Trish’s social prescribing story : Engaging a client with social prescribing

Trish, a social prescriber working in a third sector organisation in the East of England shares her experience of working around barriers that dementia poses when supporting her clients. Memory problems creates some challenges.

Trish often finds that, even when first contact has been successfully established, or certain actions have been agreed in previous sessions, the client with dementia may have forgotten them in subsequent sessions:

“There have been times where I have to remind patients who I am really exactly, what conversations we’ve had and you know, going back to that thing”.

It is good practice, therefore, to:

“Check with them ongoingly that they know that they are with you and that they agree to your support in this journey. Starting every consultation with a reflection of the last thing that we said and ending each consultation with that reflection as well. And sometimes I ask them to write some things down and then I might suggest putting it somewhere we can both remember. So next time we’ll speak I’ll ask them to go to that place and then they’ll find where it’s written down. And that already helps to jog their memory”.

Building trust and rapport with clients with dementia might also prove difficult, especially, as Trish suggests, with clients who live alone. Trish finds it quite helpful to go and visit the person in their own home, or to schedule a face-to-face appointment at the GP or office with the client and a family member.
She feels that talking over the phone is not conducive to building rapport and working with clients with dementia:

“I’ve gone through so many difficulties with supporting remotely a dementia client. And you know, this is where sort of adaptability does have to happen just because their perception and how they’re receiving the information on the phone can be really difficult”.

Visiting a client at home also provides important clues when assessing the person’s situation and environment:

“You are assessing the person as a whole. It’s a holistic approach. So even the way they look, how they move is important. We can see the environment, how they live, what it looks like, you know, is it unkempt? Is there any hoarding? We don’t get that information over the phone”.

When visiting a client in their home, Trish finds it helpful to break ice with some small talk:

“I start by asking questions like – what does your day look like? Talk to me about your day – Humour also works well. I always say a joke is good. Or if they’ve got a dog, I’d ask about the dog and what’s its name, what kind of dog is it. And then the next call I’m mindful to say, like – how’s Sherry doing? – Cos if you show a little bit of humanity and kindness and interest, clients eventually start to open up”.

Asking clients to talk about themselves is a perfect icebreaker and it also enables Trish to start identifying potential support needs.
Because of the lack of knowledge around social prescribing and the lack of personalised care within healthcare and general, Trish finds that a lot of clients:

“Just hearing their background story, just hearing what’s been happening for the past six months. You know, just having that kind of narrative sometimes can help. Cos people are a bit like – I don’t know what I need. No one’s asked me this before. I have no clue where to start”.

Trying to engage clients in conversation might not always work. So, social prescribers should be flexible and open to revisit questions and discussions at a later stage.
Lack of cooperation or mistrust may be common on “bad days”, and the person may be willing to engage on the following session, as dementia symptoms fluctuate over time:

“You might ask a question and if they’re not receptive to it at that time okay leave it then ask it another time. Being able to read their mood is important. You know, some people with dementia can be very frustrated, so bringing up the topic brings up a lot of frustration for them. And you know, just being able to recognise and be sensitive towards that”.

It is also good to keep in mind that when working with clients with dementia, social prescribers have to be realistic about goal setting. Trish finds that in her experience:

“Sometimes, it is baby steps, really. The first goal that we might agree is that they’ll answer the phone to when we make an appointment, because we get a lot of people who don’t answer. So that’s the initial small goal, and that really is a lot sometimes”.

And sometimes, working toward a final goal requires finding out and addressing all the barriers that act like immediate barriers to that end goal:

“I had somebody who wanted to be linked with activities and exercises, but when we started talking they wouldn’t really engage because there were mobility issues, bereavement and financial issues and all of that together created one big barrier. But once we started talking about these and addressing them, then again, they’re more likely to actually reach their goal”.

When setting goals with clients with dementia Trish also finds it helpful to summarise what has been said/agreed:

“So, when they do speak for quite a bit and then I notice recurring themes within what they’ve brought up, I always kind of summarise them and I ask them whether they agree that these things are there or whether they feel like they need to correct me in anyway”.

It is also good practice to send recap notes upon completing individual sessions. This also helps to keep caregivers up to date, if they are not present in the session:

“Quite often I like to send an e-mail afterwards. Just saying this is what we discussed. These are the things we agreed. I think the idea of a follow up e-mail with a list of the sort of actions, is very helpful for people to remember, but also to structure their mind in terms of action plans. I think that’s quite helpful for my protection, I also put in if they’ve declined anything”.