A STRENGTHS BASED APPROACH
TO COMMUNITY DEMENTIA CARE
KATE IRVING, RACHAEL JOYCE, PAULINA PIASEK,
PATRICIA MCPARLAND, CATHERINE DALY, LOUISE HOPPER
OBJECTIVES: TO EXPLORE AND DEVELOP A NARRITIVE CARE MODEL
TO FOSTER THE STRENGTHS IN THE PERSON WITH DEMENTIA, THEIR
VALUED RELATIONSHIPS AND THEIR COMMUNITIES.
• WHY?
1.
2.
3.
4.
We know some essential conditions of care but these
don’t seem to be sufficient
Services for people with dementia are under funded and
often not fit for purpose
Dementia friendly communities movement – what’s it for
if not for helping people age in place
Strength based models have worked in other disciplines
and are in keeping with the theoretical constructs of
person centred care
REVIEW OF THE LITERATURE
• Deficit model very
evident
• Strength based
models – 50 studies
only 15 in the elderly
and 4 with a focus
on dementia
Community
Friends
Family
Person
CRES (CARE RECEIVER EFFICACY
SCALE)
• 5 domains and was
found to be consistent
and reliable in
measuring strengths in
youths.
• (1) Self-care
performances; (2)
Relational coping with
caregivers; (3)
Perceptions of
dependence; (4)
Performance-related
quality of life; and (5)
Accepting help.
Community
Friends
Family
Person
ANSWERS (ACQUIRING NEW SKILLS WHILE
ENHANCING REMAINING STRENGTHS)
• Dyadic six 90-minute
guided sessions including
education about
dementia and memory
loss, communication,
recognizing emotions
and behaviors
• Mild to moderate
dementia
• Very well evaluated (52
dyads)
• (Judge, Yarry, & OrsulicJeras, 2010)
Community
Friends
Family
Person
MODELS TAKING COGNISENCE OF
ENVIRONMENT
• VIP (Vital Involvement Practice)
Strength-based intervention for
working with older, frail adults
(Kivnick & Stoffel, 2005).
• a) systematic identification of
individual strengths and assets,
including the environment; b)
consideration of strengths in
relation to individual and
environmental challenges.
• Functional-age model of
intergenerational treatment:
Assessment and intervention
that focuses on older adult’s
functional capacities, the
demands of the environment
and interdependence
between family members
(Greene, 2000)
Community
Friends
Family
Person
COMMUNITY ASSET MAPPING
Capacity-building /assetbased community
development;
This model recognizes that
social capital and
networking are important
assets within a communty.
Allows members of the
community to take a
participatory approach
and ownership of their own
development (Chaskin,
Brown, Venkatesh, & Vidal,
2001).
Community
Friends
Family
Person
ASSUMPTIONS?
• In any system there will be strengths
• A focus on strengths would contribute positively to
quality of life
• These strengths may lie to differing extents in the
personal qualities of individual, their valued relationships
or their community resources
• Any potential to improve quality of life only exists if the
person with dementia or the carer are motivated to
make a change
• Any narrative led by the person with dementia and their
carer about their day to day life would in time focus on
the most important issues for them
• Errorless learning is essential in a dementia context
METHODOLOGY
• Methods:
• Case study with 5 individuals each was paired with a
practitioner
• We made twice weekly visits over 14 weeks
• taking a narrative approach to identifying exisiting or
potential strengths of the person with dementia and carer /
community
• Co-creating a goal / goals to work towards
• Taking an intensly reflective style in thining through issues
and in clinical supervision was taken seriously
FINDINGS…
1.UNTAPPED POTENTIAL - THERE WAS POTENTIAL IN ALL INSTANCES
TO MOVE THE PERSON WITH DEMENTIA OR CARER CLOSER TO A COCREATED GOAL.
“Without those strategies, or whatever, I couldn’t
make progress. I couldn’t. I just couldn’t, it wasn’t on,
because you are the professionals and… it would be
different if I’d gone to somebody else, like you know
they give… gives these things, or you go to a group. I
knew that that wasn’t for me at all. At the beginning, I
found it quite difficult, I did, but gradually it was the
confidence I got more than anything else, that I could
do this. I got worried there about the memory thing at
one stage, but you can’t do that, you just have to
make use of… or improve what you can improve, you
have to practise it. Practice is a big thing.” (Participant
5)
3. LOCI OF STRENGTH: STRENGTH POTENTIAL LAY IN A
DIFFERENT LOCATION FOR EACH INDIVIDUAL.
Comm
-unity
Family
Self
2. GOAL DEFINITION- UNDERSTANDING THE
PERSON WELL ENOUGH TO CO-CREATE A GOAL WAS
COMPLEX AND DYNAMIC.
• …And then realised, in one of those door handle
conversations, their marriage fell through ten years ago, it’s
just that he can’t remember it. So, you know, I still had to
work with the relationship because there was still a
relationship there to draw some strength from, and that’s
what we did then as best we could with really poor
resources. (Practitioner focus group)
4. ETHICAL ISSUES: ENGAGING IN THIS WAY CAUSED ETHICAL
DILEMMAS FOR THE THERAPISTS.
• Playing it by ear– were we doing the right thing blurred
lines between research and practice
• I know I said that [wife] had her own needs, but [pwd] needed
to talk about the dog being taken away, and he couldn’t talk
about that in front of [wife], and I think if I had gone in and said,
‘This has to be dyadic,’ [pwd] wouldn’t have got as much from
it because he wanted to tell somebody how much that hurt,
and it wasn’t something that we were going to resolve so there
was no point in the three of us having a conversation about it.
• Achieving neutrality in dyads was very complex where
dementia is in the mix
• Concerned that the participants set too much faith in
our ability to fix them
CONCLUSIONS
• A strengths based, narritive model gave flexibility for
the development of a therapeutic relationship that
was in all cases positive for the person with
dementia, the carer and the therapist. The breadth
of the model was a challenge for the therapists and
gave rise to ethical issues which required group
reflection to ensure the approach was appropriate.
• We have used the findings to form a reflective
educational tool to give confidence to other
practitioners in these approaches and to try to
contain the breadth of the approach