Steps to creating a community-based music group for people living with dementia and their carers Andy Baker, Anthea Innes, John Murphy, Kevin Pritchard & Laura Reynolds
This guide is written for those interested in setting up a community based music group. Every community music group will evolve organically and be different, and each group will need to accommodate individuals abilities and musical preferences. The authors have not received any endorsements from companies or organisations mentioned in this guide. This booklet is freely available to those wanting more information about running a community-based music group for people with dementia and their carers. It should not be reproduced or sold. If using the guide for academic purposes, please use the Citation Reference. We are interested in knowing how this booklet is being used, and therefore request that those wishing to use the booklet contact the authors, not for permission, but stating circumstance of use. This booklet was funded by Dorset County Council s Inspired by 2012 Health and Wellbeing Legacy Fund as part of a wider project funding the continuation of the BUDI Orchestra for people with dementia and their carers from the local community. Baker, A., Innes, A., Murphy, J., Pritchard K., & Reynolds, L. (2015). The BUDI Orchestra Method: A Guide. Bournemouth, UK: Bournemouth University Dementia Institute.
About this Guide... 2 Philosophy and Principles... 2 Positive Expectations... 4... 5 Creating the Group Environment... 5 Selecting a Team... 6 Instruments... 12 Music Selection... 13 Styles of Music... 14... 16 Warm-Ups... 16 Rehearsals... 17... 18 Location... 18 Layout... 18 Before the Performance... 19 After the Performance... 19... 20 1
Following the success of the original BUDI ( buddy ) Orchestra, we decided to create a guide for those wanting to set up their own music-based community groups. This guide provides recommendations or hints and tips that may be useful when setting up a community-based music group. Although our previous work has focused specifically on engaging people with dementia and their carers, this does not mean that our approach will not work with other groups of people. We hope this guide will provide the ingredients, rather than the recipe, to create music groups that give pleasure, fun and a sense of accomplishment to all involved. The starting point for this guide to using music with people with dementia is one of having fun, creating an opportunity for social engagement and group learning. Core to our philosophy is person-centred care: each individual participating in the group is celebrated as an individual and welcomed and valued as a person. This approach creates the starting point for a sense of community, bonding and social togetherness. These are important values to promote life-long learning and a willingness to engage in new learning. The underlying assumption is that everyone who participates will benefit. The aim of creating an orchestra or other musical ensemble is not just to benefit people with dementia, even though they are central to the process. Professional musicians, volunteers, academics/researchers and family members are not just there as supporters or facilitators, but as coproducers and collaborators in the experience. The idea is to create an environment that is normal; rehearsing and performing together is the norm for musicians from any genre. Music can be used as therapy or as a 2
group activity ; the intention of this guide is to move away from a more simplified use of music to entertain, distract or pacify people with dementia. Instead, our orchestra approach aims to create a high level expectation of inclusive learning, progression, achievement and success. While recognising that music may sometimes be a solitary pursuit with individual benefits, a lot of music making and listening is typically part of a social activity or with a collective purpose. Providing an opportunity for people to interact with others from different backgrounds and life experiences creates a forum for people to feel included and welcomed and accepted for what they contribute and bring to the experience. In this way, the musicians, volunteers and those watching the performances are able to find out more about dementia, helping to demystify the condition. Furthermore, the approach allows for diverse music making, allowing exploration of different genres that may have been previously unexplored by those new to music. In this way, the orchestra approach can challenge perceptions, create new ways of thinking and generate knowledge for all involved. Adopting these principles will benefit all those in the group and not just people with dementia and will encourage continued learning. 3
It is important to remember many members of the group will be beginners, and even those with experience of playing an instrument may be hesitant to perform straight away. Each member of the group may learn in a different way or have individual needs that may need to be considered. Try to begin the group with patience and an open mind; it is important to be able to adapt to the needs of the group when required. Many musical mistakes were made on our journey, both by the group members and the professional musicians because at times musical patterns were just too complicated. By simplifying those patterns it was possible to perform to a much higher standard and, with that, the group were able to gain a high sense of musical achievement. Eventually a repertoire of songs and pieces emerged that the group liked and enjoyed being part of performing. The main thing that soon became very apparent was that the music and the sessions had to be fun. 4
Allowing time to meet and greet, and for people to say a relaxed farewell, as part of the rehearsal schedule is crucial for the success of the group development. At the beginning of the rehearsals, everyone needs some time to reconnect, relax with one another, chat and re-familiarise themselves with the physical setting and with other members of the group. Ensuring that time is allocated to build relationships, create rapport, promote friendships and develop a social network cannot be underestimated in the success of the group to work together. Name tags offer a simple way for each person to be able to identify others, and may be helpful when starting a group where people are unfamiliar with other group members. Creating a sense of social community encourages group cohesion and ownership and belonging. If people enjoy the sessions, they will express an eagerness to continue with the group and attend the rehearsal and performance cycles regularly. When selecting a venue, it will be important to consider the following: Does the venue accommodate different abilities (physical and cognitive)? Is the venue on the ground floor, or does it have accessible lifts? Does the venue have parking? Do the facilities provide refreshments? 5
