Facilitators guide

Facilitators guide Dementia learning resource for Aboriginal and Torres Strait Islander communities

Acknowledgements Many people contributed to the development of the original dementia learning resource for Aboriginal and Torres Strait Islander communities. Acknowledgement of the commitment and expertise goes to all the members of the Project Team, Stakeholder Review Team and National Reference Group for producing such an excellent resource. Gratitude is extended to Alzheimer’s Australia South Australia for its permission to the NSW Department of Human Services to redevelop the resource to meet the requirements of the dementia specific units of competence CHCAC319A (Provide support to People Living with Dementia) and CHCAC416A (Facilitate Support Responsive to the Specific Nature of Dementia), from the Community Services Training Package CHC08. Appreciation is also extended to members of the NSW Reference Group that provided oversight to this process: staff from the Koori Growing Old Well study, University of NSW; Aboriginal Health and Medical Research Council of NSW; Carers NSW; Alzheimer’s Australia SA; Department of Health and Ageing; NSW Health; ADHC Learning and Development Directorate; ADHC Aboriginal Service Development and Delivery Directorate and ADHC Office for Ageing.

Version 2 Acknowledgements This version of materials and specifically the Facilitators Guide, Learners Guide and Assessment Guide builds upon the initial national resource and has been adapted to align with the related national competencies within the 2008 Community Services Training Package CHC08 and the HLT07 Health Training Package. The Aboriginal Health College of the AH&MRC of NSW was contracted to perform this work for Ageing, Disability and Home Care, Department of Human Services NSW. Substantial changes and additions were made to several sections including new sections required to meet current competency standards. Key focus areas are care plans, communication, behaviour change, dementia content and cultural awareness for a NSW context. Special thanks to Daniel Cook and Sam Hoskins (from Durri Aboriginal Medical Service and ex Booroogen Djugun Aged Care Facility) whose years of work in an Aboriginal Aged Care facility with clients with dementia provided valuable feedback on existing resources, case studies and content additions.

A special note about the Artists Shane Pilot was the original artist on the National dementia learning resource and his artwork is still used on much of the information in the National resource kit. Phillip Hall is the artist for the NSW version of the dementia learning resource for Aboriginal and Torres Strait Islander communities. A descendent of the Gumilaroi / Euahlayi nation, Phillip has been actively involved in Aboriginal Affairs since 1967, as secretary of the first democratically elected indigenous body.

The opinions expressed in the publication are those of the authors and not necessarily those of the Australian Government.

© Commonwealth of Australia [2007] This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration; AttorneyGeneral’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca ISBN 9780957799912

Facilitators guide Dementia learning resource for Aboriginal and Torres Strait Islander communities

Contents Guidelines for facilitators

2

Before you begin

2

Suggested session plans

4

Topic 1 Introductions Aims and learning outcomes Associated material Topic 2 What is culture? Aims and learning outcomes Associated material Associated assessment activity

14 14 14 16 16 16 16

Topic 3 Perspectives on Aboriginal and 18 Torres Strait Islander cultures Aims and learning outcomes 18 Associated material 18 Associated assessment activity 18 Topic 4 Cultural safety Aims and learning outcomes Associated material Associated assessment activity

25 25 25 25

Topic 5 The brain story Aims and learning outcomes Associated material Associated assessment activity

26 26 26 26

Topic 6 Understanding dementia and its impact – what is dementia? Aims and learning outcomes Associated material Associated assessment activity

27 27 27 28

Topic 7 Legal and financial planning Aims and learning outcomes Associated assessment activity

37 37 37

Topic 8 Ways of communicating with a person who has dementia Aims and learning outcomes Associated assessment activity

38 38 38

Topic 9 Provide activities to maintain a person’s ability, dignity and selfworth Aims and learning outcomes Associated assessment activity

44

Topic 10 Definition of Aboriginal health Aims and learning outcomes Associated material Associated assessment activity

47 47 47 47

Topic 11 Care plan Aims and learning outcomes Associated assessment activity

48 48 48

Topic 12 Responding to the individual and their behaviour Aims and learning outcomes Associated material Associated assessment activity

49

44 44

49 49 49

Topic 13 Providing information to carers 57 Aims and learning outcomes 57 Associated assessment activity 57 Topic 14 Records writing and maintenance Aims and learning outcomes Associated assessment activity

Facilitators guide

58 58 58

1

Guidelines for facilitators Given the range of target groups and learning needs it is important that you first determine how you will use the resource. For example, you may use it to guide the training and assessment of workers to attain the two Units of Competency or you use it to support a community capacity building program.

Before you begin Familiarise yourself with the content of the learning resource kit The kit provides the materials and resources and includes suggested additional information sources. Familiarise yourself will each items in the kit. Read the content of the facilitator’s guide with particular attention to facilitator notes. As you read consider how you could use each of the items in the kit. Reflect on each of the exercises. Bear in mind that if you have experience in the content areas you will be able to add your personal and professional experience and examples into the discussions. View the PowerPoint presentations and suggested videos. Explore additional resources. Make sure you have read through what you are going to deliver and researched any background information you will need in relation to local Aboriginal and Torres Strait Islander cultures. Get to know the group and community you will be delivering to Cultural values and practices of Aboriginal and Torres Strait Islander peoples differ throughout Australia, therefore, it is essential that you get to know the group or community you will be delivering to. Find out the original Custodians of the Country / Land. Invite an Elder to be present at the training to support accurate exploration and understanding of local issues. Identify the learning requirements and learning styles of participants (for workers this would also include the organisational culture within which they are working). Remember that the learning group is a resource to be utilised. Creating partnerships between participants who can share their current skills and knowledge is a core part of the program. Size and composition of the group It does not really matter what size the group is, however, the size will influence what and how you deliver. For example an information session with little interaction may be provided for a large group while a small group will enable a more interactive learning approach with greater depth and customisation of content. Notice which sessions may be sensitive for gender issues and be prepared to check with the group about whether men and women should be in separate groups to discuss certain issues.

2

Facilitators guide

Be familiar with local legislation and issues In addition to cultural values and practices that differ throughout Australia, laws and services will differ in each State and Territory. Venue, resources available Know where the session will take place, including what teaching technology is available. Prepare your session(s) Determine the aims and learning outcomes, content, duration and schedule for the session(s). Don’t forget to allow time for administration (e.g. enrolment, safety information etc). Develop your session plan, or trainer notes including the materials and resources you will use. Plan the time you can allocate to each exercise. Select materials from the kit or prepare customised materials. (It is not intended that you necessarily use the materials as they are included in the resource. The materials provide you with a range of options for your selection, or act as models or examples to guide your preparation of materials that will be appropriate for the session and participants). Materials and equipment Prepare materials, including handouts, exercises, attendance records and evaluation forms. Ensure resources (e.g. videos) and equipment (e.g. computer/data projector, overhead projector, Video/DVD player, whiteboard and pens, butcher’s paper etc) are available. This guide follows the student guide and assessment guide in order. These are referred to but by and large the information is not repeated here. This guide serves to provide activities and guidance in regard to each section of learning. All activities are suggestions only except where they link to assessment. Often they serve to reenforce the learning content in the relevant section of the student guide. Where PowerPoint slides are referred to they are provided separately as an attachment. You are able to use your own template background provided that the source of slide information is acknowledged.

Facilitators guide

3

Suggested session plan Day 1 block 1: Cultural awareness Dementia learning resource for Aboriginal and Torres Strait Islander communities

4

Day 1 block 1

Topic content

9.00am – 9.04am 9.05amam – 9.14am Topic 1: Introductions

Acknowledgement of Country Introductions, ice-breaker and overview

9.15am – 10.30am Topic 2: What is culture

• What is culture • Dominant culture

10.31am – 10.45am 10.46am – 12.30pm Topic 2: What is culture (cont’d)

Morning tea • Internalised racism

12.31pm – 1.15pm 1.16pm – 2.50pm Topic 3: Perspectives on Aboriginal and Torres Strait Islander cultures

Lunch • Concepts and key principles • Traditional Aboriginal languages

2.51pm – 3.00pm 3.01pm – 3.45pm Topic 3: Perspectives on Aboriginal and Torres Strait Islander cultures (cont’d)

Afternoon tea • Concepts and key principles • Traditional Aboriginal languages

3.46pm – 4.00pm Feedback review and informal evaluation day 1

• Check on learning • Check on feelings/perceptions of day • Cover off any unresolved issues from day 1

Facilitators guide

Related Unit HLTIR404B Work effectively with Aboriginal and Torres Strait Islander people Suggested learning strategies Respecting country and elders Who Am I ? game

Activities/presentations/videos as outlined under topic 2 section




Resources required

• Who Am I cards and instructions • Alternatively ice-breaker of facilitator’s choosing • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • student guides All materials as outlined for activities/presentations /videos under topic 2 section Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for Activities/presentations /videos under topic 2 section Assessment task 1 Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 3 section Assessment task 1 • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 3 section

Facilitators guide

5

Suggested session plan Day 2 block 1: Cultural awareness Dementia learning resource for Aboriginal and Torres Strait Islander communities Day 2 block 1

