Learning Tools

Learning Tools
Learning Tools


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Direct Observation Form
What the result will look like: A written on-the-spot account of the clown vist
Description of the tool: This tool is a checklist to assess conditions and reactions of participants observed during a clowning visit.

Observers attend a clown visit in person and fill in a standard form organized into 5 major areas in which clowning is expected to have an effect on participants: mood, stress, attention, physical behaviour and connection. Observers are asked to note each unique instance of a positive change in the effect area, and to provide a brief description of the change observed. They were also encouraged to review the results with a caregiver or someone who know the participants well in order to validate and interpret what occurred during the session.
When it can be used: The tool can be used to understand the effects of clowning for participants (people with dementia, children with autism etc.)
Who it’s useful for The clowns can use the observations to understand the effects of the visits and adapt their interventions.

The project team / organisation can process a greater set of data (if there is a systematic collection of the observation forms) to create evidence of the effects of the interventions.
Length of process This is a one-off tool that takes about 15 minuted to fill in. To extract deeper learning, it needs to be repeated and time should be allotted for processing the data.
Main features – advantages It is time considerate.
The prompts facilitate more openess to notice and capture effects of a visit.
Main features – disadvantages The data collected depends on the training and orientation of observers.
Guidelines for implementation: Explain the purpose of the tool.
It is important to emphasize that the form is not an evaluation of clown performance.

Make sure there is a common understanding of the concepts.

Validate the assumptions.
Encourage observers to validate the information with caregivers.
Tool in practice: In ClowNexus, this tool was used during the evaluation, both at the beginning of the project and as part of the final evaluation, to understand the effects of clowning and what changes can be observed in time at the level of immediate effects.
Attachments / Images The unfilled checklist featured in ANNEX D can be turned into an attached PDF.
Origin of the tool: This tool was developed in the ClowNexus project.
My Favourite Story
Name of the tool: MY FAVOURITE STORY
What the result will look like: A collection of stories, ranked and interpreted
Description of the tool: This method focuses around a group discussion where participants discuss and rank stories, to find the favourite story of the group that best illustrates a certain theme.

The facilitator leading this activity firstly collects and edits stories that can illustrate notable moments (i.e. “the positive effects of clowning on older people or children”). Then, a group reviews the set of “special moments” narratives, each participant chooses a favourite story. In the end, as a group, they come to a consensus about their favourite story overall and describe the reasons why.

The group discussion can take 90 minutes to two hours and is organised in six parts:
1. Introduction: Facilitators welcome participants, obtain informed consent, and lead an icebreaker for participants to introduce themselves.
2. Discussion of Stories: Participants identify which story they had chosen as their favourite and why, and react to others. They discuss why and how the effect described in the story is relevant and share their own experiences.
3. Group Vote and Debate: The participants are asked to pick only one story as a group. Debate is facilitated to decide between the two top voted stories.
4. Final Vote: If consensus isn’t naturally reached, participants will vote on their final selection out of the two top stories voted by the group
5. Participant Reflection and Conclusion: Participants share how this activity helped them reach a deeper understanding.
6. Closing
When it can be used:
It can be used to explore shared values among a diverse group and gain an understanding of shared experiences.
Who it’s useful for The project team / organisation can use this method to evaluate the impact of the intervention, to identify promising practices and to incorporate different perspectives into implementation. Some stories can be used in raising awareness activities (keep in mind that you need to have consent for this).
Length of process It is a short-term process, involving activities to collect and edit stories, a 2 hour session and additional time for follow-up.
Main features – advantages The use of stories unearths new and deeper perspectives.

Beginning by talking about someone else’s experience is a useful entry point for discussing own experiences. Participants usually speake openly and freely about their own sensitive experiences after they had developed rapport with each other by talking about the common stories.
Main features – disadvantages It can be time consuming.
A clear understanding of the tool is necessary for the facilitator, especially in choosing the stories so they spark debate.
Guidelines for implementation: Initial story selection matters.
All stories should be at the same level so that they could be plausibly chosen by any participant. In practice, this is difficult to do, and some stories can outshine the others. It is useful to review the stories or potentially pre-test them to see that they illuminate different perspectives.

Don’t forget about the editing.
Remove any identifying information. Edit the stories to be of similar length and detail.

Decide if the discussion will be online or in a face to face setting.
During the ClowNexus project, participants joined by online video conference and viewed a virtual whiteboard at the same time. Two facilitators led the session, with the evaluator observing. The first facilitator had overall leadership for managing the discussion, while the second took notes and organized the virtual white board.