Is there enough room for the music, instruments, people and other equipment to be accommodated? Is there space for the group learning environment and a space for individuals if they require a break? Food and drink creates the opportunity to socialise together. Starting the session with time to have refreshments and chat will help people to feel relaxed. Similarly, a break after intense periods of concentration will reinvigorate and revitalise the group, and also promote bonding with others. It is important to consider individual preferences when catering for the group; not only to accommodate individual dietary needs, but to demonstrate knowledge and value of peoples preferences. The choice of players to facilitate the group is very important. The following are key points to consider when selecting musicians to run the sessions: Lack of negative pre-conceptions of people with dementia; for example, players who feel relaxed rather than awkward, and are accepting rather than feeling intimidated by people with dementia; Personal skillsets including interpersonal qualities such as: energy, enthusiasm, vision, musical diversity, flexibility, ability to improvise and adapt, communication, openness to make mistakes, fun outgoing, sociable and patient; Experience of working in a community-based project; Ability to work flexibly and improvise and/or adapt musically if a particular piece is not working; Musical understanding (and what could be achieved); 6
Knowledge of the instruments that the people with dementia are learning to play; Understanding their personal value and contribution within the project. Having a team who get on will always help, as will having skills that complement each other. Choosing the types of instruments is important, for example, the piano is an excellent instrument as it can provide harmony, rhythm and melody, giving the other team members freedom to weave in and out of the arrangements as needed. It is important to have a team that are willing to be musically flexible and take on different roles so that it s not always here s the melody instrument, here s the harmony, or here s the rhythm. It is imperative that at least one of the team knows the instrument being taught to the members of the orchestra, and that they are able to demonstrate the technical aspects of playing the instrument, yet at the same time providing assistance on an individual basis. 7
When I joined the BUDI Orchestra, I had very little experience interacting with people with dementia and their carers, both professionally and personally. I did have some experience of working with community projects, but not with this approach. During the rehearsals, the other musicians and I would support group members by helping with technical aspects of playing the instruments, for example, how to hold the instrument, and by playing accompanying arrangements; be that the tune or to help with pacing. Through this experience, I have had the opportunity to explore different styles of music, and develop my own musical skills through improvisation and the (often impromptu!) refinement of the repertoire to accommodate the skills of the group. As well as this, I feel as though my confidence to interact with people has grown, and I am now able to be flexible in my approach to accommodate individual group members needs. This experience has opened my eyes even further to the power of music and its ability to bring people together in a positive shared environment to celebrate our skills and achievements. The sense of community within the group was greater than we could have imagined; having the opportunity to play and make mistakes together, and finding out about the rich lives of everyone involved has inspired me to do so much more for people with dementia. 8
Volunteers are important to provide one-to-one support to individuals with dementia and their family members who are learning an instrument for the first time. The volunteers can help to demonstrate how to physically hold the instrument and how to follow the instruction to play a piece. There can be tensions if a volunteer attempts to take over the learning and overcorrect the individual playing. Professional musicians need to be alert to this process and intervene as required to allow for individual independent learning to occur. Similarly, lack of support can be detrimental to the learning process. Finding the right balance of encouragement and enabling an individual to thrive independently will differ depending on the person. Ultimately, the volunteer should enable and empower, rather than impose. Volunteers require the capacity to listen and follow instructions and adjust their input to accommodate the musical direction and challenges as they unfold. The volunteer role is to guide those with dementia, reinforce learning, but also to foster a sense of togetherness and learning alongside one another. It is also helpful if volunteers have knowledge of music, as the volunteers can then input and feedback to the musicians on potential improvements. However, previous knowledge of music is not an essential requirement. Our team of volunteers were essential to the success of the project. Being outgoing, empathetic and having a willingness to learn was very important. Volunteers focus should be to provide encouragement and assistance. Quite often our volunteers would be like a mentor to the same few people each week. Having that continuity and building a relationship made learning much easier and fun. 9