Topic content

9.00am – 9.09am

• Welcome back • Check for issues and reinforce any learning concepts from previous day • Concepts and key principles • Traditional Aboriginal languages

9.10am – 10.30am Topic 3: Perspectives on Aboriginal and Torres Strait Islander cultures (cont’d)

6

10.31am – 10.45am

Morning tea

10.46am – 12.30pm Topic 3: Perspectives on Aboriginal and Torres Strait Islander cultures (cont’d)

• Concepts and key principles • Traditional Aboriginal languages

12.31pm – 1.15pm 1.16pm – 2.50pm Topic 4: Cultural safety

Lunch • Continuum of cultural practice • Cultural safety

2.51pm – 3.00pm 3.01pm – 3.45pm Topic 4: Cultural safety

Afternoon tea • Continuum of cultural practice • Cultural safety


• Check on learning • Check on feelings/perceptions of day • Cover off any unresolved issues from day 2

Facilitators guide

Related Unit HLTIR404B Work effectively with Aboriginal and Torres Strait Islander people (cont’d) Suggested learning strategies

Resources required


• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 3 section Catering provided


• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 3 section Assessment task 2 & 3 Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 4 section Assessment task 3



• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 4 section Assessment task 4

Facilitators guide

7

Suggested session plan Day 1 block 2: Dementia specific competency Dementia learning resource for Aboriginal and Torres Strait Islander communities Day 1 block 2

Topic content

9.00am – 9.04am 9.05amam – 9.14am

Acknowledgement of Country Introductions, ice-breaker and overview or re-welcoming

9.15am – 10.30am Topic 5: The brain story

• • • •

10.31am – 10.45am 10.46am – 12.30pm Topic 6: Understanding dementia and its impact – what is dementia

Morning tea • Dementia is not1 • What is dementia? • Signs and symptoms of dementia • Types of dementia • Who gets dementia? • Incidence of dementia Lunch • Risk reduction • Alcohol • Vascular dementia • Trauma • Diagnosis • The impact of dementia on person, family and community Afternoon tea • Factors influencing the experience of dementia • Taking a person-centred approach • Applying the learning • Emotional needs • 10 key points for maintaining a person-centred approach • Family and community-impact on family and community • Loss and grief • Power of Attorney/Guardianship • Check on learning • Check on feelings/perceptions of day • Cover off any unresolved issues from day 1

12.31pm – 1.15pm 1.16pm – 2.50pm Topic 6: Understanding dementia and its impact – what is dementia

2.51pm – 3.00pm 3.01pm – 3.45pm Topic 6 & 7: Understanding dementia and its impact – what is dementia / financial and legal considerations


8

Facilitators guide

What is the brain and what does it do? Memory Keeping your brain healthy Associated activities

Related Unit CHCAC319A Provide support to those affected by dementia and CHCAC416A Facilitate support responsive to the specific nature of dementia Suggested learning strategies Respecting country and elders Pfeiffer and Jones Encyclopedia of group activities for ice-breaker Activities/presentations/videos as outlined under topic 5 section




Resources required

• Resources for ice-breaker • Alternatively ice-breaker of Facilitator’s choosing • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 5 section Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 5 section Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 6 section

• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 6 section Assessment tasks 6 & 7

Facilitators guide

9


Topic content

9.00am – 9.09am

• Welcome back • Check for issues and reinforce any learning concepts from previous day • Communication skills • Ways to assist in communicating with people who have dementia

9.10am – 10.30am Topic 8: Ways of communicating with a person who has dementia

10.31am – 10.45am 10.46am – 12.30pm Topic 9: Provide activities person’s ability, dignity and and self-worth

Morning tea • Why do activities? • Kinds of activity • Key principles in using activities • Planning and providing activities • Associated activities

12.31pm – 1.15pm 1.16pm – 2.50pm Topic 10: Aboriginal health

Lunch • Holistic approach • Specific dementia research

2.51pm – 3.00pm 3.01pm – 3.45pm Topic 11: Care planning

Afternoon tea • Care plan overview • Self-management or self-care approach • Care plan in action • Mentoring client care • Clinical care and support - establishing a care plan - some good practice considerations • Fundamentals of good practice in care planning between worker and client relationship • Check on learning • Check on feelings/perceptions of day • Cover off any unresolved issues from day 2


10

Facilitators guide

Related Unit CHCAC319A Provide support to those affected by dementia and CHCAC416A Facilitate support responsive to the specific nature of dementia (con’t) Suggested learning strategies

Resources required


• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 8 section Assessment tasks 8 & 9 Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 9 section Assessment task 10 Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 9 section


Activities/presentations/Videos as outlined under topic 9 section


• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/presentations /videos under topic 11 section Assessment task 11A-11E

Facilitators guide

11


Topic content

9.00am – 9.09am

• Welcome back • Check for issues and reinforce any learning concepts from previous day • Constructing a case plan from information gathered: • Making referrals • The importance of a good interview • Using Carkhuff’s model to develop trusting relationships • Client centred approach to interviewing

9.10am – 10.30am Topic 11: Care planning (cont’d)

10.31am – 10.45am 10.46am – 12.30pm Topic 12: Responding to the individual and their behaviour

12.31pm – 1.15pm 1.16pm – 2.50pm Topic 13: Providing information to carers

12

Morning tea • What is Behaviour? • Why does behaviour change? • Dementia-biological model (changes in the brain) • Unmet needs • Behavioural model • Using the behavioural model and observation to monitor and improve behaviour • Using the investigate, action, review method • Applying the investigate, action, review method • Progressively lowered stress threshold • Minimising and responding to changed behaviour Lunch • Key considerations • Good practice

2.51pm – 3.00pm 3.01pm – 3.45pm Topic 13: Providing information to carers

Afternoon tea • Basic legislative requirements - NSW specific • Information systems • Confidentiality and privacy

3.46pm – 4.00pm Feedback review

• • • • •

Facilitators guide

Block and course evaluations Check on learning Clarify assessment queries Check on feelings/perceptions of day Cover off any unresolved issues from day 3

Related Unit CHCAC319A Provide support to those affected by dementia and CHCAC416A Facilitate support responsive to the specific nature of dementia (con’t) Suggested learning strategies

Resources required


• Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/ presentations/videos under topic 11 section Assessment task 11A-11E Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/ presentations/videos under topic 12 section Assessment task 12



Small group discussion re key roles and support mechanisms – report back to larger group for facilitator led discussions which focus on key issues and phases/stages around grief and loss and how to respond professionally Discussion re cultural boundaries and expectations and look at how to work with difficulties

Catering provided • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides All materials as outlined for activities/ presentations/videos under topic 13 section Assessment task 13 • Lite-pro & Screen/ Smart Board • Whiteboard/flip-chart • Markers • Student guides • Handouts/fact sheets Assessment task 14

Facilitators guide

13

1

Topic 1: Introductions Aims and learning outcomes The aim of this section is for participants to: • To acknowledge and respect Aboriginal and Torres Strait Islander custodianship, ongoing connection and relationship to Country. • To gain a collective knowledge of who is present and support participants to get to know each other. • To invite each person to consider their own cultural background. By the end of this session learners should be: • more familiar with a few participants • a little more relaxed with their learning environment Associated materials • PowerPoint presentation: 1 Introduction draft. Note: this presentation is a draft and will require you to add content about the training you will be delivering. Provided separately as an attachment. • 1.1 Exercise: Introductions Who am I? cards (preparation required). Begin by acknowledging the Custodians of the Land on which the training is occurring and paying your respects to the Elders and ancestors. Be sure to acknowledge any Elders who are in attendance. Student note: The exercises included in this guide are provided to ground your learning in examples and scenarios that give you a working knowledge and practice experience. 1.1 Exercise: Introductions Introduce yourself, including your cultural and professional background. Here, the term ‘cultural background’ refers to the cultural origins from which each person is descended. For example, an Australianborn person with generations of Australianborn forbears, may be culturally originated from Germany, their relatives having arrived here as 19th century immigrants escaping persecution in Europe. This person is not Indigenous to Australia. Many people may not know their original cultural background and may hazard a guess based only on limited family information. They may have up to five or six generations of ancestors born in Australia. It is important to respect and acknowledge the Australian histories of participants whilst remembering that everyone brings different cultural influences to the group. What is required? You will all receive ‘Who am I?’ cards.

14

Facilitators guide

1 Who Am I? Name I was born in My parents/family/ancestors were born in My cultural background is Languages I speak include Three things that influence who I am today (e.g. place, person, activity, experience or value):

1. 2. 3.

In the group situation walk around and introduce yourselves to one another using the sentences on the card as a guide. It is OK to say as much or as little as you wish about yourselves, depending on your level of comfort. Return to the large group and each person will introduce him/herself – name, work role if relevant, where born, cultural background and briefly share something that influences who they are (a place, a person, an activity they love, or a value they hold dear). We have multiple cultures present in the room, including diverse Aboriginal and Torres Strait Islander cultures. The first principle of cultural competence is to know your own culture so you can understand the impact you have on others. This underpins effective cross cultural work. Topics 24 introduce the concept of culture and gradually build participants’ understanding of dominant culture and cultural safety.

