Griffith researchers from the Department of Business Strategy and Innovation, have completed their Intergenerational Care program trials and released their research evaluation frameworks and key findings for the conclusion of the Intergenerational Care (IGC) project – at South Bank Campus on August 21.
This interdisciplinary project was led by Dr Katrina Radford (CI Workforce Lead), and involved
Professor Anneke Fitzgerald (CI Program Evaluation Lead: Fidelity and Sustainability) both from the Department of Business Strategy and Innovation, along with Dr Nerina Vecchio (CI Economic Evaluation Lead) from the Department of Accounting, Finance and Economics, Dr Jennifer Cartmel (CI Education Lead), from the School of Human Services and Social Work, and Professor Neil Harris (CI Program Evaluation, Lead: Participants Outcome) from the School of Medicine at Griffith University.
The research assisted by Dr Xanthe Golenko (Project Manager) – demonstrates how merging child care and aged care systems, along with the widespread implementation of intergenerational care programs can enhance engagement and create a special bond between the generations – which has a positive impact on the sense of wellbeing among the elderly, especially older people with dementia, and improves confidence and communication skills in children.
“The Intergenerational Care project was funded by the Dementia and Aged Care services and it was on the back of three years of preliminary research conducted by Professor Fitzgerald, Dr Radford, and Dr Vecchio, that enabled us to get funding,” said Dr Golenko.
“The overall purpose of the Intergenerational Care project is really to contribute to building age-friendly communities, through the development, implementation and evaluation of the intergenerational learning program.”
“The project was conducted across four research sites, one in Brisbane, two on the Gold Coast and one in Sydney. And the curriculum was co-developed from the workforce at different sites, so it was tailored to meet the needs of the children, the older people and the environment at the facilities.”
“The workforce participated in a training program which was designed to develop understandings around intergenerational practice that extended beyond their professional training in either child care or aged care.”
“Our evaluation framework looked at participant outcomes, in terms of health and wellbeing and program satisfaction. We also looked at educational and workforce outcomes, job satisfaction, staff retention and career development, and the economic outcomes in terms of costs and benefits. And we looked at program fidelity and sustainability,” said Dr Golenko.
“We used a range of qualitative and quantitative methods from survey, video ethnography, reflective journals, interviews and cost information – and after an extensive process of data analysis and comparing and contrasting we will be presenting the findings tonight.”
Four short presentations were given by the Chief Investigators and researchers on the key findings in each of the main research disciplinary areas.
On the aged care learning side, Professor Fitzgerald explained the senior participant’s outcomes, and that a gap in the literature on how elderly people learn was identified, that’s being investigated further with the creation of a new field of research called ‘eldergogy’ by Professor Fitzgerald and others in the IGC project team.
“There are really four major outcomes for the senior participants, themselves. The first one is reciprocity (in learning), we looked at that issue through the interviews and video recordings. What we really wanted to know is how do older people learn, how can we actually identify that some learning has taken place?” Professor Fitzgerald asked.
“So in the background we did a systematic literature review, to have a look at what is known about how older people learn. And there is very little known about that, because people just assume that older people don’t learn, for example.”
“The learning that’s in the literature is about a medicalised learning, so how can we teach older people to take the medication – but we think there is much more to say about this, and we are at the moment developing something that is called ‘eldergogy’.”
“What we found so far, and what we are trying to find the evidence in, especially in video ethnography – is that eldergogy is a fusion of pedagogy and endagogy, on most levels. But one of the things that eldergogy is unique in is upholding independence for older people.”
“So that’s one of the characteristics of eldergogy and that needs to be taught. It’s also about preserving their social role and relevance, and upholding that is very important,” said Professor Fitzgerald.
“The third thing it’s really about obtaining transcendence, and transcendence is about knowing that you’re wise and that you feel good inside yourself in such a way that you can transfer that onto others, like self-actualisation. And transcendence is a self-reflective process that we can do as teachers of older people through reminiscence.”
“The next participant outcome that we identified was a positive sense of wellbeing, which was largely in the surveys. Even though we had a very small number of people, there was no indication that the IGC program was bad for anyone, so we are actually claiming that it was good.”
“The other one was reminiscence and reflections, and we got them out of the interviews. They reflected a lot as a result of the IGC program, on the meaning of life and their role in it, and the place of them in the lives of the children – which is actually a really a positive thing, especially when people haven’t thought about it in that way before.”
