of the purpose of the game and the benefits realised.

Facilitator Category & Card Notes: These notes are an integral part of the game. Facilitators should be familiar with these notes prior to delivering sessions. This will ensure that the purpose of the game is clearly ar8culated and the best possible outcomes are realised.

Task Cards: Certain cards are unclear and difficult to follow. i.e. Weaving focus does not give clear instruc8on, making it difficult to explain the card to par8cipants. Cards could be reviewed and refined where necessary.

FacilitaGon Notes: These notes provide an excellent overview of the game, the purpose, outcomes and logis8cs. It is vital that these notes be provided and highlighted to facilitators and any partner agencies involved.

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5.0 Case Study

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5.1 Case Study IntroducGon This case study focuses on one group member who took part in the Wellbeing Dominoes group at a Community Centre. The group ran over 8 sessions and each session was 2hrs in dura8on. The group was varied in terms of gender, age and mental health presenta8on, par8cipants suffered from a range of difficul8es including anxiety, depression and social isola8on. In total the group had 5 members.

To protect the iden8ty of the group member in this case study I have changed her name to Clare. Clare akended an assessment prior to her first group session where she completed a recovery star, spoke about her current difficul8es and received support to help her access the group. In her assessment she disclosed that she was socially isolated and depressed following the death of her husband one year ago. Since his death their joint business had failed and she had become increasingly isolated and dependent on her son for emo8onal support. She had a teenage daughter with au8sm and she some8mes struggled to cope with her challenging behaviour. She said she felt that her personality had been completely altered by the bereavement and she had lost her ‘bubbly’ ‘outgoing’ self. In the past she had enjoyed crea8ng abstract pain8ngs at home and felt that this helped her to relax, and she said she wanted to rediscover her crea8ve side. She also felt that the group would be an important step in rebuilding her confidence and helping her to be around people again.

StarGng the Group At the beginning of the group Clare was the only member who did not know anyone else in the group. She was ini8ally quite reserved in the first session but gradually began to talk to other group members and find some common ground.

The cards provided good ice breaking ac8vi8es such as ‘magnificent creature’ which helped the group to connect and loosen up. Clare was very open to trying new things and engaged well with the art materials. Her ap8tude for art making seemed to give her confidence and she gradually became less inhibited in the group.

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5.1 Case Study Progress Clare’s work was ogen vibrant, experimental and colourful and seemed to reflect the ‘bubbly’ part of herself which she felt she had lost. Cards such as ‘ink blots’ helped her to experiment with materials and focus on the process of making rather than the end result. The pleasure she took from making the work, engaging in the ac8vi8es and interac8ng with group members seemed to be helping to rekindle this part of her personality. Group members ogen admired her work and she received a lot of affirma8on from the group.

Gradually Clare began to share more with other group members. About half way through the sessions, Clare came to the group feeling stressed due to illness and problems at home. She shared this with the group and received support and encouragement from other group members appeared to lig her mood.

The group’s final card was ‘Circle of unity’ which involved group members working in close physical proximity with each other to produce a group piece. The physical closeness required seemed to facilitate more in8mate discussion among group members. Clare opened up to another group member about some of the difficul8es she had been experiencing caring for her au8s8c daughter, she discovered that another group member had two sons who were also on the au8s8c spectrum. The two group members spent a long 8me talking, sharing their stories and suppor8ng each other. They both commented posi8vely on how helpful the experience had been.

In her exit interview she spoke about how the group had helped her to be more proac8ve about her wellbeing. She also said she had realised that running her own business was too isola8ng and she wanted to find employment in a more social seRng as she felt this would benefit her mental health.

Conclusion Through her par8cipa8on in Wellbeing Dominoes Clare was able to reconnect with her crea8ve ability and begin to rediscover parts of her self which she felt she had lost. She was able to reflect on her wellbeing, become more proac8ve and begin to see how to move forward in her life. She gradually became less inhibited and reached a point where she felt able to connect and share with other group members in a meaningful way.

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6.0 OpportuniGes & RecommendaGons

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6.1 OpportuniGes In conclusion, this report has iden8fied a number of recommenda8ons and opportuni8es. The recommenda8ons, proposed for implementa8on are detailed in Sec8on 4.2 and cover the domains of partnership working & responsibili8es, group dynamics & boundaries, physical space, clarity around purpose, game appropriateness, prac88oner experience and measuring outcomes.

In addi8on to the recommenda8ons this report has also iden8fied two opportuni8es for considera8on:

Increasing ParGcipant Coverage • Iden8fy a range of services where wellbeing dominoes could be delivered. For example agencies who work with: • Children & Young People; • Drug and Alcohol; • Specific Mental Health Support. i.e anxiety or depression group; • Approach local mental health organisa8ons to discuss working in partnership to trial wellbeing dominoes.