Facilitators guide

15

2

Topic 2: What is culture Facilitator note: Explain to participants: This training invites you to think about culture for two reasons: • Firstly, everyone’s culture influences their daily behaviour and way of life but because it is so much a part of us we often think that it is ‘natural’ and the correct way, rather than only one of many ways of being. To be culturally sensitive we must look at this idea of culture and what it means. We need to examine our own personal culture in order to understand how we operate in the world and consider how this might affect others. • Secondly, culture affects memory, language, understanding and behaviour. Working with anyone who is experiencing dementia requires an awareness of their cultural context and history so that we can effectively support them in responding to the disorientation that dementia can bring. Aims and learning outcomes The aim of this section is for participants to: • Explore the concepts of culture, cultural heritage, dominant culture and cultural safety. By the end of this session learners should be able to: • Demonstrate an awareness of culture and the impact of their own cultural heritage on their values, understandings and ways of relating to others. Associated materials • PowerPoint presentation: 2 culture 2007. • 2.1 Handout: What is culture? • 2.2 Exercise: Ten key ideas about culture. 2.1 Activity: What is culture? Brainstorm: What is culture? Aim:

To gain an understanding of culture.

Activity:

Ask participants to call out their thoughts and responses to the question – what is culture? Keep a record on the whiteboard of these ideas. There are many definitions of culture. Show a range of definitions on overhead and ask for comments. Some examples are provided here: Draw out the following key themes: learned behaviours; transmitting knowledge to future generations and agreed norms.

2.2 Activity: A model of culture Present a model of culture for the group to consider. Facilitator note: There are many different models of culture that have been proposed – an example is provided here as an option for you to use, but you may have your own version. 16

Facilitators guide

2 Use the following points to lead a discussion of what is Australian culture using the levels in the circles and the following guide. Values:

(underpinning beliefs about what is important) What does Australian society value? – Is it working hard (a good day’s work for a good day’s pay), owning property, family, a ‘fair go’, being a mate?

Rituals:

(significant practices that are repeated over time and understood by everyone) What rituals do we practice in Australian culture? – Christmas, weddings, funerals, Anzac marches, summer holidays, having a shower every day, candles on our birthday cakes…

Elder/leaders:(individuals who embody the cultural values and are publicly revered) Who are our elders/leaders? – Sports people, community advocates, the Aussie ‘battler’, business entrepreneurs, war veterans… Symbols:

(icons that stand for the culture) What symbols reflect our culture? – The Australian flag, kangaroos, the boomerang, Uluru, Sydney Opera House… Ask the group to consider where Aboriginal and Torres Strait Islander people fit into this picture of Australian culture? What is different about Aboriginal and Torres Strait Islander cultures? Use a map of Aboriginal Australia to demonstrate the diversity of groups and inhabitation of Land (D. Horton 1994 is recommended and included in the PowerPoint presentation for this section).

At this point, talk to the group about dominant culture. In your own words and using group participation work through the concept and the impact of dominant culture using and referring to the relevant section in the student guide. Recommended audiovisual resource Lateral Violence (a Canadian DVD) (Bearpaw Media Productions) Lateral Violence highlights how internalised racism/lateral violence (violence against peers) can impact in a workplace when two people are going for the same job. This powerful DVD has been known to have immediate impact on participants and to raise similar issues experienced in their workplace or community. Care needs to be take to discuss and debrief appropriately – however it is a very useful educational tool. Read through the Internalised racism speech by Kerri Tim and allow students time to reflect and write down their thoughts follow on with a showing of Lateral Violence or a similar resource OR read it out, have someone read it out or use an audio recording to discuss the sentiments and then ask learners to record their thoughts at the prompts in Assessment task 1. Associated assessment activity Please refer to Assessment task 1: Impacts of racism in the assessment workbook.

Facilitators guide

17

3

Topic 3: Perspectives on Aboriginal and Torres Strait Islander cultures Aims and learning outcomes The aim of this section is for participants to: • gain an understanding of the impact of European invasion upon Aboriginal and Torres Strait Islander cultures and the ongoing affect of this. By the end of this session learners should be able to: • demonstrate an awareness of culture and the impact of their own cultural heritage on their values, understandings and ways of relating to others. Associated materials • Videos (not included in kit refer to information below). Student note: An important principle of cultural competence is to have knowledge and understanding of the history of relationships between Aboriginal and Torres Strait Islander communities and dominant Australian culture. This helps us to understand what informs current issues and how they affect trust and understanding of mainstream organisations. The next section looks at the impact of invasion and reviews legislation since that time, to provide a context for today’s service delivery. 3.1 Activity: Cultural memory Video A video presentation followed by discussion may be of benefit in this section. In NSW it may be useful to use Lousy Little Sixpence (distributed by Ronin Films) which tracks Aboriginal Rights movement and the impact of the Stolen Generations policies on NSW Aboriginal people. The following activity sheet can be used for this film (there is also a more detailed workbook that comes with the film when purchased. After watching Lousy Little Sixpence: • What strikes you about the Lousy Little Sixpence and working as a “domestic” (servant)?

• Are you surprised by the political rights movement longevity, the Cummeragunja events and the punishment dished out?

18

Facilitators guide

3 • What strikes you about the Movietone News AIF footage?

• How might these collective experiences impact on a current generation of Aboriginal people?

Women of the Sun (distributed by Ronin Films) also has significance and episode 3 Nerida Anderson Cummeragunja is of particular relevance to dominant culture discussion The following activity sheet can be used for this film (there is also a more detailed workbook that comes with the film when purchased) After watching Women of the Sun episode 3: • How would you respond to dust inspections?

• How would you feel if your experience as a bookkeeper was diminished, you were accused of "leading the supervisor on" when he was assaulting you?

• What level of agency could you have in such situations?

Facilitators guide

19

• What could be done?

The video Alinta – the flame (Episode 1 from the series entitled Women of the Sun) (distributed by Ronin Films) offers a possible insight into traditional ways in SouthEastern Australia during the early European years after invasion. The Alinta video is about the experience of European invasion from the perspective of an Aboriginal Community. It offers one depiction of local Aboriginal customs and culture and shows the impact of the arrival of Europeans. The following activity sheet can be used for this film (there is also a more detailed workbook that comes with the film when purchased) Possible debrief questions: • What stood out for you in this film?

• How would you describe the Nyra people’s culture? (Draw out the rituals, values etc)

• How did the hair of fire become part of this society – what did he do? – What does this have you thinking about what other non–Aboriginal people have done?

• What did he fail to do when his own people began to take over the land of the Nyra people? – What about the sacred sites?

20

Facilitators guide

3 • What did you notice about how the land was taken? (Highlight the signing of the papers – how is this still happening today?)

• What has been the intergenerational impact of European contact/invasion on Aboriginal and Torres Strait Islander people and their communities?

• How different do you think it is for Aboriginal and Torres Strait Islander peoples today what has changed?

Note: The whole Women of the Sun series is worth watching 4 episodes in all)

Other video possibilities include: • Rabbit Proof Fence particularly useful to a Western Australian context and Stolen Generations work • A Secret Country (a John Pilger documentary) this gives an historical account of oppression under dominant culture (it is perhaps the most confronting of these DVDs) Vote YES for Aborigines Land of the Little Kings Why me? Aboriginal History – life stories and Aboriginal views (access this via www.aboriginaleducation.sa.edu.au/files/links/1960s_Aboriginal_history_r.pdf) Warning: this video may be distressing, especially for Aboriginal and Torres Strait Islander people in the group. Time should be provided for adequate debriefing. • Barbakueria (ABC TV) offers a light hearted “Boot on the other Foot” look at Invasion and dominant culture – it does not however offer the same in depth analysis of issues as the DVDs above

Facilitators guide

21

3.2 Activity: Legislative timeline Aim and learning outcome • To gain an understanding of specific legislation that has significantly upon Aboriginal and Torres Strait Islander people’s lives since invasion and reflect on how this might influence current relationships. Associated materials • 4.1 Exercise: Legislation cards (preparation required) • 4.1 Handout: Legislative timeline. Facilitator note: A fact sheet with an explanation of relevant legislation is included in this kit to enable you to run this exercise. However, you may wish to use other appropriate lists that have been researched and developed. It is important that you are familiar with the many pieces of legislation listed on the handout and be prepared to give examples to briefly illustrate them, including information of local relevance. Each State will have particular, differing legislation that you may wish to include. One location to access timeline information is the Australian Museum online at: www.dreamtime.net.au/indigenous/timeline2.cfm

4.1 Exercise: Legislative timeline Prepare each piece of legislation on a separate card without the date of its implementation. Create a set of these cards for each small group. Divide the participants into small groups of four or five people. Hand out a set of cards to each group and ask them to place them in chronological order. After 10 minutes run through the legislation in the correct order illustrating each item as you go and answer the questions. Within the exercise, ensure that the following issues are named and briefly described: • Protection • Assimilation • Self determination • Reconciliation • Mutual obligation/Shared responsibility • Stolen generations • Deaths in custody report. Discuss: • What do you think was the impact of this legislation upon the lives of Aboriginal and Torres Strait Islander people? • How might the impact be continuing to date? • How might this history affect the way Aboriginal and Torres Strait Islander people see Government and mainstream services now? 22