“People also commented on the self-actualisation and the wisdom and the things that they had that they could share, and we termed this the preservation of social capital. They like to reflect on their achievements in life and tell their stories to the children on the basis of the activities that had been done,” said Professor Fitzgerald.
“And the fourth outcome which was, evidence of meaningful engagement in the video recordings. What we saw over time was people grew and became much more comfortable with one and other, there was quite a bit of bonding especially through physical contact.”
“We also did some mood scores with community-based participants, and we saw that over the 16 weeks, the mood score at the beginning of the sessions increased and the people started to look forward to coming – they were already happy before it started and that was an interesting finding.”
“In terms of the senior participant’s outcomes – the type of activity was really important. The low-energy activities, like reading, bonded people closer together. The one-on-one activity helped with meaningful bonding.”
On the child care learning side, Dr Cartmel explained the research commenced with an extensive literature review utilising the Early Years Learning (EYL) Framework, and the Neurosequential Model in education to underpin the research framework – along with the Lewin Scale to ensure there was a high level of learning for the children.
“We undertook an extensive literature review when we started to establish the program and considered what would the program be about?” Dr Cartmel asked.
“So we used the Early Years Learning (EYL) Framework, because that was one of the other important things around this project, because our workforce was our researchers as well and so we wanted them to undertake activities that were part of what they already did, without too much being layered on top of them, when we were asking them to feedback to us.”
“We used the EYL Framework to help with the development of what kinds of things we would expect, and we also relied heavily on the neurosequential model in education.”
“It was really interesting to see the different ways that the program was documented Weekly the different sites used different methods to actually help the children remember what was happening.”
“So they are able to use the Intergenerational program and the activities both to be accountable but also to support the work within the program,” said Dr Cartmel.
“Because one of the things around engaging the children and the older people was actually choosing experiences that were going to have a high level of learning for both participants.”
“We used this underpinning of the neurosequential model, looking at how the brain actually developed and what kinds of learning experiences pinched to those.”
“If you look at that neurosequential model, the baseline sensory experiences to the higher-order more complex challenging activities – we found that some of the group activities were actually too complex, too many rules to follow, so it was really difficult for that engagement to happen.”
“One of the ways that we measured the children’s responses was with the observation of staff using Lewin Scale – and we used this score also for the older people to measure their wellbeing and contributing and how involved they got in the activity,” said Dr Cartmel.
“The Lewin Scale looks at scoring children’s wellbeing between 1-5, and scoring their engagement between 1-5. The Lewin score said that if you have got good high-level wellbeing and high-level engagement, then learning will occur.”
“It was helpful to us and the workforce because it gave them something to leverage off – and I had a chance to look at the Lewin Score for the children over the 16-week period and it went up – so we can be really excited about that the children did learn and had sense of engagement in the program.”
“So that even though it went up and down depending on the activities, with the overall program the children really have some mutual gain from being part of that program.”
In the workforce area of research, two questions were examined by Dr Radford. One question asked what value does an IGC Program add to the attraction of the child care and aged care workforce? And the second question asked did being part of an IGC Program change people’s perception of the opposite career path?
“We know that both these workforces actually have a challenge around turnover and getting people into the program,” said Dr Radford.
“What we wanted to know, was there anything that Intergenerational Care did to both workers, in order to add to that attraction? And we actually looked at would it change their perception, pre and post, of being in that career path – so are we actually giving reflow into that other sector?” Dr Radford asked.
“What we found was that across both aged care and child care, that it adds meaning. We know that child care and aged care workers, have a whole lot of intrinsic motivation that goes behind what they are doing on an everyday basis, but this program added more meaning.”
“It really gave them an opportunity to say, what else is out there and how can I go and get it? So it expands their knowledge and it actually enriches their job, which is really exciting but at the same time it adds more stress to them.”
“And some of the nuances that came out were around the concept of setting-up and packing-down – so who is responsible, who does it and do we share that responsibility, is there a consultant? Or how do we organise that at that practical level?”
“Because it does add that extra workload and it does tell us that if we are going to create IGC as a workforce career path, then we do need to think about how do we price position that salary because it is extra work on top of what they are doing,” said Dr Radford.
“The other finding was that Intergenerational Learning programs allow for greater possibility for attracting employees. What was interesting before the program most of our staff members said ‘I would never go over there’, with a negative schema in their minds. But then they got into the program and learned how to talk with new groups.”