Agencies to consider include Mind, Self Help Services and 42nd Street; • Development of a consistent trialling format, to ensure demonstrable outcomes for par8cipants; • Promote the training programme for delivery of game within these iden8fied seRngs with key workers, for in-­‐ house delivery.

Benefit: Expanding the reach of Wellbeing Dominoes as a wellbeing tool will increase the number of par8cpants posi8vely impacted by the game and raise the profile of

Cartwheel Arts and the charitable work it performs.

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Commercial OpportuniGes • Mindfulness and stress reduc8on ac8vi8es are increasingly being employed by businesses to support employee wellbeing; • Some of the benefits realised at the teambuilding sessions provide evidence to support the games efficacy in helping with common stress relievers in the workplace, with the following benefits being men8oned in feedback: • Collabora8on/teamwork; • Relaxa8on and stress relief; • Space to create and have a fun; • Opportuni8es for mindfulness.

• Iden8fy a number of organisa8ons to approach with a commercial offer to deliver the game as a wellbeing at work project; • Promote the game as a wellbeing at work tool at the IMPACT conference in August.

Benefit: The adapta8on of the game as a wellbeing at work tool could provide an addi8onal revenue stream which may be used to subsidise delivery of the game into charitable seRngs.

7.0 Appendix

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Appendix A: Input Documents The documents listed below were reviewed during the wriGng of this report. The informaGon presented within these documents was drawn from in compiling and substanGaGng this report and its recommendaGons.

•

AssociaGon for Specialists in Group Work: Best PracGce Guidelines 2007 Revisions, R. Valorie Thomas Rollins College Debra A. Pender Northern Illinois University

•

EvaluaGon of Wellbeing Dominoes at Sunshine House, Wigan. November 2015, Jodie Silverman

•

EvaluaGon of Wellbeing Dominoes at Dandelion Create, Rochdale. January 2016, Jodie Silverman

•

EvaluaGon of Wellbeing Dominoes at CreaGve Living Centre, Bury. December 2015, Stacey Coughlin

•

Project EvaluaGon: Wellbeing Dominoes at CreaGve Living Centre, Bury. December 2015, Stacey Coughlin

•

Wellbeing Dominoes Training ParGcipant EvaluaGon, Open QuesGons, CreaGve Pulse. January 2016, Kerry Bertram

•

Wellbeing Dominoes Training ParGcipant EvaluaGon, Open QuesGons, IMPACT Conference. October 2015, Kerry Bertram

•

Wellbeing Dominoes Training ParGcipant EvaluaGon, Team Building, Alive. September 2015, Kerry Bertram

•

The Spirit of Wellbeing Dominoes InformaGon Sheet

•

Teambuilding-­‐Alive EvaluaGon QuesGons

•

Teambuilding-­‐CreaGve Pulse EvaluaGon QuesGons

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Appendix B: Wellbeing Dominoes Outcomes These are the predicted outcomes for game parGcipants based on research conducted into elements which underpin the game: •

Development of crea8ve skills to aid relaxa8on, leading to an increased sense of inner calm an wellbeing;

•

Increased ability to focus;

•

Development of crea8ve skills to decrease rumina8on and distract from difficult thoughts and feelings;

•

Stress reduc8on;

•

Increased self awareness and ability to reflect;

•

Increased emo8onal expression, self-­‐expression and emo8onal literacy;

•

Increased insight into maintaining wellbeing, adaptability and enhanced coping strategies, increased ability to self sooth and manage own mental health;

•

Development of social skills through group involvement and interac8on;

•

Increased social inclusion;

•

Increased sense recogni8on and achievement;

•

An enhanced sense of iden8ty, self acceptance and self-­‐esteem;

•

Increase in cogni8ve flexibility – play, design, crea8ve decision making, metaphorical thinking, associa8ve thinking – all combat rigid thinking pakerns;

•

Increased awareness of and capacity to engage in ‘flow’ ac8vi8es. Flow is an ac8vity in which a person becomes fully immersed and gains a feeling of energised focus, and enjoyment. It is characterised by complete absorp8on in what one does and is an innately posi8ve experience.

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For more information on Art for Wellbeing or Wellbeing Dominoes please contact:

Kerry Bertram Art for Wellbeing, Project Coordinator kerry@cartwheelarts.org.uk

Phone: 01706 361300 Address: Cartwheel Arts, 110 Manchester Street, Heywood, OL10 1DW

www.cartwheelarts.org.uk

www.artforwellbeing.wordpress.com www.facebook.com/CartwheelArts www.twitter.com/CartwheelArts

Charity Number: 519394 Company number: 2161995

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