Quench Arts Research & Development Project (Adult Wellbeing)….What Have We Learned?

In March 2018 Quench Arts was awarded Grants for the Arts funding from Arts Council England to specifically focus on research & development to enable us to sustain & expand our participatory music-making activity for isolated & vulnerable adults who wouldn't otherwise engage in the arts. This (quite expensive!) blog summarises some of our learning.

Background Summary

Since 2007, Musical Connections (the title of our main programme engaging isolated and vulnerable adults) had been funded by the Big Lottery’s Reaching Communities Fund. This grant ended in March 2018 and an application for further support was unsuccessful, primarily as increased demand meant BIG were unwilling to support the project for a 3rd time. Whilst disappointing considering the project’s reputation & impact, this did present an opportunity for reflection & development. Our adult wellbeing work had significantly grown each year, with group sessions becoming over-subscribed and demand for one-to-one support exceeding capacity. Therefore, this organisational development project was essential for us to trial new, more sustainable delivery models and to investigate alternative funding. It allowed development time to create new partnerships and project delivery, reaching new audiences otherwise not engaged in the arts, whilst also supporting ongoing work with current project participants.

Activities Summary

Our research and development project allowed us to:

1. Trial a new outreach approach to project delivery, working in partnership with the 5 integrated community mental health hubs across Birmingham & Solihull.

2. Investigate new funding models, e.g. if 'arts on prescription' is a viable option to support 1-to-1 creative sessions in the future.

3. Develop new partnerships, sharing our work and learning from Birmingham & Solihull with neighbouring West Midlands areas to widen reach & identify expansion/partnership opportunities.

4. Undertake some training and development to build our workforce and support potential sustainability after any new service delivery.

A summary of our progress and learning against each point is detailed below.

1) New Outreach Project Delivery

We gave this activity the title of ‘Musical Connections Hubs’ in order to link in with our ‘brand’ of participatory music activity for isolated and vulnerable adults and to utilise the good reputation we’d built up with potential participants and referral agencies through this previous work.

We have written a full Impact Report on our Musical Connections Hubs project activity which is available on request by emailing: info@quench-arts.co.uk. Summary outputs and outcomes included:

• 81 individuals benefitted from the Musical Connections Hubs sessions, run monthly in the 5 Integrated Community Mental Health Hubs across Birmingham & Solihull, at Handsworth Hub (at Orsborne House, 16 engaged); Yardley Hub (at Creative Support, 18 engaged); Erdington Hub (at Northcroft Hospital, 15 engaged); Lyndon Hub (in Solihull, 10 engaged); Longbridge Hub (at Longbridge CMHT, 22 engaged). Of those engaged, 66 people were new to Quench Arts.

• Overall, 75 sessions of 3 hours were delivered in total across the 5 hubs, including the setting sharing events in Handsworth, Yardley, Erdington and Longbridge Hubs.

• Analysis against the Musical Connections Hubs outcomes was extremely positive, for those regularly attending. The project baseline activities, taken at the beginning, midpoint and end of the project evidenced the following:

Outcome 1: Vulnerable and isolated adults will have the opportunity to make musical progress through the project.

• 95% showed improvement in the statement, ‘I find it easy to sing/play in front of others and express myself through music’.

• 74% showed improvement in the statement, ‘How do you feel about your artistic skills at the moment?’

Outcome 2: Vulnerable and isolated adults will make personal, social and emotional progress through the project.

• 90% showed improvement in the statement, ‘I feel valued and accepted’.

• 80% showed improvement in the statement, ‘How do you feel about your level of social confidence at the moment?’

Outcome 3: Vulnerable and isolated adults will have shown growth in regards to confidence, resilience or sense of wellbeing.

• 95% showed improvement in the statement, ‘I can achieve what I want to’

• 90% stayed the same or showed improvement in the statement, ‘I am able to do things as well as other people’.

• 74% showed improvement in the statement, ‘How do you feel about your health and wellbeing at the moment?’

Outcome 4: Vulnerable and isolated adults will have the opportunity to connect with others.

• 80% showed improvement in the statement, ‘I find it easy to work with other people and I can compromise’.

• 90% showed improvement in the statement, ‘I often take part in local positive activities related to my interests’.

• 84% showed improvement in the statement, ‘How do you feel about your opportunities to connect with other people through music at the moment?’

In the end of project evaluation:

• 75% participants stated that ‘Without Musical Connections they wouldn’t engage in the arts’.

• 100% said that ‘Musical Connections had improved their musical skills/technique’.

• 100% said that ‘Musical Connections had improved their confidence to go on to access other music or arts opportunities’.