Facilitators guide

3 Or 3.3 Activity: Using the teaching resource Snake Timeline ©Gwen TroutmanWeir This resource is an interactive resource where students are asked to put together the timeline from past to current in the form of a snake. The resource is NSW based but can be adapted for any State/Territory and any workplace/industry context. The activity is then followed by a PowerPoint presentation also available for further discussion and elaboration and debriefing. Take a step back in Australia’s history to understand the impact that events, policies and legislation have had on Aboriginal people and communities. Some of the questions we might explore are: • What are some of the contributing factors for the poor health status of Aboriginal people? • Has the Aboriginal family structure been affected by past policies and legislation? • What are some of the events that have a significant place in Australia’s history (past, present and future)? • What can we do to contribute to better outcomes for Aboriginal communities and people? • How might your dementia client have been affected personally by these policies 3.4 Activity: Media watch Ask students to review a local/regional newspaper article (supplied by you) or current TV footage (supplied by you) that has an Aboriginal focus and is sourced from a Dominant Cultural media context You may wish to use articles for your own area or recent TV footage as Articles are contemporary no specific articles are included but can be provided on request from the Aboriginal Health College NSW Ask them to: • Looking at the assigned article(s) what stands out as having elements of racism or prejudice?

Facilitator note: The nature of the content of this section requires it to be facilitated by an Aboriginal or Torres Strait Islander trainer.

Facilitators guide

23

Aim • The aim is to explore points of difference and similarity between Aboriginal and Torres Strait Islander and mainstream Australian cultures. Associated materials • Reading: Concepts and Key Principles in Aboriginal Culturally Sensitive Practice – SAAP SA • Communicating Positively – A guide to appropriate Aboriginal terminology – NSW Health 2004 • Cultural protocols for dealing with Aboriginal Communities – NSW Department of Aboriginal Affairs • or similar local and state resources 3.5 Activity: Concepts and key principles in Aboriginal culturally sensitive practice What is required? Present a short summary of Section 3 in the learner’s guide.. You may choose to use other content or access similar documents in your own region ensuring that there has been appropriate interpretation and comment from local community representatives. Run through each item and facilitate discussion and questions from the group. Associated assessment activity Please refer to Assessment task 3 cultural awareness in the assessment workbook.

24

Facilitators guide

4

Topic 4: Cultural safety Facilitator note: The items listed below are not intended as a definitive description of Aboriginal and Torres Strait Islander cultural practices but rather as a trigger to consider various aspects of Aboriginal and Torres Strait Islander society. They should invite conversations about cultural practices and be debated, not used as a fact sheet. Local people and the Aboriginal or Torres Strait Islander trainer will make a significant contribution to this discussion. Aims and learning outcomes The aim of this section is for participants to: • increase understanding of the concept of cultural safety and its relationship to cultural awareness and cultural competence. By the end of this session learners should be able to: • describe practices of cultural safety they can adopt within their workplace. • identify good practice examples. Associated materials • PowerPoint presentation: 7 Cultural safety 2007. 4.1 Modified lecture and discussion What is required: Provide overview of concepts and facilitate a group discussion about key concepts and Cultural inclusion/safety. Associated assessment activity Please refer to Assessment task 4: Cultural safety strategies in the assessment workbook.

Facilitators guide

25

5

Topic 5: The brain story Facilitator note: Up to this point, the program has focussed on the underpinning principles and knowledge for working effectively with Aboriginal communities. The training now moves more into dementiaspecific information. Facilitators should be able to refer to Aboriginal and Torres Strait Islander experience and perspectives throughout the sessions to support the group to consider resources and practices that enable us to respond to dementia in culturally competent ways. Aims and learning outcomes The aim of this section is for participants to: • learn about the brain and what it does. By the end of this session learners should be able to: • describe the brain and what it does. • explain how memory works and changes as we age. • recognise ways of keeping their brain healthy. Associated materials • PowerPoint presentation: 9 Brain Story 2007. • Flip Chart: Your Brain and Dementia. • Brochure: Your Brain and Memory. • 5.1 Handout: Brain lobes Facilitator note: If you are not using the PowerPoint slides you can draw this on the whiteboard. Not being able to remember (or forgetting) can be due to any of these three phases. 5.1 Activity exercise: We all forget! Purpose To consolidate learning and develop strategies to assist memory. What is required Ask the group what sort of things they forget. Discussion As responses are received, discuss the possible reason for forgetting and what strategies can be used to help memory. 5.2 Activity: Keep your brain healthy What is required Lead a group discussion about ways participants can keep their brain active and healthy. Associated assessment activity There is no specific assessment for this topic but participation in associated activities is expected. Assessment is embedded in topic 6 assessment.

26

Facilitators guide

6

Topic 6: Understanding dementia and its impact – what is dementia? Aims and learning outcomes The aim of this section is for participants to: • learn about dementia, types of dementia, and its impact on the person, their family and community. By the end of this session learners should be able to: • explain what dementia is • list the most common types of dementia • explain the impact of dementia on the person, their family and the community • identify and/or provide support and services in their community Associated materials • Flip Chart: Your Brain and Dementia • Brochure: Your Brain and Dementia • PowerPoint presentation: 10 Dementia 2007 • PowerPoint presentation: Meet Dementia: The Bad Hawk that Steals • PowerPoint presentation: 10.6 Impact 2007 • Video: A Tale of Dementia: Lily’s Story (not included in kit) • 6.2 Exercise: Brain Puzzle (preparation required) • 6.3 Exercise: Imagine if you had dementia… • 6.5 Exercise: Emotional Needs • 6.6 Exercise: Resources • 6.1 Case Study: Wellbeing: A) Percy & B) Lucy • 6.2 Case Study: Rachael • 6.1 Handout: Types of Dementia • 6.2 Handout: Factors that Influence a Person who has Dementia • 6.3 Handout: Assistance may be required • 6.4 Handout: Emotional Needs • 6.5 Handout: Ten Key Points for Maintaining a Person Centred Approach • 6.6 Handout: State and Territory Contacts

Facilitators guide

27

6.1 Exercise: What words do we use? Purpose: To explore terms commonly used in the participants’ communities to refer to dementia. What is required: Ask participants what thoughts come to mind when they hear the word dementia? What labels and descriptions pop into their heads and what beliefs do they think most people in their community hold about dementia? Write on the whiteboard a list of words that are used to talk about or describe dementia in their community. Invite people to name English words and Aboriginal Language words that may be commonly used. Prior to the training, facilitators should find out words used by local Aboriginal communities that may be relevant here, and seek permission to name them in the group. Discussion points: Facilitator note: It is important to recognise the impact of language use and how it can lead to negative perceptions and stigma. Without judgement, consider with the group what the terms are and how they might be used, for example, as descriptive terms, whether they show a lack of understanding of dementia, are a way of dealing with a sense of hopelessness about dementia, or have a symbolic meaning. Facilitator note: Keep the list for future reference. It may be helpful to use or relate to some of these terms as you work through the session(s). 6.2 Exercise: Brain puzzle Purpose: In this exercise we are looking for a connection with people who have dementia: how they feel, think, and respond when they know “something is missing” or their brain is sick and not functioning as it should. However, diverse and rich learning opportunities will be provided by the many and varied response that arise from each group of participants. What is required? • 2 x large piece puzzle • 1 x small piece puzzle Facilitator note: This exercise needs to be set up before the session commences.

28

Facilitators guide

6 Preparation before session begins: • Remove the limbic system from one large piece puzzle. • Remove the frontal lobe piece from other large piece puzzle. • These puzzle pieces MUST be hidden around the room before the session begins. • The third small piece puzzle must have all the pieces intact. • Place the remaining pieces of each puzzle in a bag ready for use. Task: • Group the participants into three groups. (If the group is small divide into two groups and use only two puzzles.) • Allocate a bagged puzzle to each group. • Each group is to complete their puzzle in 5 minutes. After building the puzzle and realising pieces are missing, all participants then search for the missing pieces. When pieces are found, the appropriate pieces are to be given to the appropriate group. If after 2 minutes pieces are not found, facilitator may give hints, until all pieces are found. When puzzles complete, participants return to the larger group. Debrief 1 (to reinforce the functions of the brain) Ask each group the following questions: • What piece was missing – what are the functions of that part of the brain? • What impact would it have if that part of the brain was damaged? • How might a person feel if that part of the brain was damaged? • How might a person behave if that part of the brain was damaged? Debrief 2 (to explore feelings, thinking and actions) Write three columns on the whiteboard and label them “feel”, “think” and “do”. Ask the group for responses to following questions, and record their responses in the appropriate column. • What did you 1. feel 2. think 3. do when you realised you had pieces of your “brain” missing? • What did you 1. feel 2. think 3. do when you realised you must look for the missing pieces to your brain? • What did you 1. feel 2. think 3. do when you couldn’t find the missing piece?