“And the other interesting finding was interprofessional communication. So aged care and child care they talk different languages, and that was really challenging for our staff. But over the course of the trial 16 weeks, our staff members actually learned a different language.”
“One of our key findings is you need to invest and you need a professional training program. You need to start thinking about where is your support, when one talked about educating and the other one talked about care workers.”
“We found that it either strengthened their desire to never go into that sector, as a career path, or it strengthened their desire to go into that sector. This does tell us that ultimately we do need to see it as a legitimate career path because some people do want to go between both, and to do that we need to have some form of qualification,” said Dr Radford.
“And for the second question, how does the IGC Program influence work satisfaction and the overall retention and turnover – e.g. will adding another job responsibility change whether you want to stay or leave? And the answer to that was no.”
“If the IGC Program is going to be a new career option – which seems to be supported by the workers that wanted to do a Certificate 3 or 4 in Intergenerational Care – then we need to recognise that as a form of qualification, and then pay them appropriately for the workload.”
The important question of how much does the program cost for stakeholders, agencies and other policy-makers looking to implement a learning program, was evaluated by Dr Vecchio’s research team and presented by Ms Nicole Moretto Health Economics Research Officer at the University of Queensland.
“What we did in order for us to do a cost analysis we took the study data and the costs, we supplemented that with the interviews from some of the agencies as well as some other published information,” said Ms Moretto.
“And we did the cost analysis from an agency perspective, valued in 2018 Australian dollars. So we had to make some assumptions about the program – in the trial it was a 16-week program of a one-hour duration.”
“After we got together with the project team and some of the experts, and what we wanted to do was look at a two-hour program that was once per week, 36 weeks in the year with some breaks that aligned with the school term.”
“We also had to look at some other assumptions, so we had to ensure that staff ratios and staff-child ratios were met at all times. The national staff ratios are one staff member to eleven children, in most States and Territories across Australia.”
“We had to take into account an excursion ratio when children are travelling off-site to the aged care facility, that ratio goes down. So it is one staff member is to four children – that significantly affects the costs,” said Ms Moretto.
“We made the assumption there would be a class size of twenty-two, a portion of them would be engaging in the learning program and a portion of them would not. So we had to make sure that we staff back-filled for those that were not engaging in the program.”
“So what’s the best model? Is it the visitation model, whereby the program is operated from the child care centre or is it the visitation model where the program is operated from the aged care centre – or is it the shared model, e.g. is a co-located or shared-centre – what is going to be the lowest cost? We looked at five scenarios that tried to answer this question.”
The breakdown in costs was discussed and it was explained that the one-off costs were similar across the scenarios, i.e. equipment, furniture, chairs, etc. As was the initial staff training costs. Materials and facilities costs were also evaluated and ninety percent of this cost was the room where the learning was conducted, along with minor costs for books and craft materials.
“Where we had a variation across the scenarios was with the recurrent staff costs. These are the educators and the aged care providers that are undertaking the IGC project, as well as those that are backfill in the centre,” said Ms Moretto.
The costs of running an intergenerational learning program were found to be the lowest in two scenarios; (1) where the older adults were transported to the childcare centres and (2) where both older adults and children were based at a shared centre. In conclusion, Ms Moretto suggests there is no best model of intergenerational care because it’s very context dependent.
“So what is the best model? Ultimately, it really depends on context. So if you have a new suburb, then it might be best to have a shared centre. But if you already have an existing service, then having it at a child care centre would have the lowest cost,” said Ms Moretto.
“But if you already have an existing aged care service that would like to invite some children over and they can walk down the road, then that would be appropriate too. It’s overall a low-cost program that has many benefits that fit the different sectors.”
For further information on the costing breakdowns that were examined in detail, please contact Ms Nicole Moretto for a summary.
The findings of the IGC program fidelity evaluation – was discussed by Professor Fitzgerald, after extensive analysis and contributions from program researchers, child care and aged care experts – the key message was while intergenerational learning is complex it’s wise to do it as a community and society.
“Fidelity is a word that comes from the implementation side, and it is about, did we achieve what we set out to achieve? And fidelity should really be considered prior to the whole program starting,” said Professor Fitzgerald.
“But what we wanted to do was to figure out what could be the barriers to this implementation, because implementation science tells us that implementation failure is 80 percent or upwards.”