• 87% stated that, ‘because of Musical Connections, they were already involved in other music-making activities’.

• 93% said that ‘Musical Connections had given them new personal skills’.

• 100% said that ‘Musical Connections had made them feel less isolated’.

• 100% stated that ‘Musical Connections had improved their health and wellbeing’.

• 94% stated that ‘Musical Connections had improved their mental wellbeing’.

• 100% stated that ‘they were going to continue with their music making’.

Our Learning: Challenges

• Musical Connections Hubs sessions ran on a monthly basis. Some of the most vulnerable participants would have preferred more regular sessions and a greater level of engagement. If a participant was unwell for one session, then the wait for the next opportunity to engage was too long, and we lost some participants as a result. We had been keen to offer opportunities across all 5 integrated mental health hubs with our project schedule steered by the budget available. In hindsight, it may have been better to provide more significant levels of activity in fewer hubs

• Some of the most vulnerable mental health service users referred to hub activities found the group sessions challenging. Even with professional support and appropriate arrangements made, some participants would have benefitted from our old project model by having additional 1-to-1 sessions to build confidence and musical/group working skills prior to attending Hubs sessions. We have addressed this issue in part with our new Personalised Health Budget offer (see below).

• Sessions in most hubs were not as well attended as we initially envisaged, though this didn’t always reflect the interest and number of referrals made (as there were lots of ‘no-shows’). Attendance was sporadic in most areas, though 4 Hubs did have core group of regular participants. Partly this was due to the reasons stated above but is also due to the nature of working with this beneficiary group. Having lower numbers was seen as a positive for members who felt overwhelmed by larger numbers but in other cases some participants felt that they were too exposed with a smaller group.

• Some hub settings were more suitable for group creative music making than others. In all hub settings our project sessions were timetabled to have least impact on clinical activities in regards to noise levels and placement within the venue and this took some liaison at the beginning of the project in order to ease any concerns and find an appropriate time and space (sometimes affecting the actual hub site that the sessions were based in).

• Non engagement in Musical Connections Hubs based activities from previously established Musical Connections members was disappointing. Continuing to offer previous Musical Connections members time and support through sustaining our Musical Connections Music Support Worker role (employed 1 day per week), may have actually had the impact of them not needing, or not accessing the new hubs based sessions, as some people were happy with just having musical support from this avenue. That being said, the Music Support Worker was able to support individual progression and development on a far more bespoke basis, including formation of new bands and progression into mainstream opportunities. 30 individuals through the Musical Connections ‘Music Support Worker’ role, providing 181 individual 1-to-1 music sessions, 131 collaborative sessions, and supporting members to engage in 42 external events and performances.

• Some established members were concerned about going to a mental health focused venue for musical activities as they were wary about sharing their details with a professional organisation and felt more comfortable accessing this kind of provision in community venues. This contradicts much of the positive feedback from those actually attending the project activities on site, where evaluations stated that attending music sessions at such a venue would make them more comfortable using the professional services offered there in the future.

• Musical Connections has historically had a mixture of participants from varying backgrounds with a range of different barriers and reasons for their isolation, including those with physical disabilities and long term health conditions. This mixture of participants has been incredibly positive and the project has always recognised the clear links between mental and physical health. Although the Musical Connections Hubs project was open to any isolated or vulnerable adult, the fact that sessions were held in mental health settings and promoted through Birmingham & Solihull Mental Health NHS Foundation Trust (BSMHFT) networks meant that most new participants engaged were mental health services users.

Successes

• The project engaged isolated and vulnerable adults in hub locations who otherwise would not have taken part in the project. Most new participants anecdotally stated that they would not have travelled outside of their local area to take part due to the extra anxiety that this would cause in addition to meeting new people. The fact that the sessions were local and, for the majority, in a venue that they were comfortable with as mental health service users was a real positive.

• Having had this local support and built up their confidence with the team and other participants, 100% of those completing the project evaluation said that they will continue with their music making. All have been offered the opportunity to engage with the wider Musical Connections project, with the Music Support Worker, and to attend sessions at our Winson Green base.

• The quality of songwriting and number of original tracks created (105) through the project was really very impressive, especially considering the amount of contact time and the relative inexperience of new project participants.

• Though opportunities for engagement between each Musical Connections Hub was limited, it was a real success that 3 of the hubs managed to perform at our final project fundraiser concert (the Handsworth Hub at 2 of these). In addition, it was lovely that some participants travelled to other hubs to see their informal setting sharings.

• Offering CPD opportunities for emerging practitioners was certainly a success. This will be covered later.

What Next?