Facilitators guide

29

• What did you 1. feel 2. think 3. do when you found the missing piece? Responses can be interpreted in a number of ways. As responses are given, use the opportunity to gently relate what participants felt, thought and did in the following: • “did nothing” = refusal to participate • ‘thought nothing” = withdrawal in difficult/ unfamiliar circumstances • “felt nothing” = inability to identify/label a feeling • “couldn’t be bothered looking” = too difficult/gave up. Ask the group how we can relate this exercise to our interactions with people who have dementia. You will be looking for: • connection between missing piece of a puzzle to the experience of people with dementia and their families to missing stories, experiences, etc • connection between an emotional response to a situation (first) and then thought and then action • observation of different responses (feelings, thoughts and actions) to the same experience and circumstances • exploration (even at a basic level) of the same types of diverse reaction and responses of participants to the situation, and those of people with dementia to challenging/new circumstances • connection between each person’s personality, life story and previous experiences to their response to the activity • connection between the person, family and community. Facilitator note: The following tables give summary information about some of the types of dementia. They are provided for your information and included as handouts for participants. 6.3 Presentation: Meet Dementia The Bad Hawk that Steals Facilitator note: For some groups the hawk is a sacred totem with particular cultural significance and it may not be appropriate to use this resource. Remember to check with local Aboriginal and Torres Strait Islander Community before using this story. The story Meet Dementia – The Bad Hawk That Steals is included in the resource materials as a PowerPoint presentation. It is an option that may be used in culturally appropriate contexts. The story, written by Brian Lampton an Aboriginal man from Queensland is about alcohol related dementia and introduces the early symptoms, deterioration and final stages of loss of memory and health. The story can be easily understood and used across all generations. After the story discuss with the group the messages that were raised. Provide an 30

Facilitators guide

6 opportunity for participants to reflect on their own experiences with dementia in their Community. Facilitator note: The above are significant issues and a full exploration of the issues and preventative strategies is beyond the scope of this resource. Further information: • National Indigenous Drug Strategy – www.nationaldrugstrategy.gov.au/ • Aboriginal Drug and Alcohol Council (SA) Inc – www.adac.org.au • Alcohol Go Easy: LowRisk Drinking – www.dassa.sa.gov.au/site/page.cfm?u=90&print=1 • National Indigenous Alcohol Treatment Guidelines – www.alcohol.gov.au • The Chroming Game Additional resource: • The Brain Story: A kit depicting the brain damage caused by solvent abuse. Developed by the Alcohol and Drug Resource and Education Service (ADRES) Funded by the Commonwealth Department of Human Services and Health www.adac.org.au/siteF/resources/brainstory/index.html Facilitator note: The Kimberly Indigenous Cognitive Assessment (KICA) is a valid and reliable assessment tool for cognitive impairment in the older Indigenous population of the Kimberly and Northern Territory. Available [on line] www.healthykimberley.com.au/chronicdisease.html 6.4 Activity: Imagine if you had dementia… Purpose The purpose is to develop empathy with the experience of dementia. What is involved? Distribute handout and ask participants to write their responses to the questions or divide the group into pairs to discuss their responses to the questions. Inform the group that you will ask them to share their response. Questions If you had dementia... • What would you want from people who were caring for you? • What would you not want from them? Debrief • Ask the group to share their responses to the questions. Facilitators guide

31

• You can expect that there will be some similar responses and some that will be different. • Write the responses on the whiteboard. Points to be covered • Discuss how the group has some similarities but also some differences. • Explain how people with dementia have similar preferences. • Discuss what this might mean for providing care and support for persons who have dementia 6.5 Exercise: Being treated as a person – experiencing personhood Purpose To identify the feelings experienced in positive/good or negative/bad situations that can maintain or diminish personhood. What is required? Ask participants to work in pairs and discuss the following: • Tell each other about an instance when they were not treated as a person and how they felt and responded in this situation. (For example: You walked into a room and were ignored by the people in the room.) • Tell each other about an instance when they were treated as a person and how they felt and responded in that situation. (For example: You walked into a room and were greeted warmly by the people in the room.) • Before you bring the group back together make two columns on the whiteboard – the first heading “BAD” the second “GOOD”. Bring the group back together and ask participants how they felt in each situation (the feelings part of the questions above) and write on the whiteboard under the appropriate heading. Discussion points • How we respond in positive or negative situations • The strength of our feelings and the behaviour this may trigger • Ask/suggest why they think being treated as a person does not occur • Relate this to a person who has dementia, cannot rationalise what is happening and will respond or act according to how they feel 6.6 Case study: Maintaining wellbeing Purpose To identify ways of supporting a person with dementia to maintain sense of self, dignity and wellbeing. Facilitator note: Students split into two or more groups and discuss these case studies and the best ways to support these people 32

Facilitators guide

6 A: Percy Percy is an 85 year old Aboriginal man, who was living in a remote Community. Percy has several medical conditions. He has been on blood pressure medication for seven years. Recently he had a stroke and was diagnosed with vascular dementia. His family aren’t able to care for him because he is unable to walk and needs two people’s help to stand up to move from his wheelchair to his bed. Their house isn’t built for a wheelchair to move around in. The local old people’s hostel is unable to care for Percy because it is already full. Percy has moved to the closest regional centre and is staying in a nonIndigenous nursing home. His behaviour has become withdrawn, sometimes staff see him crying. He refuses care and tells the staff to leave him alone. Percy has never left his remote Aboriginal community; anything he ever wanted was there, Country, family and community. In his younger days, he used to hunt, and all his life he has eaten traditional foods. He speaks simple English and Creole, but his first language is an Aboriginal Traditional language. Before he became ill he used to tell stories and talk about traditional culture to the children by making drawings in the dirt. Younger people would often ask his advice on life and ceremonies. He is a very well respected Elder, when people in the community spoke to Percy, they had certain cultural protocols to follow. B: Lucy Lucy is a 64 year woman who moved from an Aboriginal community to the city when she was 16 years old looking for work. She meet her partner a Torres Strait Islander man when she was 18, they have lived together for 39 years, her husband passed away 7 years ago. They raised a family of six children, these days she’s a greatgrandmother. While raising their family in the city they had strong community links with the Aboriginal and Torres Strait Islander people (family and friends), she had only one nonIndigenous friend from her husband’s work. She was diagnosed with head injury dementia four years ago, after a car accident. Her family is very supportive, but now they have families of their own. They can not handle the aggressive behaviour their mother shows; when she was growing them up she was a very patient lady and only sometimes showed her temper. Now she gets angry without being provoked, they can’t understand why, so they moved her to a nonIndigenous hostel, her angry behaviours are getting worse. Lucy’s children are also starting to fight amongst each other. The hostel has one Torres Strait Islander carer who seems to be able to calm Lucy easily, when she talks Creole to her and brings in some Torres Strait Islander food. This carer is starting to explain to the children what type of dementia their mother has, and asking Lucy’s children what she used to like before the dementia. Discussion points After reading the case study above discuss the following questions or points: • How would leaving their community affect an older Aboriginal and Torres Strait Islander person, their family and community? Facilitators guide

33

• What would be important to the Aboriginal and Torres Strait Islander older person? • How could you help to improve their sense of self, dignity, and wellbeing? 6.7 Activity: Meeting emotional needs Purpose To raise awareness of emotional needs, what it would be like if these needs are not met, and how another person can support the emotional needs of a person with dementia. What is required? Distribute the Emotional Needs handout and exercise sheet (or you may choose to draw model on whiteboard and work with the group.) Task Working in groups of two or three, ask participants to identify ways they meet each of the emotional needs. Report back to the main group. Write responses on the whiteboard/flipchart. Discussion points • Discuss what it might mean for our wellbeing if we are not able to meet our emotional needs. • Relate this to people who have dementia. • How might we assist a person with dementia to meet their emotional needs? • We can show our respect for the person with dementia by maintaining their personhood and sense of wellbeing. A personcentred approach guides us to do this. Ten key points 22 for maintaining a personcentred approach are described in the table that follows. Students note: The case study exercise “Rachael” is provided as an example and is intended to enable you to relate your learning to your real world context. You can use this story, or you may choose to a different story that comes from your experience. 6.8 Case study: Rachael Purpose To explore: • relationships between life events, the pattern of alcohol consumption and the consequence of dementia, • identify the impact of dementia on the person, her family and community. Case study Rachael was born on an Aboriginal Community in 1966. She started drinking alcohol when she was 15 after her father passed away. Rachel would go out with her cousins every weekend and occasionally during the week and get drunk. At first Rachael drank beer and wine, but as the years went by she was drinking spirits, rum, bourbon and vodka. 34