“So we looked at the fidelity of the process of implementing because we know that the intervention is good – the challenges that we had at looking at the program fidelity, is that it was much more complex than we imagined – also fidelity is very contextual.”
“We found there was not a really good definition of fidelity, so we added to this, and we said why not have a framework – something that is much more practical to use.”
“There are quite a few learnings – something that is really quite clear in our fidelity testing is that interprofessional collaboration doesn’t just happen,” said Professor Fitzgerald.
“We found quite a lot of things that we partly or did not achieve even though we set out to achieve them, basically because that needs some very basic planning, leading and organising control. It needs management of that and we need to do that in the beginning, not in the middle or at the end.”
“Another learning was at the beginning we should articulate the roles and responsibilities of the different professions, as early as we can. And that includes policies and procedures with that.”
“So that planning of how are the age care worker and child care worker going to work together, to actually get the best out of this for the children, needs to be addressed very early.”
“Another finding that we came across, and the biggest challenge that we had, was at one point we asked experts what do you think is the core component?” Professor Fitzgerald asked.
“And identifying the core component of the project in this case, the intervention, was incredibly difficult to articulate, and we probably are still not there yet, there’s probably still a little bit to do.”
“Basically what we found with the program fidelity is that we can prove with this, that we have gone from something that we all know is quite nice, warm and fuzzy, to something that should be right.”
“So from something that is nice to do, to something that is wise to do as a community, as a society, we really need to encourage intergenerational learning.”
The Question and Answer session followed with some interesting questions from participants about the continuation of intergenerational learning programs in Australia and if there were any concerns raised by parents about engagement between children and elderly people with dementia?
Participant 1. (Child Care Industry)
At the sites that you were working with are there any Intergenerational programs continuing?
“Yes, those programs I know that they are continuing in a couple of sites. Particularly in the first site, that program has actually shaped what the whole child care centre is doing,” said Dr Cartmel.
“Previously they had a very much performance approach to the way in which they engaged with their older residents in their community.”
“And now they have taken it to a much deeper level, looking at what learning opportunities are there for both the children and for the older people.”
Participant 2. (Mother/Grandmother)
“I’m living with younger onset dementia. So I have a special interest in what you’re doing as a mum and grandmother,” said participant 2.
As you went through the trial did dementia come-up? Were there concerns from the parents? How did that fit together with when you were thinking of the risks and the tasks as you went forward to designing your project?
“Yes well – it was a big concern of ours and actually we were talking a lot at the beginning as to how can we mitigate those issues,” said Professor Fitzgerald.
“And in the end we let the aged care facility choose their participants and the child care facility choose their participants.”
“Even though originally we thought it was a cop-out, in the end it was actually a really good decision. So that dealt also with some of the ethical issues that we had in terms of getting research ethics (approval) for this project, because we were dealing with vulnerable people.”
“Originally we set out to have this program particularly involving people with cognitive decline who had been diagnosed, not too long ago. And that happened but we did not focus on it.”
“We did not ask in the demographics for example, whether they were diagnosed with cognitive decline, we felt that was not the mission because they were chosen by their own organisations,” said Professor Fitzgerald.
“Because it was in the community there tended to be less risk involved. Because of a lower existence of the dementia condition,” said Dr Cartmel.
“But we really felt that it was important to look in the community rather than something like a nursing home, because there is a real need for it in the community.”
“In fact we find that people aren’t taking up services in the community, either it’s not there or it’s not suitable for them.”
“People with dementia as a main disabled condition are 8.5 times more likely to be in a nursing home, than people with other disabled conditions. We need to do more in the community and this is what we are doing now.”
“In the beginning the biggest question that we had was, do we need a police check? And that is a practical and ethical decision based on values of that organisation. I think that from the end of this project we can recommend that we should have police checks,” said Dr Radford.
“And that includes all participants as well as all workers. And we know that child care and aged care workers already have police and federal checks, so that will just be extending on volunteers basic police checks for participants.”
For more on the questions and answers from the event, see the full video recording.
The research impact summary was presented by Professor Anneke Fitzgerald that explained the five key areas of research impact and dissemination.
“So we really need to find out have we actually impacted where we intended to impact? And from the researchers in the room we know that this is becoming a much more of an issue, also in terms of trying to get funding for some of the ideas we had and setting up a national network for us,” said Professor Fitzgerald.