Voting and debate is one way to spark discussion, but not the only option.
Holding a two-round runoff vote for the group’s favourite story is planned to spark deeper discussion and help participants understand and adopt new perspectives. This typically works well in cultural contexts where such competitive debate is welcomed, and if the facilitator keeps the session light and fun. Other methods to encourage discussion include a wider set of discussion questions, exploration of the second-favourite stories, and exploration of the last favourite stories.
Tool in practice: In ClowNexus, the tool concentrated around stories of ‘special moments’ that described the positive effects of clowning for old people, to uncover what are the perceptions of different stakeholders about healthcare clowning and the impact it can generate at the level of the target group.
Attachments / Images The sample planning guide featured here can be turned into an attached PDF.
Origin of the tool: This is an adaptation of the Most Significant Change method, which is a qualitative method used for group learning and adaptation. Most Significant Change is a narrative-based tool that generates stories from frontline stakeholders on changes in their lives, organizations, and contexts. Most Significant Change is traditionally used to help program managers understand which parts of the interventions had the desired effect, what other results have emerged, and why and how change occurred. The process of collecting, analyzing, and prioritizing stories through this method provides insight into what an organization values. By repeating the activity over time, the method supports continual learning and adaptation, as well as early identification of successes and failures.
How change happens
Name of the tool: HOW CHANGE HAPPENS
What the result will look like: A map of factors generating change, their effects and the relationships between them
Description of the tool: This method refers to a facilitated discussion useful in exploring diverse and complex perspectives around a given theme. Participants generate ideas on different factors that influence a change and then they create a visual map of the relationship among different factors: what causes what and how they interact to create change.

The session starts with a short introduction to welcome participants, obtain informed consent, and allow participants to introduce themselves through an icebreaker. Then, using a guiding question (i.e. “What happens during a clown visit?”), participants share their experiences related to the issue discussed. Each individual idea or factor is captured by a second facilitator on sticky notes on a board, and grouped together with similar themes.

While participants take a short break, facilitators check in with each other to reflect on the session so far, as well as continued to organize the stick notes thematically on the board.

After the brake, facilitators help the group to draw connections between sticky notes, drawing arrows between ‘causes’ and the ‘effects’ and create a final moment for reflection and closing.
When it can be used: It is a method useful to collect and analyse data about the current needs of audiences.

It can serve as a foundation for collaboration. This method helps different individuals explore and understand how others view a specific issue. It uncovers not only perceptions of how the world is, but also what are the driving forces behind it. Systems mapping is often used to explore and shape “mental models,” which are the deep-rooted beliefs that capture how an individual makes sense of the world. The How Change Happens pilot specifically sought to bring together individuals with different perspectives, and this was considered to be a major component of its success. In the future, this activity could be a useful starting point for stakeholders who will be working collaboratively
Who it’s useful for The project team / organisation can use the map to understand the point of view of different stakeholders.

The clowns can use the process to create the basis of meaningful collaboration at the start of a co-creation process.
Length of process It is one activity, involving a 2 hour session and additional time for preparations and follow-up.
Main features – advantages It helps to understand the programme theory of change from frontline stakeholders’ perspectives – which can be different from the programme planners’ perspective.

Main features – disadvantages It can be difficult to explain at the onset and may feel intimidating or very different from what is typically done.

Planning and managing this discussion successfully requires a highly skilled facilitator. It is also useful to have a second facilitator assist with the white board.
Guidelines for implementation: Choose your guiding question
A general framing question results in ample discussion but less depth. Part of a systems mapping activity is to define the boundaries of the system that will be mapped. For the first piloting of the activity, it was considered useful to have a broad question (the system boundary) to ensure there would be sufficient content to discuss. With more experience and planning, in the future similar activities could focus in on areas of particular interest.

Decide if you will do it online or offline.
Systems mapping can be done virtually, with limitations.

Limit the session to 2 hours.
The session should be limited to 2 hours, as it is considered that this was the maximum time that participants would be willing to spend and able to pay attention. Typical systems mapping activities require significantly more time for participants. In addition, due to the limited time and the desire to avoid technical difficulties, the second facilitator took the responsibility of writing sticky notes on the white board and drawing connections, but the method is originally intended for participants to take the lead on these activities.
Tool in practice: During the ClowNexus project, “How change happens” took the form of an online 2-hour workshop facilitated in the local language to generate ideas on the different factors that influence a change during or after a clowning visit. This provided insight into the potential benefits and impact of healthcare clowning.
Attachments / Images The sample planning guide featured here can be turned into an attached PDF.
Origin of the tool: This is an adaptation of Systems Mapping. Systems mapping can take a range of formats, from causal loop diagrams that show relational dynamics and systems change across a large number of interconnected factors, to influence mapping that shows the relationships between proximal causes and effects.