Facilitators guide

6 At 19, Rachael got a job as a domestic maid on an outback homestead near Arkaroola. Nine months later she was fired for theft and her drunkenness during work hours. Rachael never worked again. By the time Rachael was 25, she had four children under the age of eight years and an abusive husband who was in jail for domestic violence. Rachael was still drinking heavily and Grannie Pat was caring for her kids. In 1992, Rachael was diagnosed with diabetes and her eldest son was killed in a car accident. Unable to cope with this, Rachael drank even more. She was now drinking every day from the time she woke up until she passed out. At 34, Rachael’s behaviour had started to change, she was becoming aggressive. She was forgetting things and having difficulties planning her day. When Rachael was 35 years old she was diagnosed with dementia due to alcohol related brain damage. At the age of 37, Rachael was placed in a residential facility as her care needs were extremely high. 1. Discussion points • What was the cause of Rachael’s dementia? • Could the dementia have been prevented? • If so, what was needed and when did that need to occur? 2. Discussion points • If you were one of Rachael’s family members, what would be useful to tell the doctor, health workers or care staff at the facility? 3. Discussion points choice of care • Why was residential care chosen? • Identify the people who were affected by the choice of care. • In what ways were they affected? • Could Rachael be cared for in the Community? Consider: • advantages and disadvantages • personal resources • carer resources • community resources 6.9 Video: Lily's story: a tale of dementia Details for obtaining this video are: Call Number: VID 94 A Available from Bynoe Community Advancement Cooperative Society Phone (07) 4745 2333 Lily's story: a tale of dementia is an Aboriginal and Torres Strait Islander based story written by participants at a Good Practice in Dementia Care Demonstration Workshop in Normanton, Queensland. The story is about Lily, an Aboriginal woman with Alzheimer’s Disease. It reflects on her life and experiences to explain her behaviour as a result of Facilitators guide

35

dementia. The story of a young man, Barry, who has alcohol related dementia is also told to demonstrate how excessive alcohol consumption has resulted in dementia and affected his life. After viewing the story prompt the group to discuss the following questions. • What was the impact of dementia of each of the people in the story? • How did dementia impact on their family and community? • Are there people like Lily and Barry in their community? • How do families and community deal with dementia? 6.10 Activity related to assessment task 7 Purpose Participants will develop a comprehensive list of resources available in their community and how they may access additional resources. Brainstorming Ask participants to identify: • What resources currently exist in their community? • What additional resources are needed? • How can additional resources be accessed? Write responses in three columns on the whiteboard or flip chart. Lead a discussion on the responses to each of the questions. Make a list of resources that are available: • Locally • State/Territory • Nationally. Associated assessment activity Please refer to Assessment task 5: Case study – signs and symptoms and Assessment task 6: What is Dementia and Assessment task 7: Networks and supports in the assessment workbook.

36

Facilitators guide

7

Topic 7: Legal and financial planning Aims and learning outcomes The aim of this section is for participants to: • learn about key legal and financial issues for clients with dementia. By the end of this session learners should be able to: • identify key legal and financial considerations and implications for clients with dementia. • identify appropriate referral options. 7.1 Modified lecture/guest speaker Modified lecture using PowerPoint slides to highlight key points and facilitate discussion using the student guide as a key to slide content. You may wish to have a guest speaker from the Public Trustees Office or similar to talk about enduring Power of Attorney, Guardianship, etc. Content will vary depending on your state context. Associated assessment activity There is no specific assessment for this topic but participation in associated activities is expected.

Facilitators guide

37

8

Topic 8: Ways of communicating with a person who has dementia Aims and learning outcomes The aim of this section is for participants to: • learn communication skills to support communicating across cultures • understand dementia can change the way a person communicates, and • gain strategies that help effective communication. By the end of this session learners should be able to: • recognise dementia related communication changes • recognise the two way process of communication with people who have dementia • apply effective strategies in communicating with people who have dementia. 8.1 Activity: More than words Purpose The purpose is to explore the experience of communicating without the use of words. What is required? Participants work in groups of two or three. Without using words tell the group: • Your favourite type of music • Your favourite animal or plant Discussion points • Did you succeed? If so, how long did it take? • How did you feel? Find opportunities to discuss principles and practices of communication. • How do we communicate? Communication is more than the words we say. It is also the tone of our voice and our body language, for example, our facial expression, posture or gestures. The saying that our body language can speak louder than words is supported by the following. • Communication is made up of three parts: • the words we use are the smallest portion, only 7% • the tone and pitch of our voice contributes 38% • our body language accounts for 55% of our communication and is the biggest portion.

38

Facilitators guide

8

8 8.2 Activity: Attentive listening Purpose To experience effective communication and develop skills to transfer this into communication with persons who have dementia. What is required? Explain attentive listening and inattentive listening to the group. Ask participants to offer ideas about how this fits with communication rules and accepted behaviour in their local Aboriginal and Torres Strait Islander communities. Create fuller descriptions of the two types of listening according to responses from the group. Facilitator note: Participants to work in pairs – sitting facing each other. • For 2 minutes Person 1 explains concerns from either scenario (below). Person 2 actively listens, for 1 minutes and then changes to inattentive listening. • Person 2 now explains concerns from either scenario (below). Person 1 actively listens, for 1 minutes and then changes to inattentive listening. Attentive listening • use appropriate eye contact • “mmm”s in right places • reflect back appropriately but don’t make suggestions about what Person 1 should do. Body language that says • I am open to what you are saying • I am opening up to your concerns • I empathise with your concerns. Scenario Your father seems to be having some difficulty with his memory and with mood swings. Discuss your concerns: • about his memory loss • his mood swings and how it is affecting your mother. • how he is becoming quite agitated and at times anxious • your mother is very upset by these changes • what can you do? Discussion points • lead a discussion with the group, asking • how they felt with attentive listening and nonattentive listening, e.g. did we feel valued as a person? Facilitators guide

39

• was as it easier or harder to talk when their partner was attentive / nonattentive? • relate this to communicating with a person who has dementia. Inattentive listening • use inappropriate eye contract (stare or make not eye contact) • do not acknowledge in any way, or make inappropriate comments, • make short and nonreflective comments that interrupt. Body language says • I am not listening • look around • arms folded, or tap your fingers • look at your watch, or toward the door. Communication changes Some changes you may notice in the person with dementia include: • difficulty in finding a word. A related word may be used instead of one that they cannot remember • reduced vocabulary • they may speak fluently, but not make sense • they may not be able to understand what you are saying or only be able to grasp part of it • reverting to a first language • writing and reading skill may also deteriorate • they may lose appropriate social or cultural communication processes e.g. they may interrupt or ignore a speaker or not respond when spoken to • they may have difficulty expressing emotions appropriately Note that while some people may have difficulty expressing themselves, they may be able to understand everything that is said to them. Causes of communication changes include: • progressive memory loss • difficulty processing information and difficulty understanding • speech centre of the brain not working properly • problems with hearing, poor sight, teeth/dentures • damage to the brain causing changes such as repetition of statements or questions Changes can also be a reaction to: • confusion, fatigue, fear or anxiety • not remembering • new places, situations, changes in routine or living in an unfamiliar environment • making mistakes, fear of making mistakes, or not meeting the expectations of others 40

Facilitators guide

8 8.3 Activity: Whispers Purpose The purpose is to experience the consequences of simple and complex communication. What is required? Each group will get a card each example below of a simple and a complex sentence and how this affects communication. • Card 1: A simple, short wellknown phrase. She sells sea shells by the sea shore • Card 2: A long complex statement. There was never a scabby sheep in a flock that did not like to have a comrade. Explain to the group that for this activity they will all together represent the head of an individual (you may want the group in a circle or semicircle for this activity). Pick a person at one end of the row, group or semicircle and tell them they are going to be the ear of that head. Tell the person on the other side of the group that they are going to be the mouth. Everyone else will be the brain cells of the head, connecting the ear to the mouth. Give Card 1 (simple phrase) to the person acting as the ear. Tell them to: • read what is on the card without anyone else seeing it • whisper what is written on the card to the person next to them • no person can repeat the phrase to their neighbour, that is, they whisper it once and once only • each person whispers what they heard to their neighbour until it reaches the person playing the mouth • this person then says aloud what they have heard. The phrase should be the same as, or very similar to, what is on the card. This is to be expected. The phrase is a familiar one and most people will have no trouble understanding and responding correctly to it. Give Card 2 (Complex statement) to the ‘ear’ and repeat the process. This time, when the ‘mouth’ speaks what has been whispered along the line should bear little resemblance to what is written on the card. Debrief You may choose to write up responses on the board. • how did you feel about doing the activity? • was the first phrase easier to understand than the second and if so why? • how could we improve the situation? • how can we apply this knowledge to situations when we are communicating with someone with dementia? Facilitators guide

41

Points to cover Stress that communication with a person who has dementia must be kept: • simple – but without patronising the person • valid – using what they know of the person to help • short – without confusing matters by asking too much at once. 8.4 Exercise: Ways of communicating Purpose To consider different approaches to communicating with a person who has dementia. What is required? Two different scenarios can be read or roleplayed to demonstrate different approaches to communication. Jill is a bright, bubbly worker who has come to take Annie to an art group. Scenario 1 Jill rushes into Annie’s room. Without stopping she goes over to the window she says, “Hello love. I’m Jill. How are you today?” (As she opens the curtains and looks out of the window she continues to talk.) “It’s a hot day. What a bright dress you have on, but you will not need your cardigan. I’ve come to take you to the art group. Are you ready? Hurry up; you don’t want to be late.” • What could Jill have done differently? Scenario 2 Jill walks into Annie’s room, sits where Annie can see her and says. “Good morning Annie. I’m Jill”. (She pauses and smiles.) “How are you today?” (She waits for a response.) “Would you like to go to the art group?” (Again she allows time for a response.) “I’ll walk with you.” (Jill takes Annie’s hand and walks with her to the art group.) • What strategies did Jill use in this scenario? • Explain the difference between the two scenarios. 8.5 Activity: Discovering a person’s life story Purpose To identify ways of finding out about a person Facilitator note: You may like to prepare ahead for this exercise by having some example to show to participant, asking participants to bring examples that they have found successful or using this as a project for the group to design a resource that will be useful to use in the future.

