Since the first Dementia UK report in 2007 on the economic impact of dementia there has been a slow, but more recently accelerated, awakening on the potential impact of dementia on our communities, with some liking it to the threat of global warning. As a result, there has been increasing investment in research. With this has come a growing evidence base for the application of non-pharmacological treatments, accelerating opportunities to improve practice and individual outcomes. However, bringing this new research, ideas and practices to front line staff has been a slow burning process. Although I am pleased to say that many of our clients have moved beyond the realms of ‘dementia awareness’ as the only training staff get.
Very early in my career as a social worker I was thrust into the depths of dementia diagnosis. Newly qualified, I was eager, motivated and interested to learn, to forge my sense of professional identity. I quickly got a job in Islington with a team known at the time as ‘Mental Health Care of Older People’. Based in the hospital, and led by a confident and dynamic psychiatrist, I sat amongst a very diverse (multi-disciplinary) group of professionals. What I learnt very quickly is that dementia is a fascinating and complex condition that requires a multiple perspective in order to truly get it’s measure. I couldn’t help feeling, though, that in this group I struggled to find an identity, to understand my professional worth; and truly the worth of the social model. I felt at the time (about 20 years ago!) there was a strong leaning towards medical interventions, some effective, and some fraught with difficulty and undesirable side effects. At this time there was a limited evidence base for non-pharmacological treatments, so many looked to medical treatments.
My occupational training in Islington compelled me to learn more, so I began personally to pursue the possibilities for good dementia support. For the first few years I read widely; I’m ashamed to say in the last 20 years I have never once picked up a novel. I am fascinated instead by the challenges and opportunities available in good dementia support; things like, the way the condition and the battle against it humanise us, connect us, and teach us the importance of meaningful connection. It also reminds us of the dangers of disconnection, demonstrates to us that there are strong correlations between our mental wellbeing and our physical health. The interplay between neurological challenges and the social world has always fascinated me, and the creative ways we can communicate and connect. After grappling with the topic for a number of years I soon started training in dementia care, and was soon asked to author a training manual for the first ever dementia care knowledge sets. By this time, I had a much firmer idea of my professional identity, and the role and power of the bio-psycho-social model of support that had challenged me in my earlier years.
For a while my learning went down a rather formal route; I studied at Bradford, which was a great way to benchmark my ideas and my work. However, I learn most from ordinary experiences, feedback from my training groups, and what I see in my own limited direct practice experience. There is a growing collective consciousness of the experience of dementia, led by many people living with dementia like the brilliant Tommy Dunne @TommyTommytee18, and Chris Roberts @mason4233. This has added another dimension to what we believe the possibilities are. This is tacking stigma and showcasing HOPE. Whilst learning about the lived experience of dementia is critical, dementia does not happen in a vacuum, it touches lives and services in so many ways. Therefore, to be a good dementia care educator we must widen our radar. It’s important to learn from all of those people, not just the academics or people living with dementia, but also family carers, front line support staff and other trainers who are often the catalyst for change. Teaching and training in dementia care and support opens you to all that and good trainers will use those opportunities to refine and enhance their message.
Having a good grounding in your subject, the practical underpinned with the theoretical, is a good start but you now have to convey the message in an effective manner and target the training appropriately. All organisations differ and individual group skills levels differ. A good dementia care trainer will ask not ‘these are the courses I can offer’, but will instead say ‘let’s have a look at what is happening in your organisation and see how we can work together to fill the gaps’. It’s about working together, combining skills, and celebrating successes.
Regulation is important in our society, and organisations like CQC work hard to ensure that staff are appropriately trained. However, their legacy has left a box-ticking approach to mandatory training. CQC make clear in their standards now that prescriptive mandatory training is no longer a requirement but rather staff should receive the training appropriate to their role. Despite this, many organisations lack the ability to audit skills and plan training based on need. Done incorrectly it can become a very expensive business. Troubled with poor staff retention, and persistent cuts, our sector needs targeted and fit-for-purpose training.
So the challenge is developing a course that will have an impact. In my years doing this I feel I have developed a recipe.
- Knowing the sector and wider policy drivers is important, and understanding relevant occupational standards to scoping a course that is properly benchmarked.
- Ensuring that your content is evidence-based ensures that the course is credible.
- Knowing how to share human experience in a powerful way that people relate to; often this means bringing in experts by experience.
- Understanding how to weave the key underpinning factors in social care: human rights, communication and recording, safeguarding, dignity, positive risk taking and safety. Person centred planning is critical in getting transition from classroom to practice.
- Developing good accessible learning resources. Despite the commercial sensitivity I think it’s always good to share.
- Develop content that encourages collaborative, integrative work with health. Giving people the opportunity to contrast medical and social interventions in scenarios helps us to identify which is appropriate, and to value each intervention. Sometimes medical interventions are required so that social interventions are made possible and vice versa.
- Providing practical tools that help to bridge the gap between research and practice.
- Using case studies that reflect the diverse society in which we live and ask the right questions to push boundaries.
- Using the right language. Inappropriate language gives poor messages. For example, ‘wandering’, ‘challenging behaviour’, ‘suffering with dementia’.