The primary purpose of creating a BUDI Orchestra (or similar music group) is to celebrate the skills of those living with dementia. This may include relearning musical skills through a forum that previously did not exist. Equally a music group provides the opportunity to learn new skills in a safe and supportive environment. Jack Jack is a 78 year old ex-professional musician living with dementia. He played the double bass. Jack s confidence to perform with a group had been shattered by a number of dismissals from previous bands due to his difficulties using some of the technical equipment needed during performances. Jack found other community groups too easy, and would often make mistakes on purpose to amuse himself. He frequently left these groups feeling patronised and so stopped attending. Jack and his wife had tried to meet other people in their local area for jam sessions, but had been unsuccessful. When Jack joined the group, he had not played around other people for a long time, and his instrument was in slight disrepair. Despite this, he was encouraged to bring it with him to the rehearsals. He did not enjoy singing or taking part in the body percussion segments as much as playing his instrument, so he continued playing during these parts to add an accompaniment. The musician leading the group asked if Jack would like sheet music to use for each song, but Jack preferred to improvise. Before each song, one of the musicians would tell Jack which key to play and he would play along. To celebrate Jack s skills, he was invited to play in place of the lead musician during songs he enjoyed while the musician encouraged others in the group. Jack would sometimes become tired during the sessions and would sit out during some songs to rest. As Jack s confidence in playing grew, he was encouraged to perform a solo segment during one of the songs in the performance to showcase his talents to the audience. 10
Walter Before Walter s diagnosis of dementia, he had been sociable and outgoing with many friends at a local sports club; he also loved to sing. As Walter s diagnosis progressed, he found his friends began to distance themselves, and trips to the sports club became less and less frequent. His wife suggested he might like to join the group as they had enjoyed going to a similar community group in their local area. He was hesitant as he had never played an instrument before, but was happy to attend on the basis he could join in with singing where possible. As the rehearsals began, Walter found the body percussion segments difficult to keep up with, though he enjoyed singing. His mistakes often frustrated his wife, as she tried to encourage him to follow her lead or would take his hands to tap out the rhythm. A volunteer suggested they try playing the violin together and, as the weeks progressed, Walter found playing the instrument less difficult. The support from the volunteer enabled Walter s wife to play alongside Walter and engage with the music as an active member of the group, rather than as an aide for Walter. She found she was able to relax and enjoy the experience with him. During one of the sessions, Walter suggested to a volunteer that he felt scat singing (vocal improvisations that fit within a melody or rhythm) would work well in a particular piece of music. The volunteer encouraged Walter to share this with the group, but he was not comfortable to do so. The following week, he expressed the idea again, and the lead musician asked if he would like to try. Walter did and the lead musician suggested they could add this to the performance. After the performance, Walter was pleased with all he had achieved and believed that everyone in the group had a professional part and did it very well indeed. 11
Maggie Maggie is 92 years old. She used to sing in a community choir and taught dance during World War II. Music was an important part of Maggie s life as she loved to sing and listen to music. Her daughter believed Maggie would enjoy attending the group, but felt that she would only be able to sing or engage with percussion instruments, rather than play the violin, due to Maggie s deteriorating eyesight. The songs chosen were familiar to Maggie and she would often dance in her seat, sing, hum or tap along to the tunes. A volunteer encouraged Maggie to use the violin and within a few brief sessions, she was able to pluck the strings with the support of a volunteer. Her daughter was surprised at her mother s abilities; she never thought Maggie would be able to participate in this way. During the performance, Maggie was nervous: it was an unfamiliar environment and there were lots of people watching her. She did not want to stand from her wheelchair to reach the stage, and so the volunteers lifted her in her seat. When she was handed a violin, Maggie began to strum, and as the music started during the performance, she played with the rest of the group, singing loudly and playing as much as she could. At the end of the performance, while the group stood to take their bow, Maggie motioned to a volunteer that she too would like to stand with her peers and receive her applause. She walked down from the stage with the aid of two other people with dementia, head held high. When considering the instruments to use, the ease of creating a sound is important. String instruments are ideal in the sense that a beginner can produce sounds that make an immediate contribution to a group piece. In practice, this means selecting pieces that allow for a variety of playing techniques and progression of abilities as confidence grows. For example, selecting music where open strings can be plucked at the outset, but as the group becomes more 12
comfortable with the instrument, they may begin to develop more complex skill-sets, such as increased concentration, dexterity, co-ordination, as well as musical abilities. Some practical considerations when selecting the appropriate instruments to use are: Availability of instruments; Previous musical experience e.g. if people already play an instrument, encourage individuals to bring them along or if they have enjoyed a genre of music this can be included; Facilitator knowledge and ability to play chosen instruments; Selecting one instrument (for example, the violin) encourages a levelling between group members new to the instrument. Choice of music is crucial to the experience of the group. The music should demand an element of challenge, promote learning and enable a sense of personal achievement. When choosing the music the following points are useful: Encourage group members to suggest pieces of music they enjoy to promote ownership and involvement e.g. based on previous musical preferences; Select pieces that will ideally promote the opportunity to learn new styles of music (e.g. jazz to opera); Be recognisable to the group members so they feel a sense of accomplishment when performing; Use repetitive musical patterns to reinforce learning while allowing individuals to regroup and join in again should someone lose their place; 13