42

Facilitators guide

8 What is required? Explain to the participants that there are situations where you may not know a person who has dementia or have access to information about a person, for example, if the person with dementia is moved away from their Land and family. You may only have medical information about the person. Ask the group the following questions: • How would you go about collecting information to include in a “memory box” or “life story book”? • How would you put this information together in a way that could be used to assist with reminiscence? As you discover the person, their life history, their Land and family, their passions and the things they love to do you can put together an album or life story book. For example: You may find out that a person with dementia loved to go fishing. You could gather some pictures of fish and fishing rods, rivers or ponds, etc and compile a little album. Or you may put together a fishing tackle box with some fishing equipment. The book or the box could be left with the person so that anyone could use the items to stimulate memories or feelings and prompt reminiscence. Reminiscence can: • give a sense of safety and security through identity • be used often and by different people. Associated assessment activity Please refer to refer to and complete Assessment task 8: The need for good communication and Assessment task 9: Maintaining relationships in the assessment workbook.

Facilitators guide

43

9

Topic 9: Provide activities to maintain a person’s ability, dignity and selfworth Aims and learning outcomes The aim of this section is for participants to: • learn about the role of assisting persons who have dementia to maintain their ability, dignity and sense of selfworth through meaningful activities. By the end of this session learners should be able to: • define the concept of meaningful activities in the lives of people who have dementia. • state the purpose of activity. • identify and apply appropriate activities to maintain a person’s self esteem and dignity, skills and health. • make sure activities ensure the safety and comfort of the person with dementia and are balanced with autonomy and risk taking. 9.1 Activity: What is an activity? Purpose The purpose is to define the concept of activity and identify the meaning and significance of activity. What is required? Ask participants to make a list of everything they did today from the time they opened their eyes in the morning until they came to this session. This can be done as an individual or group exercise. Discuss how we do these things without thinking about them, and take them for granted. But what would happen if we could not do these things? Now ask them to imagine they have a broken arm and leg and to cross off all the things they would not be able to do without assistance. Discussion points How do you feel? • Responses you may expect are helpless, frustrated, angry, loss of self esteem, etc. • What would you do? • Some may try harder to do things their own way, some may be happy to rely on others, etc. You can relate their responses to their different personality/coping styles. Relate these to the experiences of a person who has dementia. Points to cover • An activity is anything that we do from the time we open our eyes in the morning until the time we go to sleep at night – even sleeping is an important activity. The everyday things have meaning for us; they also have meaning for a person who has dementia. Activities include: • occupation: our role or the work that we do

44

Facilitators guide

9 • leisure: the special things such as sport, hobbies and relaxation that each of us likes to do such as going to the football, yarning with our friends, dancing or painting • self care: (sometimes called ADLs or Activities of Daily Living, which includes all of our hygiene and personal care). 9.2 Activity: Activity examples link to assessment activity 10 Purpose The purpose is to identify examples of the types of activities. What is required? This can be a group activity or completed individually. • Provide each participant with a handout of the table below. They are to provide an example for each point below. • Ask participants to THINK specifically about a person with dementia that they are caring for, so they can begin to build up a file of activities that are purposeful and enjoyable. • Some examples include ADLs such as getting dressed, singing, dancing, art, painting, craft activities, cards, walking, cooking, quizzes, crossword puzzles, photo albums, favourite videos, bus trips, creating sensory environments. Features of successful activities

Examples of activities

Have a purpose but also give the person pleasure in doing.

Fulfill a need for self expression.

Take into account lifestyle and old routines, activities and interests, boosting self esteem, confidence and safety.

Facilitators guide

45

Features of successful activities

Examples of activities

Allow opportunities for repetition, which often helps people with dementia, feel comfortable.

Tap into some of the five senses.

Take advantage of old skills and thereby comfort the person with dementia by helping to reinforce their identity.

Include some physical activity where appropriate, so mobility can be improved. This may also improve sleep patterns.

Associated assessment activity Please refer to refer to and complete Assessment task 10: Activity plan in the assessment workbook.

46

Facilitators guide

10

Topic 10: Aboriginal health Aims and learning outcomes The aim of this section is for participants to: • provide information on the current health and wellbeing of Aboriginal and Torres Strait Islander communities compared to other populations in Australia, in order to support participants gain an understanding of issues that their Aboriginal and Torres Strait Islander clients and colleagues may be facing. By the end of this session learners should be able to: • identify some key health issues for Aboriginal and Torres Strait Islander and their impact • identify places to source information on Aboriginal and Torres Strait Islander health data. Associated materials • PowerPoint presentation: 5 Health facts & figures 2007. 10.1 Modified lecture and associated article discussion: Aboriginal and Torres Strait Islander community health and wellbeing has been significantly affected by European invasion and the ongoing impact of post invasion policies. Present a short summary of Aboriginal and Torres Strait Islander health statistics as a legacy of this history – more details that relate specifically to dementia are provided throughout this training. An example of health and wellbeing information is provided in the power point presentation entitled Some Facts and Figures on Indigenous Health. You may choose to add information local to your State and you will need to update this data regularly. Useful sources of health and wellbeing data include: • The Australian Bureau of Statistics – www.abs.gov.au • The Australian Institute of Health and Welfare – www.aihw.gov.au • Dept of Health and Ageing – www.health.gov.au Here are some papers to further clarify the differences and similarities to Aboriginal and non Aboriginal Australians in the dementia area: Handout and discuss 3 articles: • David A. Bennett, MD Cognitive health in indigenous peoples Neurology® 2008; 71:1–1 • K. Smith, BSc L. Flicker, PhD N.T. Lautenschlager,MD O.P. Almeida, PhD D. Atkinson, MBBS,MPH A. Dwyer, Dip Arts, D. LoGiudice, PhDHigh prevalence of dementia and cognitive impairment in Indigenous Australians Ne urology® 2008;71:1470–1473 • LoGiudice D, Smith K, Thomas J, et al. Kimberley Indigenous Cognitive Assessment tool (KICA): development of a cognitive assessment tool for older indigenous Australians.Int Psychogeriatr 2006;18:269–280. Associated assessment activity There is no specific assessment for this topic but participation in associated activities is expected.

Facilitators guide

47

11

Topic 11: Care plan Aims and learning outcomes The aim of this section is for participants to: • identify care plans their benefit in working with clients and key considerations in developing and implementing care plans • learn good practice in care plans. By the end of this session learners should be able to: • identify key components of care plans and when and how they are used. • identify the principles of selfmanagement • identify good practice in engaging with clients and maintaining effective relationships • identify good practice in working with clients and developing care plans. 11.1 Modified lecture and associated activity: linking to assessments tasks 11A11E Use PowerPoint slides to highlight key points and facilitate discussion in modified lecture format drawing on learner examples where possible. Use the leaner guide a as resource for students and to drive PowerPoint slide content Suggested activities are assessment tasks 11A to 11E Associated assessment activity Please refer to: • Assessment task 11A • Implementing care plans • 11B Identifying factors • 11C Language and communication • 11D Emotional responses; and • 11E Establishing trust in the assessment workbook.

48

Facilitators guide

12

Topic 12: Responding to the individual and their behavior Aims and learning outcomes The aim of this section is for participants to: • learn about identifying, minimising and responding to changed behaviours that may occur in people who have dementia. By the end of this session learners should be able to: • explain behaviour changes in persons with dementia. • describe situations that may trigger behaviour changes considered to be challenging. • implement strategies which minimise the impact of changed behaviours. Associated materials • PowerPoint slides taken from student guide content • Assessment task 9: Impact of behaviours. • Assessment task 10: Triggers and responses. 12.1 Activity: What is behaviour? Purpose The purpose is to establish an understanding of “behaviour”. What is required? Ask the following question: • What do you consider behaviour to be? Record responses on whiteboard Discussion points: • Behaviour is the way a person acts (what we see a person do) • We all ‘behave’ • Our behaviour is governed by our feelings, culture, social norms etc. (e.g. we are here in the group today behaving in the way we have learned is the appropriate way to behave) • Our behaviour may also be a response to a stimulus – e.g. if we hear an unexpected loud noise we may be startled, our body may tense or we may jump. Use the model in Figure 12.1 to illustrate behaviour.