You can read more about Systems Mapping here.
Art Voices
Name of the tool: ART VOICES
What the result will look like: A collection of pictures and short testimonials
Description of the tool: Art Voices is a participative method that uses photography and small testimonials to gather personal views on a specific topic.

The participants receive a question (such as “What are the benefits of healthcare clowning?”) and are asked to respond with their own photo and a small text explainig / narrating the image. Participants also have the option to respond with another type of art, such as a drawing.

By using photo submissions in response to a question prompt, this activity invites broader and more creative responses to qualitive questions, and may be particularly useful for gaining the perspectives of groups that are more comfortable expressing through image.

The activity can be repeated over time to understand shifts in themes and perspectives.
When it can be used: Possible uses:
– to evaluate interventions (e.g. How did the visit make you feel?)
– to explore the viewpoints of participants and family members
Who it’s useful for The project team / organisation can use the findings to shape interventions. Photos and captions can be used in raising awareness activities (keep in mind that you need to have consent for this).

The clowns can use the insights to understand different points of view on their work.
Length of process It is a short-term process that implies consecutive related steps.
Main features – advantages The ability to explain ideas and experiences using visual images rather than words.
The method generates more creative expression than others.
Main features – disadvantages – It is time consuming in regards to preparing the instructions, sending the instructions, collecting the responses.
– Including a final sharing session is highly recommended, but presents practical concerns.
– It is important to consider the permissions and parameters of the photo submissions. Pictures should follow strict consent guidelines and ethical requirements that need to be made available to all those involved.
Guidelines for implementation: Choose a framing question. One idea is ‘What does clowning mean to you? You can suggest another, similar question that makes sense in your context. Some other ideas are, “What feelings does a clown visit bring?” “How does clowning affect you and those around you?” You can also focus it on one of the audiences, like “What benefits does clowning have for children with disabilities?”, “How does clowning affect children with autism?” etc. ]
Decide how the photos will be shared/used. You may want to do an exhibition or a virtual gallery show. You might also consider how you could share the results with participants, even if you don’t hold an event. For example, a selection of photos will be shared on our social media, or we will send you a slideshow, etc. People are generally more willing to participate if they know that they get to see the results (and I’m sure they will find it interesting!)
Protect privacy/photo consent. Emphasize that photos should not be of participants, minors, and vulnerable groups. Please include in the instructions any additional privacy/safeguarding guidelines from your organization for informed consent. An analysis plan is required in advance, which outlines how the submissions will be used by participants as well as data collectors. For the purpose of this evaluation, thematic coding of the art and accompanying narrative was used. Collecting the characteristics of respondents in a standard way can be useful in the analysis.
Choose a deadline. 1-2 weeks should be sufficient to complete the activity. Too little or too much time may make it difficult for the participants.
Tool in practice: In ClowNexus, the tool was used to understand current clowning experiences and to prepare for new clowning activities with the elderly and children.
Attachments / Images Photos and messages are featured in the baseline report. The sample instructions featured below can be turned into an attached PDF.

Sample Instructions

Art Voices
We want to SEE your perspective! As part of the ClowNexus project, we are collecting ideas and perspectives about clowning from six different countries in Europe. This information will be used for the project’s baseline evaluation to understand current clowning experiences and to prepare for new clowning activities with the elderly and children.

The Challenge

Please TAKE A PHOTO or DRAW A PICTURE to answer this question:
What does clowning mean to you?
Write a brief (1-3 sentence) explanation of your photo/drawing.
Email your submission to me by [date].

Be creative! There is no right or wrong answer so you can express yourself any way that you want. There are so many ways to answer this question, and you have a unique viewpoint.
But… Be private! We would like to use your submissions in the Virtual Gallery Show. So, to protect privacy, please do not take pictures of the participants (such as the elderly in homes or children in schools). You may take photos of other adults if they grant you permission.

Please contact XXX.
Thank you!
Origin of the tool:
(Is it copyrighted? Who is describing it? Who supported us in developing / using it? Is it an original method / replicated / adapted?)
Art Voices was developed as an adaptation of the PhotoVoice method (for more information, visit https://photovoice.org).