Musical Connections Hubs activity finished in September 2019. The activity was initially set up with a view to sustaining activity through localised budgets after evidencing outcomes to partners for engaging people on an early intervention and recovery basis. Particularly at Longbridge, Handsworth and Yardley we felt that there was some scope and demand to sustain or develop activities and partnership working. Unfortunately, to date, despite interest from some hub managers, no Musical Connections Hubs activity is currently ongoing. The main reason for this is that there has been pressure on BSMHFT’s Interim Clinical Director to make cuts of over £1million by the end of March 2020, which is including service and staffing reviews. In light of these cuts, it was deemed inappropriate to commit new spending elsewhere, even if funding for ongoing Musical Connections Hubs activity is relatively small in comparison. That being said, team managers particularly at the Longbridge CMHT (which had the most referrals and where distance from the city centre means participants are less likely to access other provision) are looking at other avenues to re-establish session delivery. This includes our Personalised Health Budget offer (see below).

2) New Funding Models

The time that Quench Arts Directors have been able to devote to investigating different models and ways of sustaining Musical Connections and other participatory music activity for isolated and vulnerable adults has been very helpful. A summary of our learning and actions is detailed below.

‘Social Prescribing’: refers to participants/patients being referred by health or social care professionals to any activity or project run by external or third sector providers in order to address loneliness and social isolation, which can have a significant impact on wellbeing.

‘Arts on Prescription’: is a type of social prescribing whereby participants/patients are referred by health or social care professionals to an arts project or opportunity, with growing recognition of the value and impact that the arts can have in addressing social and wellbeing outcomes. ‘Arts on Prescription’ has been particularly used for people experiencing depression and anxiety and to support early intervention and recovery, often alongside other support and therapy.

Both ‘social prescribing’ and ‘arts on prescription’ are now fairly common terminology, used increasingly widely in the press and in national, regional and local mental health and arts strategies. Whilst this is extremely positive for future resourcing, if you speak to any occupational therapist then you’ll hear that this has been the crux of their working practice for many years! At Quench Arts, our project activities have always been designed in partnership to address a real need and, as such, our Musical Connections project for vulnerable and isolated adults, as well as our programmes of activities for young mental health service users, have always benefitted from social prescribing in the sense that these projects rely on referrals from appropriate professionals, who recognised the skills and experience that our organisation and staff have built up in this area.

Over the last few months, there has been much more emphasis on social prescribing. From June 2019, groups of GP surgeries have been joining together to form Primary Care Networks (PCN) on a geographical basis. Across Birmingham and Solihull there are 33 PCNs, each representing around 30-50,000 patients. Each PCN has funding to appoint a Social Prescribing Link Worker.

Locally, organisations including:

• Our Health Partnership working with Health Exchange

• Gateway Family Services

• SDSMyHealthcare

• Smartcare

• Midlands Medical Partnership

• Solihull Healthcare Partnership

• GPS Healthcare

are supporting social prescribing in several areas, together with others such as Living Well UK, working on a smaller or independent basis.

Unfortunately, at the moment, no referral to our provision via social prescribing/ arts on prescription comes with any associated funding to support us to actually deliver our activity. The expectation is that patients would be willing to pay an equivalent amount to access an activity as they would an NHS prescription (though in practice, a prescription for medication may last longer than equivalent access to an arts activity, as £9 may only cover attendance at one or two sessions). However, as an organisation we have not yet introduced direct charges to participants to access activities as we feel that this would restrict access for those most vulnerable and in need. That being said, we are now much more transparent regarding the costs involved in running our projects and sessions and do better profile fundraising and donation opportunities to participants and networks, which is having some impact.

The most positive thing regarding the recent recruitment of Social Prescribing Link Workers is that there is definitely more recognition locally of the role that Third Sector organisations like Quench Arts can play in supporting wellbeing outcomes, in valuing our work and working in partnership. Quench Arts is advertising our offers via partners sites such as The Waiting Room and Health Exchange. In addition, we are members of strategic networks for information sharing and notice of funding opportunities, such as the Social Prescribing Network, The MARCH Network and Culture, Health & Wellbeing Alliance.

Personalised Health Budgets: Personalised Health Budgets (PHBs) allow people, sometimes with the support and guidance of professionals, to manage their NHS healthcare and support needs in a way that works best for their own needs. PHBs are similar to personal budgets for social care and support needs and, in fact ‘integrated personal budgets’ cover both areas. PHBs are not new funding but give people more input and say in deciding the most important services and support that will have the most positive impact on their life.

