"Music still comes to you, you know. I've been sitting here listening, I can't bend or anything but once you hear that music it makes you feel you want to get up."

Background & Context

This project is the latest in a number of music and dance initiatives developed as part of Bournemouth Borough Council’s Arts Development programme addressing health and well-being issues and the aims of the Joint Arts Plan. 

Earlier projects have taken place in partnership with musicians from Bournemouth Symphony Orchestra and independent musicians/music practitioners. Projects were held in day centres, residential homes and public venues and included:

• reminiscence and music project with BSO musicians and a storyteller at three Bournemouth day centres which led to a play 'Dancing Years' based on the stories told.
• a programme of regular Tea Dances with BSO targeted primarily at older, frail, people as well as more active dancers.
• Ageing Well – a music and dance project developed in partnership with Boscombe and Springbourne Healthy Living project for staff and residents at three Boscombe residential homes. This led to publication of a book of memories about music and dance, called One Good Tune - Remembered Forever.

Participants of these projects told us they felt "Contented, elated, happy." "I like every kind of music – I used to play the piano before this with my hands. My aunt taught me when I was four and I played until 20 years ago when I was struck with arthritis. I listen to the radio. I used to play ‘Little Man, You’ve Had A Busy Day’, when I was six or seven."

As part of research to develop an action research project Bournemouth Borough Council Arts Development visited musician Andrew Knights and the Music in Care Homes project run in the homes of Eastleigh Borough Council. Evaluation of this respected work has revealed social and health benefits of regular music engagement and a report by Southampton University has been published. 

Kings Park Hospital was keen to participate, viewing the project as a progression on previous work by music therapist Rachel Millman. Further information on the Music Therapy Pilot (August 2006) is available as a report from Kings Park Hospital. 

Kings Park Hospital Project

The Kings Park Hospital pilot project is funded by Bournemouth Borough Council through a Service Level Agreement with Bournemouth Symphony Orchestra (BSO) and developed as a partnership between Bournemouth Borough Council Arts Development, Bournemouth Symphony Orchestra and Kings Park Hospital.

Aims

· To develop a pilot programme at Kings Park Hospital, providing regular live music events for people.
· To evaluate the social and health benefits of listening to music and participating in music making.

Objectives

The aims will be achieved by
· a series of four weekly sessions facilitated by three musicians from BSO at which people will be invited to listen to live music, including well-known songs, and to take part in making music and singing.  
· to provide Continuing Professional Development opportunities for BSO musicians, as well as music students.
· to work with Kings Park staff to develop an evaluation framework to capture the social and health benefits. 

Outcomes

· An evaluation report providing the basis for development of a funding application to support a longer-term project.
· Increased confidence of BSO musicians and music students in working with older people in community setting. 
· Provide advice to Kings Park on possible community music groups who could visit occasionally to play.

What Happened

Staff selected six people with dementia from one ward at Kings Park Hospital who would be likely to benefit from the live music sessions. It was agreed that where possible and appropriate these same six patients would attend each session in order that levels of and changes in engagement could be monitored and measured.

The four sessions were facilitated by BSO animateur, Andy Baker, music therapist, Rachel Millman, and BSO musician and music student, Lisa Dashfield (flute). Another student attended one session as a work placement.

Andy and Rachel presented a range of live music using a combination of double bass, flute and keyboard. Familiar music (mainly well known songs and some classical pieces) and freer improvised structures were used to provide opportunities for participants to join in. Active participation was encouraged using tuned and un-tuned percussion instruments (e.g. drum, chime bars, xylophones, shakers, tambourines and hand chimes) or through use of voice to join in with singing. For example one participant playing djembe (African drum) to accompany popular songs and tunes and another sang the words to familiar songs.

All participants responded positively to the music demonstrating interactive responses, be it playing instruments, singing or interacting more passively through movements or facial expression. All participants were thus able to be actively engaged in the sessions. Sessions began with improvised music that contained a simple and repetitive structure to facilitate as much participation as possible in whichever way participants chose (playing along with handchimes, clapping, vocalising etc.). Also the improvised structure enabled the musicians to respond directly and spontaneously to musical contributions from individual participants.

Familiar songs were presented and participants were also given opportunities to make requests or suggestions. When songs were being played the musicians ensured that any responses from the participants were acknowledged. For
example by giving opportunities for 'solo spots' when this was appropriate, verbally thanking someone for singing and ensuring that there was enough space and time for individuals to respond to and engage with each song. This resulted in some participants singing the words of once-familiar songs.

Evaluation – Dementia Care Mapping

Lucie Penny, Occupational Therapist, organised the use of Dementia Care Mapping, an observational tool designed to show “whether a person with dementia has been engaged or neglected, stimulated or bored, affirmed or de-valued, helped or hindered as a result of care practice” (Bradford Dementia Group, 1997). All six participants were mapped for approximately forty-five minutes prior to the sessions and for the duration of each session. The mapping involves recording an activity code for every five minutes that is mapped and assigning this code with a well-being or ill-being score. The scores for each individual are processed and a well/ill-being value is calculated which forms the basis for the graphs attached.

Examination of the data reveals that each participant was commonly assigned a score of 1 (“coping adequately with the present situation; some contact with others; no signs of ill-being available) prior to the sessions, and during the sessions all scores increased, for one participant to 4.9 (5 being, “exceptional well-being, it is hard to envisage anything better; very high levels of engagement, self-expression, social interaction”). It would appear that the live music sessions increased the levels of well-being for all six patients significantly and at times maximum levels of engagement were recorded.

For some patients these levels of engagement and interaction had not previously been observed by staff on the ward and therefore the results appear all the more meaningful.

What Next?

Plans for a further project in 2007 are being developed as follows:

• Two BSO musicians will work over a period of 12 weeks, starting in April, over 6 months (to be confirmed). During this time funding opportunities will be considered and an application made to sustain the project over a 2/3 year period.
• An opportunity for professional development will be offered to a musician wanting to gain experience of community based work in a health care setting.
• Kings Park Hospital staff and carers will be invited to visit the project to better understand the social and well-being impacts.
• A recording of music and song from the sessions will be made and provided for all participants.
• The project will be documented  and evaluated.
• Nordoff Robbins Music Therapy will be invited to join the project to discuss development, funding opportunities and evaluation.

Although arts development work does not involve formal arts therapy practice, there are clear commonalities and complementary approaches between the different disciplines of music therapy and community music. Analysis and reflection of these might be a useful point to consider for research.