376 D. J. Brooker & R. J. WoolleyTable II. Core components of the enriched activity programme.Core component Function Locksmith role Staff role Management roleGeneral good qualityperson-centred careIndividualised simpleand fun activity andoccupation that canoccur everydayCommunal spaceand equipmentMeets psychological needs of vulnerable<strong>people</strong>. Overcomes exclusion.Maintains well-being on a day to daybasis.To support the individual and groupactivities.Getting out of the facility Maintains feeling part of the world,empowers to continue everyday activities,fresh air, excitement and fun.Models this in all interaction, can explainits importance to all.Assesses what works <strong>with</strong> whom. Deviseskey cards. Communicates to all team.Monitors its implementation.To assess what is needed, to maintain itsuse, safety and security.Organises and liases <strong>with</strong> appropriateplaces and <strong>people</strong>. Assesses suitability.Positive attitude towards and empathy<strong>with</strong> residents/tenants. Low number ofpersonal detractions.Carries this out on a one-to-one <strong>with</strong>identified tenants/residents or in smallgroups.To use equipment and props imaginativelyand safely on a day to day basis.Provide one-on-ones where necessary.Risk aware.Recognition and rein<strong>for</strong>cement ofperson-centred care practice.To give priority to this in workloadplanning and scheduling.To provide resources and space.Provide staff resources and planningsupport.
<strong>Enriching</strong> <strong>opportunities</strong> <strong>for</strong> <strong>people</strong> <strong>living</strong> <strong>with</strong> <strong>dementia</strong> 377‘‘...even though they can’t talk you can tell. <strong>The</strong>ireyes are fixed on you and they’ll smile or they’ll befar more relaxed when you’re doing something.But to be honest, even the most impaired we getsome kind of feedback from them.’’<strong>The</strong> Locksmith needed to work out everydayactivities that would maintain and sustain well-being<strong>for</strong> each individual participant. This needed to besomething that staff could work on <strong>with</strong> participantsas part of the everyday routine.‘‘We have one woman that spends a lot of times inthe rooms, and we know from her family that sheused to listen to classical music. Now becausewe’re playing that a lot, this lady, we’re getting somuch more response. She’s smiling, she’s happy,she’s laughing. And we haven’t had that <strong>for</strong> a longtime – and it’s lovely. It’s really lovely.’’‘‘We’ve actually got a bottle of Tia Maria, andsherry, so she’s having a tipple <strong>with</strong> her meals, andit’s lovely – she enjoys it. And her chocolate. Soeven though we’re not doing a LOT <strong>with</strong> herdown here in the main lounge, she is getting moreone-to-one attention. She’s getting something shelikes listening to, she likes a drink, and a lot oftouchy-feely.’’‘‘It is the simple things, it is like last week they hada snowball and put it in front of Bill (resident) andhe picked it up and was passing it round, that is anactivity. It is sensory, it’s ...whereas if somebodycomes in and says, ‘‘you bake a cake’’, whatreaction are you going to get?’’‘‘With Elsie who’s so difficult to engage ...<strong>with</strong> theballoons, she loves knocking balloons around.I mean she’s just like plus 5, plus 5, plus 5(exceptional well-being). And once you stopknocking it around she’ll kind of hold on to aballoon and use it in a sensory way, so it’s brilliant.’’All Locksmiths used a lot of objects in their work.<strong>The</strong>se were either reminiscence-type objects that<strong>people</strong> enjoyed handling or using, or objects like theballoons that <strong>people</strong> could have fun <strong>with</strong>. <strong>The</strong>re wasalso the more specialist equipment such as massagecushions or craft material that some <strong>people</strong> foundbeneficial. A member of staff described using variousprops to help one of her residents:‘‘I mean Bob, he can’t communicate, he justshouts; he can’t say any words at all. But if he likesan activity that we’re doing <strong>with</strong> him he usuallygrins at you. So, you sort of read his body languagethat way. He likes hats. Different hats just keepchanging the hats. Or he likes reading gardeningbooks, sports. So we know really by his bodylanguage. We read his body language that he’senjoying the activity that he’s doing.’’<strong>The</strong> main groups of <strong>people</strong> that were important toengage <strong>with</strong> the Enriched Opportunities Programmeare summarised in Table III. Staff commented onthe interest generated by outside therapists andentertainers.‘‘On St Patrick’s Day we had two Irish Dance girlsin and the reaction from some of the residents waslovely. And we did a proper Irish meal and oh itwas really nice. <strong>The</strong> relatives came in and theyenjoyed it – the residents enjoyed it. <strong>The</strong>y love liveaction stuff – close stuff.’’Working <strong>with</strong> local community mental healthteams was well established already in the practicedevelopment sites. Had this not been the case, thiswould have been a bigger role <strong>for</strong> the Locksmith. Interms of specialist expertise, the Locksmith is ideallyplaced to engage <strong>with</strong> specialists outside the facility,whilst also being able to implement and monitoradvice and suggestions.Element 4: Staff trainingLack of staff knowledge or skills is often highlightedas a reason <strong>for</strong> interventions not achieving positiveresults (e.g. Ballard et al., 2002: Turner, 2005). <strong>The</strong>value systems, knowledge and skills of staff arefundamental to providing good quality care <strong>for</strong><strong>people</strong> <strong>with</strong> <strong>dementia</strong>. <strong>The</strong>re is evidence that shortfocused training courses (1–5 days) increases careteams’ confidence and knowledge in working <strong>with</strong>older <strong>people</strong> (Lintern, Woods, & Phair, 2000a;Mayall, Oathamshaw, & Pusey, 2004; Moniz-Cooket al., 1998). Although all these studies showed apositive impact on staff knowledge, none of themmanaged to demonstrate a significant impact on theclients that the staff were caring <strong>for</strong>. <strong>The</strong> EWGemphasised that all staff, particularly those <strong>with</strong>greatest participant contact, needed to have thenecessary skills to support the EnrichedOpportunities Programme. <strong>The</strong>re was no prescribedtraining at the commencement of the EnrichedOpportunities Programme. Part of the Locksmithand managers’ role was to use the Expert WorkingGroup to assess what training would help themdeliver the programme.From the interviews and focus groups, all agreedthat training had to change hearts and minds andprovide the skills and attitude necessary to deliverthe Enriched Opportunities Programme. Trainingshould be accessible, fun, practical, and based onexamples from practice <strong>with</strong> the client group. <strong>The</strong>rewas a strong commitment that the whole of the staffteam should be trained in the core approach and thatthis staff training should also act as a team buildingexercise. <strong>The</strong> core content of training <strong>for</strong> all directcare staff should include:. Mental health awareness – Knowledge andawareness about mental health and cognitiveimpairment in later life and how it affects <strong>people</strong>.. Person-centred approach – Valuing all <strong>people</strong> andunderstanding their perspective, team building.
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