Only those fulfilling certain criteria have the right to a personalised health budget:

• adults receiving NHS continuing healthcare (NHS-funded long-term health and personal care provided outside hospital)

• children receiving NHS continuing healthcare

• people with mental health problems who are eligible for section 117 after-care as a result of being detained under the Mental Health Act.

There is also funding to support people to obtain wheelchairs where needed, for those eligible for personal wheelchair budgets.

Birmingham & Solihull Mental Health NHS Foundation Trust (BSMHFT) has been one of the first areas to introduce an effective offer for PHBs in the mental health sector, working alongside The Rowan Organisation, and has been gradually rolling out its offer across each district.

PHBs are an area in which the Arts Council funding has made a huge impact for Quench Arts. As a result of our research and partnership development, we are now in position to obtain fully funded referrals whereby we provide musical activities for those eligible for section 117 support, working with 3rd party budget holders (those managing the individual grants provided to patients for their care plan). In liaison with our partners, we have designed a PHB offer that has been promoted via BSMHFT and Forward Thinking Birmingham networks to care coordinators with a package of options including one-to-one musical support and also options to pool budgets depending on numbers of referred participants, to support group activities. This is an avenue that some of the Musical Connections Hubs are looking into to re-establish group activities in their location.

To date, the process for a potential participant receiving a PHB has been quite slow, with each individual working with their care coordinator to devise a personalised funding application covering a range of services and support (not just our musical support), with all applications being signed off by 1 individual at BSMHFT before being sent to commissioners for consideration. For this reason, the PHB offer has been rolled out gradually in a managed way and only being promoted to those currently eligible. However, a threshold cost per participant has now been agreed with commissioners, enabling quicker approval for funding and a faster turnaround for those wishing to work with us.

To date we have had referrals for Personalised Health Budgets from BSMHFT and Forward Thinking Birmingham. Off 66 new individuals engaged in the Musical Connections Hubs project, 17 are eligible for PHB funding and have been/are being supported to apply. Even more exciting is the fact that we have been informed that BSMHFT are keen to open up Personalised Health Budget funding to a wider demographic of potential beneficiaries in the near future, which will help to better balance our reliance on charitable trusts and foundations.

Whilst we build up numbers of referrals to our PHB activity, we have also been able to sustain a level of activity for our current participants and those not eligible for PHB funding through to August 2020. A National Lottery Community Fund (Awards for All) grant is enabling us to run Musical Connections activities from our base in Winson Green and covers:

• 1 day per week of our Music Support Worker role, who will have the remit of working with members on an individual and small group basis, including participants who took part in the Musical Connections Hubs programme.

• Monthly special interest sessions focused on a particular musical skill, theme or genre, as advised by the project’s Member Advisory Group

• Monthly group music making sessions, led by a Musical Connections Artist and supported by the Music Support Worker

• Quarterly project newsletters for all members

• 3 fundraising gigs with guest artists

3) New Partnerships

As a result of this grant, we have been able to profile and promote our adult wellbeing offer and our partnerships have grown significantly both in Birmingham and regionally.

Two taster days were delivered for the Black Country Partnership NHS Foundation Trust and Sense, with one planned for Cannock Chase Mental Health Hub (Staffordshire County Council Public Health & Prevention) on 12th March 2020. These have included presentations to strategic staff to share our practice, outcomes, model and learning; performances/insight from previous participants as experts by experience; a participatory music session delivered for staff and service users; evaluation and potential partnership discussions. Strategic conversations/ presentations have also been held with Coventry & Warwickshire Partnerships NHS Trust and with Dudley & Walsall Mental Health Partnership NHS Trust which may lead to future partnership work. A pilot project, following the taster, has been confirmed in partnership with Cannock Mental Health Hub, who will provide match funding for this activity.

As a result of this work, we have formed new delivery partnerships with Sense, with Cerebral Palsy Midlands, and with Inspiring Health Lifestyles, Cannock Chase Council, for additional project delivery. We have provided summer scheme activity for Sense and have devised and developed a project with Cerebral Palsy Midlands members, focused on creating a new musical to raise disability awareness, with music leader training. A project with Inspiring Healthy Lifestyles has also been created, benefitting parents with post-partum/natal depression & their children, to help build attachment through music. Both these projects have funding applications pending. In addition, we are working in partnership with MAC on the Hidden Voices programme via the Carers Music Fund (funded by Spirit of 2012), for female carers, a direct result of the increased capacity that this grant has provided.