Facilitators guide

49

12.2 Activity: Feelings and behaviour Purpose To identify the relationship between the way a person feels and expresses that feeling, and relate this to the behaviour of a person who has dementia. What is required? Students as a group or a class will make 4 columns and feed back in the activity sheets below. Part 1 The first part relates to the behaviours of people with dementia. • Ask the group: When we think of behaviours regarding people with dementia, what are we talking about? • Write the responses in the second column. • Then ask: Why do you think people with dementia display these behaviours?” • Write up the responses in the first hand column (do not rub out responses). In the second column you may have a response such as “aggression” and next to it in the first column you may have responses such as “angry” or “scared”. Part 2 The second part relates to the participants’ own feelings and how they show these feelings (or the behaviours they show). • Arrange the group to work in pairs or small groups and hand out the Exercise Sheets. • Ask each group to work through each of the four Exercise Sheets (or if you have four groups you may designate one Sheet to each group). Ask them to write down everything they can think of for the first column, and how they show that feeling in the second column. Then feedback for each activity sheet and write up the responses on the whiteboard. Write the responses in columns 3 and 4. Discussion points: • Ask the group to highlight similarities between the person with dementia list and their own feelings and behaviours. • Emphasise that behaviours communicate feelings – the behaviour of a person with dementia may be their form of communication (link to changes in verbal communication). • There may be a scarcity of happy feelings and behaviours for the person with dementia. If someone doesn’t volunteer this observation, point this out before moving on.

50

Facilitators guide

12 Feelings and behaviour activity sheets: Activity Sheet 1: Happy behaviours • Things that make you happy

• Ways you show happiness

Activity Sheet 2: Sad behaviours • Things that make you sad

• Ways you show sadness

Activity Sheet 3: Angry/frustrated behaviours • Things that make you angry/frustration

• Ways you show anger/frustration

Activity Sheet 4: Scared behaviours • Things that make you scared

Facilitators guide

51

• Ways you show being scared

12.3 Activity: How would you behave? Purpose To explore triggers and responses in everyday situations and the different ways individuals may respond. What is required? Students note: A similar scenario from the perspective of a person with dementia will be used again later. Explain the following scenario to the group. • You have just arrived home from work and are tired and have a headache. You want to sit quietly for a while. You just get comfortable when someone in the next room puts the television on to watch the football and turns the volume up very loud. You do not like football since your son broke his back playing the game. Then ask … • How do you feel? • What might you do? For example, you may have: • felt annoyed/angry but not have done anything • shut your eyes and gone to sleep • tuned out and read a book • asked the person to turn the television off or the volume down • moved to a quieter place • taken something for your headache • felt annoyed and yelled at the other person. Talk with the group about their response and why they responded in that way. Identify the range of problem solving skills they may have used in this situation. We need to examine behaviour from an holistic perspective as there can be many reasons why a person with dementia may behave in a certain way. Sometimes the behaviour may be related to the changes occurring in the brain. In other instances, the behaviour may indicate the person is in pain or not physically well. There may be many triggers, events or factors in the environment that influence the behaviour. It is important to explore all aspects to assist in identifying the reason and, where possible, take actions minimise.

52

Facilitators guide

12 12.4 Visualisation Purpose To explore behaviour as a way a person with dementia will communicate how they feel. What is required? Tell participants that you are going to describe a situation to them. Ask them to close their eyes, relax, and concentrate on the scenario. Scenario You are in a strange building. You have been left in a white room by a young woman you do not know. The room is cold and there are strange noises and smells that are not familiar to you. Another young woman, again a stranger to you, comes in, takes hold of your arm and rolls up your sleeve. She ties a tight rubber band around your arm. It hurts! The door to the room opens and a man you have never seen before walks in. He is dressed in a black suit, and although he addresses you by your name, you do not know him. The man picks up a needle, takes hold of your arm and tries to put the needle in your arm. Ask the group to open their eyes. Debrief Ask the group how they felt and how they would react in this situation. Write responses on a whiteboard or flip chart. Possible responses may be: Feelings • threatened • scared • afraid • angry • intimidated • powerless Reactions • defensive • call out for help • struggle • show aggression • run away • resignation Points to be covered These are natural responses given the circumstances. It is natural to protect yourself or want to run away if you feel threatened.

Facilitators guide

53

12.5 Activity: How would you behave? Students note: This is similar to the previous scenario but now relates to it from the perspective of a person with dementia. Purpose To recognise how everyday situations can trigger ‘difficult’ behaviour and explore ways that triggers may be reduced. What is required? Explain the following scenario to the group. Scenario You have dementia and are tired and have a headache. Someone has put you in a room with a group of people that you do not know. The football is blaring on the television. You have not liked football since your son broke his back playing the game. You cannot tell anyone how you feel. You don’t want to be there and cannot get up and walk out. Ask the group: • How do you feel? • What might you do? Part 1: Recognition of triggers This situation is similar to the situation in the previous exercise. The person with dementia is experiencing a situation containing factors that may trigger a response that is considered a problem. How many triggers can you identify? For example: • life story: do not like football • physical health: have a headache • changes in the brain: not able to say what you feel or want, not able to move away • environment: surrounded by strangers, noise from television Part 2: Behavioural response Ask the group to describe the feelings experienced in this situation and the reasons for these feelings. Write the responses on the whiteboard. You can expect responses such as: • frustration – not able to tell anyone how you feel or move to another place • sadness – memory of son’s injury • pain – headache Discuss nature of the feelings – the distress they may cause. The person with dementia is not able use the range of problem solving skills to respond to the situation in the way that you did (in the earlier exercise) because of changes that 54

Facilitators guide

12 have occurred in the brain. Their response may be to call out loudly and repeatedly, using words that do not make sense, then to become agitated and angry and start hitting out at others. In this situation, what the person does may be referred to as ‘behaviour’ and be interpreted as a problem. Working in pairs or small groups, ask the participants to identify what they would do. Then feed back to the large group and discuss strategies – ensure there is recognition that this behaviour was communicating how the person was feeling and expressing their unmet need. It is important to explore the impact of the environment on the person and their ability to cope with the situation (lowered stress threshold) and recognise the feeling behind the behaviour and consider what the person was trying to communicate. Imagine yourself in their shoes and remember to see the person behind the behaviour. Lead the discussion to recognise that this has been difficult for all concerned and that it would be preferable to prevent it. Part 3: Minimising behaviour Work in pairs or small groups or use a brainstorming approach. Ask participants to identify what would be required to prevent this situation and then feed back to large group. You are looking for them to: • identify the need to know the person, e.g. to be aware of their life story and preferences • recognise pain (i.e. their physical health – headache) • create a physical and psychosocial environment that suits the person (e.g. level of noise and stimulation) • identify other factors that may be specific to the cultural and spiritual needs of the person. Facilitator note: Documentation Before commencing this session find out the recording and reporting processes used by participants and incorporate this into the session.

Facilitators guide

55

12.5 Activity: Assessment task 12A: Impact of behaviours This activity equates to Assessment task 12A Ask participants to describe four behaviours and the potential impact of each of the behaviours on the person with dementia and others. Behaviour Example Does not sleep and calls out during the night

Impact on person with dementia

Impact on others (family, community, care staff)

Sleeps during the day and becomes angry if woken

Family carer not able to sleep and during becomes exhausted. Requires additional community support and respite services

Associated assessment activity Please refer to Assessment task 12A: Impact of behaviours and 12: Triggers and response in your assessment workbook.

56

Facilitators guide

13

Topic 13: Providing information to carers Aims and learning outcomes The aim of this section is for participants to: • gain an understanding of the key principles behind effective delivery of information to carers and other loved ones/significant people in the clients life. By the end of this session learners should be able to: • identify good practice processes for sharing information • identify confidentiality and privacy considerations • identify what carers may need to know and may want to know • identify key principles in attending and hearing the carers requirements and providing information. 13.1 Modified lecture and associated activity: linking to assessments tasks 13 Use PowerPoint slides to highlight key points and facilitate discussion in modified lecture format drawing on learner examples where possible. Use the leaner guide as a resource for students and to drive PowerPoint slide content. Associated assessment activity Please refer to Assessment task 13: Providing information to carers in your assessment workbook.

Facilitators guide

57

14

Topic 14: Records writing and maintenance Aims and learning outcomes The aim of this section is for participants to: • become familiar with good practice in record keeping and writing including legislative and procedural requirements. By the end of this session learners should be able to: • identify key considerations in writing records • identify good practice in recording and storing information • identify and list key legislative and ethical requirement sin regard to record keeping and writing. 14.1 Modified lecture and associated activity: linking to assessments tasks 11A11E Use PowerPoint slides to highlight key points and facilitate discussion in modified lecture format drawing on leaner examples where possible. Use the student guide as a resource for students and to drive PowerPoint slide content. Associated assessment activity Please refer to Assessment task 14: Maintaining and recording information in your assessment workbook.

58

Facilitators guide

Notes

Facilitators guide

59

Notes

60

Facilitators guide

Notes

Facilitators guide

61

Notes

62

Facilitators guide

Notes

Facilitators guide

63

Notes

64

Facilitators guide

Ageing, Disability and Home Care Department of Family and Community Services Level 5, 83 Clarence Street Sydney NSW 2000 Ph 02 8270 2000 TTY 02 8270 2167 www.adhc.nsw.gov.au © November 2010