“So there are at least five key impact areas, and to start off with – impact on the research team. We’ve been able to support a PhD student and also some scholarships to tender in the general school. And we are also looking at career advancement by creating these combinations that Dr Radford talked about earlier.”
“In terms of participation in the program – for program participants, there is an absolute impact in terms of wellness and we have been able to show that as well as a reduction in social isolation.”
“We also think that children communicate better, when we look at the video ethnography we can see that the engagement becomes more meaningful over a period of time.”
“We actually think there is definitely potential to reduce ageism, and we think it improves communication and understanding of the children, so a lot of potential impact from participants,” said Professor Fitzgerald.
“In terms of aged care and child care sectors – well one of the major impacts I think we have had is the Maranatha House, where we have been able to support Maranatha to get the funding from the government to build a purpose built building for intergeneration learning.”
“And another one of course, is the professional development and career opportunities that we are creating through our idea of creating a pathway through education.”
“For the general community – we know that we need to preserve social capital of older people who have got a lot to offer and that offering may need to be encouraged through intergenerational learning.”
“And the big impact area is International stakeholders – so we went to Generations United (US Conference) and they were very interested in the Australian experience. There were a couple of us there and we certainly made some impact through the discussions we had there,” said Professor Fitzgerald.
“We also work together with the University of Granada in Spain, and they actually do have a Certificate for Intergenerational Learning, we have trained-up one of our staff in that so that she has now got that certificate in Intergenerational Learning.”
“And she will be trained up as an Australian tutor for that particular qualification. Because we know that it will be taking us a little while to get a qualification up and running in Australia. So at least we are opening the pathway up for Australians to do the Intergenerational Learning Certificate here.”
The Q&A event was attended by Griffith University academics and students, child care and aged care industry participants and representatives from the Australian Broadcasting Corporation (ABC) and Playgroup Queensland.
Ms Terri Calder from the ABC announced that they have a new television factual series on intergenerational care – ‘Old People’s Home for Four Year Olds’ that starts on August 27. The ABC is embarking on an intergenerational experiment addressing Australia’s loneliness epidemic that will be screened over five weeks, with a team of experts in geriatric health and wellbeing and an early childhood expert who will scientifically analyse and monitor the progress.
“I think it’s really going to support your work – and we have had briefing events in Sydney and Melbourne and we invited people from the aged care sector, early childhood learning sector and the IGC Project to have a conversation,” said Ms Calder.
“That really is about supporting and strengthening your work for building this support for intergenerational programs to produce better health outcomes and reduce ageism.”
Ms Penny Allen and Ms Maree Stanley from Playgroup Queensland presented on the initiative ‘Ageless Play’, that seeks to bring together the generations through a range of playgroup programs, supporting communities and nurturing relationships through play for mutual benefit.
“Playgroup is where parents stay and carers stay with their children and they play, and the children range from birth to five years. They often meet once per week, in a community space, perhaps a hall, a school, a park or their own home,” said Ms Allen.
“The overall aim is that families are connecting with each other in their communities and often building life-long friendships.”
“In 2017, I was given the opportunity to pilot the intergenerational playgroup here in Brisbane. We worked in collaboration with Catholic Health Care – and we embarked on a journey and it went amazingly well.”
“We started with a couple of families who became parent advocates for the group, and they invited other families at every opportunity they had.”
“We began a process of trial and error. We created a program based on the guiding principles of respect, sustainability and quality,” said Ms Allen.
“This program ‘Ageless Play’ encompasses learning experiences that are aligned with the play pathways, which is the ADC and the EULF mapped together.”
“There is also an online training mechanism and guidebooks that explain how you join the generations together, while also providing quality and sustainability.”
Ms Maree Stanley is currently working on a research and evaluation plan for Playgroup Queensland to examine the perceived benefits of attending playgroup for each of the stakeholders.
“Our hope is that ‘Ageless Play’ will become the norm, not a novelty in our community,” said Ms Stanley.
To learn more about the Intergenerational Care Project that was co-created by Griffith researchers and workforce participants through a collaborative process drawing on theoretical frameworks from the literature, and to see what resources are available and what activities are continuing, please visit Intergenerationalcare.org or contact Dr Katrina Radford or Professor Anneke Fitzgerald
Video: See the Q&A Open Forum 2019 event recording here.
Feature Image: ‘Old People’s Home for 4 year olds’, the ABC