Despite these successes, we have faced some challenges. Notwithstanding significant interest and enthusiasm across the region regarding our taster and pilot project offer to all those we presented to, senior staff in all regional Mental Health Trusts seem to be stretched to capacity. In some cases, staff redundancies and/or mergers between Trusts meant that taster activities couldn’t be effectively supported and organised within the timeframe of this grant. Though need and demand was clear from our conversations, as a key aim in delivering these tasters was to engage senior staff in order to support possible partnership development and sustainability, we only provided tasters in locations where activity would fully supported, which limited delivery locations. Our original aim was to engage 3 regional mental health trusts in our taster activities; in the end, one taster was instead offered to Sense in Birmingham, rather than regionally, with approval from the Arts Council. However, where the tasters did take place, the feedback was overwhelmingly positive. Evaluation from the two tasters delivered to date shows that 94% of staff thought the session was excellent; 83% rated the relevance to the needs and interests of service users as excellent (17% good), 94% thought that their service users could benefit from a music project in their setting.

The new partnerships and contacts made will enable us to continue to develop and expand our adult wellbeing programme, giving us wider reach and furthering our knowledge, learning and experience with specific groups.

4) Workforce Development

Quench Arts is committed to developing the local workforce and through the Musical Connections Hubs programme offered 5 Assistant Music Leader roles, 1 per hub, with associated mentoring from the Lead Artist. After an application and interview process, 5 people were appointed to the role.

All Assistant Music Leaders completed a baseline questionnaire at the beginning of the programme, reviewing their skills and experience and setting personal aims for the role. These baselines and aims were revisited at the end of the project to self-assess their progress. The Musical Connections Hubs Impact Report gives a full analysis of these roles but, in summary, 80% showed improvement in the statement, ‘I feel confident in running music activities with groups of musicians with varied skills, experience and musical interests’ and 45.4% of the collective potential progression points available were achieved. Each Assistant Music Leader set themselves 3 personal goals that they would like to achieve as part of their role. Of 15 personal goals set for the role by the Assistant Music Leaders, 12 goals were achieved or exceeded, 1 goal was partially achieved, 2 goals were not achieved (mainly because participant interests meant that the skills that the assistants had identified for development weren’t relevant to the settings/people engaged). We feel that all Assistant Music Leaders have progressed their skills and confidence significantly through the opportunity and all 5 are now in a stronger position to be able to lead musical sessions with vulnerable adults within their specialist areas. This is fantastic news for Quench Arts as we develop and expand our wellbeing work in the future.

“I believe the project has helped me gain more experience in working with a wider range of people and with that developed my skills further to be more confident about taking up roles like this in the future.” Assistant Music Leader

In addition to the Assistant Music Leader roles offered through Musical Connections Hubs activity, we have also planned 2 training sessions for 20 emerging music leaders and those wishing to expand their skills within the wellbeing sector:

• Working with vulnerable adults (mental health service users) in group situations (17th March, 2020)

• Working with adults with varying physical disabilities/sensory impairments (24th March 2020)

This training is engaging Hidden Voices (female carers project) music leaders, assistant music leaders and carers interested in support their group musically to sustain the project. It is also being promoted to artists in the taster session locations, to develop the workforce locally to potentially support further musical provision.

Summary

In summary, this Research and Development Project has been incredibly useful for Quench Arts as well as having a wider benefit.

The Musical Connections Hubs activity has enabled us to reach and engage a total of 96 incredibly isolated and disadvantaged adults in arts activity and build their confidence to access other central and mainstream opportunities in the future.

Being able to sustain our Musical Connections Support Worker Role for ongoing project participants from previous years has also had a wider impact on other local organisations as we have been able to support a number of events. A particular example of this is our support of Arts All Over The Place, where we have been able to provide performers for their gigs and events. This not only helps the organisations we support but provides more performing opportunities for the members of Musical Connections.

Our fundraising activities and research into new funding opportunities for our work with vulnerable adults has identified new income possibilities for project work and identified Personalised Health Budgets as a means to engage those most in need, where music making can make a huge difference to their personal and artistic development, networks and community integration. Building relationships and partnerships in this area has been incredibly strategically beneficial for Quench Arts and, in time, may lead to far less reliance on charitable trusts and foundations to support this work.

The grant has supported significant partnership development within Birmingham and regionally. This has allowed us to share our organisational knowledge and experience, widening our reach. As a result, many more hard to reach participants may benefit from participating in quality arts provision and arts & health organisations/ practitioners reached will be able to incorporate our methods into their own practice/services, giving wider sector impact. The grant has also enabled us to develop the practice and confidence of our own workforce in engaging specific groups of vulnerable adults. These partnerships are already developing into new project delivery.

We would like to give a huge thank you to Arts Council England for supporting this project; the learning and impact of this work will continue well beyond the grant timeframe and we know will result in further fruition in the future with additional partnership delivery and growth in PHB referrals.