Running a Conversation Partner Scheme

1. Running a Conversation Partner Scheme Introductions Setting the scene

2. What is a conversation partner scheme? • Students and people with aphasia • supported conversation • In their own home • An hour a week • 6-month agreement • Referrals from local population

3. Origins in London Partners in 11 trial sites - NHS and Universities Now a Conversation Partner Network 15 different organisations at the Network Meeting, January 2009 At least 9 other schemes Interest across the Britain, Scotland, and Eire Origins of the scheme • Inspirational work of Jon Lyon, Aura Kagan, Nina Simmmons Mackie and the LPAA group • South London Conversation Partners 2001 - 2004 (Henry Smith Charitable Trust) • 65% of volunteers went onto study as a health professional

4. Count down January 2009 From all the participants attending the Network day, the tally was: • Trainers with aphasia 79 • Students or volunteers 434 • People with aphasia receiving the scheme 234 • from an original 72 pairs in the London plot project • Plus other pilots from the another 9 pilot schemes not attending the day

5. Key elements of a scheme • Shared beliefs: • A value in conversation • Simple tools to communicate • Volunteering – 1x week I hour, fixed period • Supervision • People with aphasiaas trainers, as experts • Skilled interactions / expertise • Therapeutic

6. Students’ encounters with aphasia

7. What we know about conversation partners • Training in supported conversation can significantly improve the practice of those working with people with aphasia Kagan (1999) Kagan et al (2001) • Students develop communication skills and understanding about themselves as communicators (Horton and Guyon 2007)

8. Building on this • Included conversation partner scheme in new postgraduate diploma course jointly set up by University of Greenwich and Canterbury Christ Church Universities 2007 • Weekly visits for 5 months to person with aphasia • Fortnightly support groups facilitated by lecturers • Reflective logs • Evaluations of the experience

9. Students’ experiences • Learned about aphasia, impact on person with aphasia and impact on others “increased insight into how communication impairment impacts on individual and family” • Learned about self as communicator “now I don’t panic at silences” • Learned about developing professional identity “I learned not to be so desperate to try and solve the dilemma”

10. Wider impact of experience on the student practitioner • Introduction to social model of disability • Introduction to reflective practice • Sited at beginning of course provides students with opportunity to “repeatedly go back to the original experience, re-evaluate it and associate it to theoretical principles” (Boud 1985)

11. Reflective practice” “Reflective practice allows one to become aware of one’s experience. One learns to analyse the sources of one’s own interpretations, to question and resist the predefined meanings one is encouraged to adopt. In so doing one can move to a position of autonomy and responsibility because one can take personal accountability for one’s actions. These actions are shaped by one’s awareness of self in terms of beliefs and values, feeling and reactions to many situations” Graham (1995)

12. Student reflection “I never realised that in doing speech and language therapy I needed to think about my own beliefs and personal cultural assumptions” “excellent learning experience, challenging and enlightening”

13. Wider impact • Introduction to consideration of power relationships between client and student • Student is learning from the person with aphasia “my conversation partner taught me so much” • Emphasis not on performing as it is later in course • Alteration of traditional clinical relationship • Student not in role of “aspirant expert clinician” with its attendant unequal power relationships (Beecham 2005)

14. Contribution to developing philosophy of course • Encouraged “deep” approach to learning, situated in experience • Primacy of practice, rather than theory • Group supervision developed supervision skills, built trust, group working skills • Development of professional skills • Encouraged students to set learning objectives for selves and measure outcomes

15. Students’ reports of change • Increased confidence in communicating with someone with limited communication skills • Increased confidence in leaving silences • Increased confidence in responding to distress • Being involved with a conversation partner allowed me to reflect on my own communication skills

16. Potential applications • Other students of health, educational and social care • Interest expressed by occupational therapy, nursing and social work programmes • Further developments at University of East Anglia

17. ‘Reaching further out’ – Conversation Partner training & beyond! Simon Horton, Anne Guyon (University of East Anglia) & Tammy Davidson (Norfolk PCT)

18. Aims • To outline the scope of ‘Reaching Further Out’ • To explore the impact of the ‘Reaching Further Out’ project on stakeholders • To discuss the implications for future activity, sustainability & research

19. ‘Reaching Further Out’ • Funded by UEA Alumni • Exploratory workshop • Facilitated discussion (Sally McVicker, Connect) • Initiate group identity work • Common (communicative) experiences of living with aphasia • Experiences as a trainer • Name agreement: ‘Conversation Partner Trainers’ • Future activity focus

20. Experiences & activity focus • “Training influences how people are treated in the future” • “Give them an idea of stroke & aphasia” • “Training helps my confidence” • Train other healthcare students & healthcare workers • Physios, OTs, nurses, doctors, social workers – “…better to catch them young!” • Make a training DVD • Collaborate in future research

21. ‘Supported conversation skills’ training • NHS specialist rehab centre • Approx 130 therapy, medical, nursing and ancillary staff trained • Faculty of Health, UEA • Nine 3rd Year medical students • Sixteen 2nd Year OT & PT students

22. Trainee feedback • NHS • Significant increase in staff confidence & perceived success • “[it] was the best training I’ve attended” • “it’s made such a difference – I feel more confident” • Students • “I feel more confident” • 24% ‘strongly agree’ • 76% ‘agree’ • “I would recommend the training to a colleague” • 72% ‘strongly agree’ • 24% ‘agree’ • “…enjoyed the genuine authentic experience” • “…more sessions please!”