Ensure that professional players musical skills are maximised to enhance the performance; Be musically flexible - to fit any instrument available; Promote fun! A number of musical styles can be included when choosing the repertoire: for example, including pieces of music that allow for singing and body percussion as well as instruments. Group members may be more comfortable with a specific style of music; therefore multiple styles can promote a sense of inclusion and provide individuals with the incentive to showcase particular skills. This song was originally made popular by Perry Como in the early 1960 s and is likely to be familiar to many people with dementia from the current generation. Structuring the piece in a simple repeated form, for example Introduction Verse Chorus Verse Instrumental break Chorus Verse - sung as a round Introduction can work well as the words are simple and repetitive. Performing the verse as a round allows for a real sense of musical achievement. Notation is a very important part of the process. Sibelius software is one way for experienced musicians to create parts and scores. The music scores for the musicians leading the BUDI Orchestra groups were created using 14
Sibelius software. This allows the opportunity to create parts for all musical abilities from professional musicians to beginners. This software allows group leaders to transpose and refine the music to suit the instruments used by the group. Simplifying the music to enable everyone to participate, regardless of their ability to read music, is fundamental. To achieve this in our project, we used a simplified guitar tablature-type method, for example: 8 x D, 4 x A, to direct group members. 15
It is very important to begin with confidence building exercises to promote bonding between everyone within the group and encourage a relaxed atmosphere. Musical warm-ups serve to prepare the group for the session ahead; they can also be used to: Break the ice. This will be particularly useful when starting a new group; Enable the group to recognise a starting point to their music-making; Physically warm up the body and vocal chords to promote well-being. Warm-up exercises can be continuously built upon to become more elaborate and complex as the group becomes more confident. These may be integrated into the final repertoire where appropriate to add variation to the music-making. Body percussion (for example, stamping feet, clapping hands, clicking fingers) can also form part of the warm-up. This might be integrated into the pieces later in the rehearsals if enjoyed by participants. One example is highlighted below. This phrase was spoken and each word clapped along to by members of the group to emphasise the pace they were to play the violin in specific music pieces (slow slow fast fast slow). This is demonstrated by music notation below: 16
Variation of the repertoire, accommodating individual preference, can help to sustain engagement and concentration and is a cornerstone for rehearsing. It is important to include pieces to build on learning and demonstrate progression. Facilitators need to be able to improvise and refine in the moment to respond to group members reactions and individual abilities. The rehearsal repertoire needs to build up to the performance over time at a pace that meets the members progress. Remember: the aim of the rehearsals is to create a fun and engaging atmosphere that is focused on enjoyment, rather than achieving a musical masterpiece. Ravel s Bolero was chosen as it is a one bar (three note) pattern, repeated continuously over a very hypnotic drum pattern. The beauty of this piece was that whilst being very simple to accompany, it is also very challenging to perform, as it should never get boring in its delivery. Instrumental blending could also be experimented with whilst at all times being underpinned by Bolero s three note pulse. When the professional instrumentalists were not playing, they were able to choose their own musical pattern naturally adding to the piece contributing to the rhythm or the simple C major harmony. Group members also had a choice of the notes they could play, as there were more than one that would work. This also allowed the opportunity for experimentation, confidence-building and to change their musical pattern to maintain their interest. 17
Performing is a normal part of participating in a group music activity that can often be lost when running music groups for people with dementia. This was a key feature of the BUDI orchestra as performances offer the opportunity for participants to showcase their skills while also providing pleasure for the audience. Choosing a setting that may be familiar to members can promote an environment to perform that is less pressured and more informal. It can promote direct contact with the audience much more easily and encourage performance energy. It is important to select a venue that has sufficient room to accommodate everyone (including any physical requirements they may have) and have enough space to be able to play their instruments comfortably. Mirroring the set-up of the rehearsal room is important to feel familiar and secure. Sitting in pairs can be very helpful to provide support as required. It is also important that everyone can see the lead facilitator during the performance as this may promote a sense of involvement and group cohesion. Music stands for the song sheets enable members to focus on holding the instruments. 18
Factoring in time to have a brief rehearsal immediately before the performance promotes confidence and comfort in the environment. Repetition is paramount to promote a sense of security and confidence when performing without losing the fun aspect or spontaneity when playing. Providing the opportunity for group members to socialise together and celebrate their achievements after the performance is important. Reflecting on the performance collectively creates a bonding experience and a willingness and enthusiasm to rehearse and perform in the future. 19
1 2 3 4 5 6 7 8 9 10 Make it fun! Treat people with dementia as people. Create a social environment that promotes friendship and belonging. Draw on, encourage and showcase the natural and existing abilities of individuals. Don t underestimate what can be achieved. Adapt the music to suit the needs of the group. Develop a relaxed atmosphere to promote learning. Embrace mistakes and go with the flow. Choose music that is meaningful to the group and engages individual interests. Provide refreshments to promote bonding alongside learning.