HARP Journal: June 2021

Welcome to the HARP Journal!  Here we will share news and emerging learning from the ‘HARP’ (Health, Arts, Research, People) programme each month during 2021-22.

HARP is go!

It’s so great to now be in a ‘delivery’ phase of the programme, having spent much of last year re-shaping HARP around the pandemic, processing applications and testing how we might support innovation in arts and health through our HARP Sprint.

We now have 13 teams of arts and health partners working with us to seed, grow and sustain a big range of creative projects to support peoples’ health and wellbeing in Wales.  We announced these partners and places on 15th March.

In HARP we are working in two strands. The first is Seed, where we are forming new partnerships between health places and artists to test out new creative solutions to three key health challenges – care staff wellbeing, supporting Black NHS workers to tell their story, and reducing stigma and trauma for sexual violence survivors in rural Wales. We’re just about the dive into the testing part and can’t wait to see how it goes!  We’re also working with teams to ensure the involvement of data teams, sponsors and people with lived experience to help them develop better innovations that they can embed in health systems.

Nourish is a longer-term endeavour, with 10 innovative projects across Wales receiving grants, coaching and learning support from the HARP team between now and Mar 2022.  The focus here is on scaling and sustaining their innovations, so we are forming learning groups around five key topics that we feel we need to know more about in order for arts and health projects to become embedded in health systems: evidence, referral pathways, delivery, building shared understanding of value and funding. Each month in this Journal we’ll focus on one of these topics and share what we’re learning, starting with evidence!

Project Spotlight – Impelo

Impelo’ is a community dance charity based in mid Wales.

Dance is great for physical and mental health generally, but Impelo are now shifting to more targeted work addressing specific conditions – dementia, high blood pressure, cancer, and so on – with impact for them being people living healthier, more connected lives. This shift in focus means navigating more intense relationships with participants and more complex relationships with health partners, who also require Impelo to have better evidence of impact. The rurality of Powys, where 35% of the population are over 65, also presents a need for innovation.

In Spring 2020 Amanda from Impelo joined the HARP Sprint project, a small pilot innovation project where we brought 12 arts and health practitioners together to see what we could learn about supporting people’s health during the pandemic by testing out new innovations as a team. Amanda’s team ended up running Zoom dance sessions with care home residents and their families. This taught them a lot about how to work in care settings, as well as helping care homes to navigate technologies to keep families connected.

The family here were so happy to be involved and said the dancing gave the video calls with Nan much better quality family time than just the usual stunted ‘how are you’ video calls. The benefit to Nan is that she is physically and mentally stronger, so better able to cope with being pretty cut off, in a high-risk environment for Covid.

Impelo built on this work when developing ‘Joio’, an online dance programme to improve mobility and reduce falls for older people with cognitive impairment. We’re so pleased that Joio is now in the HARP Nourish cohort focusing on scaling and sustaining Joio to reach as many people as possible

Learning points this month: Evidence

Building the evidence base around arts and health innovations to help scale and embed them is a complex challenge.  Through our initial meetings with HARP Nourish and Seed teams, and our first learning group session on 28 Apr, we’re already seeing the following themes and challenges emerge around this topic:

Focusing on the right impacts to measure without narrowing too far: Arts and health projects have many possible outcomes and benefits, not just to participants but also to health organistions’ strategic priorities. Small arts and health innovations can’t measure every possible outcome in a meaningful way, but they don’t want to ‘miss’ something important or unexpected and the language of the health systems necessitates a difficult ‘translation’ exercise for arts practitioners conducting evaluations. We are exploring whether an upfront conversation between participants, clinical teams, commissioners, project managers and artists, where they agree on a concise list of intended impact goals, can lead to meaningful evaluations.

Generalisable vs bespoke findings: every arts and health project is different, with a bespoke and unique set of circumstances – a particular location, a particular artist and/or artform, a particular health impact.  But, in evaluation, how does this fit with the aim of health research which is to find general approaches that can be used across all settings?  We believe you can’t ‘drag and drop’ innovation – a balance is surely needed – so we are exploring whether approaches like meta-analysis, something our HARP research fellow is aiming to do, can help by drawing out common themes from a number of bespoke evaluations.

Ensuring evaluations don’t interrupt engagement with participants: The relationship with participants, especially at the beginning of their involvement with arts and health projects, can be quite delicate. People often join activities with a level of trepidation that can be heightened by requests to fill in (for example) baseline questionnaires. Therefore, some HARP projects are thinking about how to approach the concept of a ‘baseline’ a bit differently, so could there be an existing data set or data collection method that could be used instead of upfront questionnaires?

Budgeting for evaluations and commissioning evaluators: the cost and process of commissioning evaluations, and availability of evaluators (especially Welsh speaking) is a worrying barrier for many practitioners here in Wales.  In HARP Nourish, we have specified that a minimum of 10% of the budget should be spent on evaluation, however this still limits some projects – especially if they want ‘gold standard’ academic evaluations. As well as our partners WAHWN drawing up a list of possible evaluators, we’re interested in how health partners can therefore use existing data collection and research channels to support better evaluations. For example, one team working in a hospital setting is using tools and scales to measure health and wellbeing improvements that the clinical teams already routinely use. Leadership support in health settings is crucial for this.

Next time we will be looking at referral pathways.

Interesting Links

HARP is funded by Arts Council of Wales through the National Lottery. It is delivered by Y Lab, a partnership between Nesta and Cardiff University, supported by Wales Arts, Health and Wellbeing Network and Welsh NHS Confederation.