23. Conversation Partners: other types of participation • One:one interviews with UEA staff – the experience of stroke and aphasia • Developing educational resources for inter-professional learning – video clip scenarios • Making a DVD – UEA Faculty + UEA Summer School for Yrs 10 & 11 • Interprofessional Student Conference (IPL3) • Expert participation – insider perspectives • Participation facilitated by SLT 2nd Year students

24. Interlude with Mary & Anne

25. Being a trainer – satisfaction & a sense of belonging?

26. Interlude with David • Naked David… • …and missed-understandings

27. Future activity & sustainability • Training OT & PT students June 2008-9 • CP Trainers group members participating in IPL3 student conference, 2009 • Yr 2 SLT students facilitate participation • Research initiatives: SCA – project steering group membership • New members for CP Trainers group • Challenges • Providing training for trainers • Maintaining links & sustaining the network • Training opportunities

28. Working with people with aphasia as volunteer befrienders within the framework of a conversation partner scheme Sally McVicker, Connect

29. Aims of this talk • To consider the question: ‘Can a person with aphasia be a volunteer conversation partner?’ • To consider how this links with the National stroke Strategy • To report on the impact and learning of a pilot scheme

30. Links to the Stroke strategy • high quality services, including “expert patient programmes” and “peer delivered activities” (QM 10) • seamless transfer of care, including “peer support” (QM 12) • access to long- term care and support, including “access to good peer support” (QM13) • Participation in community life, including peer support to “enable and empower individuals” (QM15) • access to “volunteering both as a means of trialling return to work and a satisfying alternative to paid employment” (QM 16)

31. Setting up a pilot scheme • A ‘befrienders’ pilot scheme • Modelled on the Conversation Partner Scheme (McVicker 2007) • 10 volunteers with aphasia were: • trained • ‘matched’ • supported • Visits to another person with aphasia

32. Who volunteered?

33. The role of the conversation partner / befriender The Volunteering Process Health and Safety Conversations with aphasia Roles and Boundaries Support and Supervision Difficult scenarios What did training cover?

34. Who used the scheme? • 11 people with aphasia • Varied in age from 20’s to 90’s • White British, except 1 Irish and I Asian lady • 6 men and 5 women • Variety of aphasia – very severe to very mild

35. Voluntary Connect Community Home Out and about in London art galleries the pub Cathedral walking… Where did the visits take place?

36. ‘You talk about day to day stuff’ ‘As a befriender I hope I offer motivation and hope’ ‘listen and listen well’ ‘it help because you have been there and it makes people realise they are not alone’ “Going out(Cathedral, Tate ) made more time” ‘personal experience’ What did they do?

37. The process: differences? • ‘regular visiting’ varied in timing and duration • Supervision • Feedback sheets – don’t work for all • Support groups excellent • more often • Prime means of supervision and peer support • Greater flexibility to allow for difference

38. How is a befriender different to a conversation partner? • Not necessarily providing ‘supported conversation • Ramps, props – yes • Key words - tricky • Befriendees often more ‘eloquent’ though much less confident than the befriender • Supporting befriendees with very severe aphasia was a severe challenge

39. For the volunteers: A new role as a trained volunteer Increased confidence positive information sharing about stroke For those they visited: Information and support at a critical time Positive role model – someone positively living with stroke Confidence What were the benefits?

40. What did the volunteers say? • “confidence” • “engaging quite a challenge…rewarding – getting message across” • “I see myself fulfilling a role” • “I don’t want anyone left on their own. I remember what it is like. Families are kind but they don’t really understand” • “it’s a rewarding thing”

41. What did those they visited say? • “J. more confidence and willing to try new things” • “confidence” • “Think he enjoyed it” • “Its really made a difference” • “Its giving people the message that there is life after stroke and people shouldn’t be intimidated” • “They have given me hope about the future”

42. So what is Befriending? • ‘same as me’ • meeting up • Being friendly and supportive • Interacting … Listening • Sharing experience, empathy… • Tips and ideas…trying new things • volunteering…

43. From the eyes of the volunteers • “You couldn’t do it” • “Really is not yours, its ours…The only way people with aphasia will feel supported will be by speaking to anotherperson with aphasia” • “You are one person, we are 8 people… seen 8 different people”

44. Contact us: Your sallymcvicker@ukconnect.org www.ukconnect.org