RN 040

Artistic Tools



There are no filter terms yet


In our experience through ClowNexus, , people with dementia and autistic children can both enjoy art because it engages their senses, lets them express themselves without words, gives them a sense of structure and freedom, and helps them remember and share emotions. Art is a way for us all to connect and communicate.

Grief support for older people with dementia

How do senior citizens with advanced stages of dementia perceive or remember the death of a beloved person?  What signs can we recognize that might indicate that a person with dementia is experiencing grief? How can we best support them?

Read the interview with Ibon Nuñez, Geropsychologist specialized in grief, loss, and trauma intervention.


Older people with dementia experience a progressive loss of cognitive functions such as remembering and thinking. How do they perceive or remember the death of a beloved person?

Ibon Nuñez: Typically, the question is, do they really perceive it? Do they remember the death of a loved one?

The important thing to consider is how it emotionally impacts them to not have that person present in their daily life. Even though the person with dementia may not exactly know who this is – perhaps they don’t know if it’s their child or their partner- but it’s a face, it’s a person that brings comfort, that provides a sense of security.

As studies and literature indicate: individuals with dementia need a routine! Because this routine helps them to have a minimal sense of control. When behaviors occurm that we don’t understand, such as increased agitation or increased aggressiveness, they are often related to a change in the person’s daily routine.

Therefore, the absence of a person who has passed away in the life of a person with dementia is bound to bring about some change. We cannot specify exactly what kind of change it will bring, because it will depend on the individual experiencing dementia and their daily life. But in the end, what we need to consider is that it is a change in their life.


As communication and speaking gets very reduced, what signs do you recognize, that could indicate that older people with dementia are grieving?


Ibon Nuñez: I remember a case of a lady whose husband passed away during the COVID pandemic, and regardless of his passing, the access to the nursing home was completely restricted. She went through changes, and even though she didn’t know that her husband wasn’t there every day helping her with her meals as he used to, she somehow sensed on an emotional level that something had changed, and her attitude shifted accordingly.

The way she expressed herself was changing, as well as the way she communicated, and interacted with other people was significantly different. I am talking about a lady, who, for instance, used to smile a lot, searched for eye contact, and wanted to communicate. Perhaps not verbally, but non-verbally, she communicated in an impressive way.

When we discuss in general what signs we can recognize that might indicate that a person with dementia is experiencing grief, what I would say is a change in behavior, a change in their effectiveness, a change in their way of relating. This might be indicating something.

It’s very challenging to pinpoint a specific pattern for how a person with dementia expresses their grief. It will depend greatly on the individual’s condition, the stage of the neurodegenerative disease, and of course, their connection to the person they’ve lost.

One crucial aspect is that if there’s a change in behavior, and especially if there’s behavior we don’t understand, at the very least, we should pause, observe it, and give it importance, recognizing and validating that something is happening to this person. This is how we can provide support and companionship.


How can staff, but also clowns or other visiting artists best support a person with dementia during a grieving process?


Ibon Nuñez: Not only geriatric caregivers but also the staff working in nursing homes, and, of course, the clowns on an artistic level, a fundamental way to provide companionship is to look at the person experiencing dementia, to look into their eyes. The eyes often reflect the emotion they may be expressing. If they feel sadness, look at them with a sad face, somehow convey that we may be understanding, that we may be empathizing with what they are going through. This brings a sense of security to the person.

Of course, it’s not always necessary to speak in rational terms, to explain what has happened or who has passed away. It’s about recognizing that this person is sad about something, and this acknowledgment can make them feel more accompanied. I believe this is the essence because it’s very challenging to establish a general protocol for how to interact with people with dementia. Each person is entirely different, and we have to adapt to their rational needs.

What’s clear is that we need to make this person feel safe, that we see them, that we visualize them, that we validate them, that we’re not judging them, that we’re not forcing them to express or say something they may not want to. If they are sad, let’s be sad with him or her. Let’s not try to distract and cheer them up because during a moment in the day when we’re providing this expression, feeling accompanied in this expression can autonomously change their emotional management. I’m talking about unconscious and non-rational matters here.

When we want to accompany a person who is grieving and has advanced dementia, the most important things are the gaze, the facial expression, if the person allows it, physical contact, holding their hand or touch their shoulders. And if there is trust, give them a hug. I consider this to be the essence of accompanying a person with dementia who may be experiencing a loss.


Thank you very much for this interview.

photocredits: Pallapupas

This interview was conducted with the help of Yaiza Nieto from Pallapupas.
RED NOSES International

Dementia Care Mapping: a tool to measure quality of live and quality of care of older people

As a person’s dementia progresses, the cognitive functioning is decreasing, resulting in reduced communication and social isolation. The elderly seems to withdraw into their own world. How is it possible to tell their needs and if their needs are met?

Interview with Helena Martínez, Social educator at Fundació Pere Relats, Barcelona

What is Dementia Care Mapping and how does it work?

Dementia Care Mapping is an observational and quality assessment tool that aims to measure elements of both quality of life and quality of care.

DCM is designed to provide a better level of well-being through observation for individuals with cognitive impairment who cannot express their needs or feelings.

The mapping is the methodology of intensive and detailed real-time observation that allows professionals trained in DCM, known as mappers, to work with dementia patients in specialized care environments.

Mappers observe whether the person receives interactions from the attending staff, evaluate them, and determine their impact.

With all the data and behaviors collected, a well-being score, engagement, and activity participation, among others, is obtained, which will determine the level of well-being the person exhibits and also establish guidelines for action.


What kind of reactions of the residents of the elderly home did you observer during the encounter with the international group of clown artists? Is there any feedback or recommendations that you could draw from your observations to improve the interactions between the elderly and the artists?


The reactions we observed in the residents during the interaction with the international group of clown artists were positive. It is worth noting that the individualized interactions, maintaining visual and physical contact resulted in more reactions and connection from the residents.

IMG 1795 scaled

Thank you, for your visit, it has been a very emotional afternoon. The impact of this intervention with the clowns has been tremendous, not only for the residents but also for the staff. We appreciate your support for projects like Clownexus and for involving us. Elder people need more moments of laughter, emotions, and connection. Pallapupas helps make this possible.

Interview Dementia Care Mapping

photocredits: Pallapupas

This interview was conducted with the help of Yaiza Nieto from Pallapupas.
RED NOSES International

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).
Brussels: Culture and Mental Health – Practices and Policies

On May 23rd ‘Culture Action Europe’ and RED NOSES International invited to an event as part of the current EU projects “Culture for Health” and “Clowning Connects Us”, which tool place at the Permanent Representation of Lithuania to the European Union in Brussels.

The event “Culture and Mental Health – Practices and Policies” showcased how arts and culture contribute to health and wellbeing. Recent projects, publications, and research underline, that we need more investment in cultural activities for long-term health promotion and disease prevention as cultural activities can be a key contributor to a holistic mental health strategy, supporting well-being.

During the event, ClowNexus presented a movie about the project “Clowning Connects Us”, which beautifully captured the profound connections between clown artists and their audiences, including elderly individuals with dementia and children on the autism spectrum.

A big thank you to everybody joining and engaging in such inspiring conversations.

349081096 6139494936134218 6537024718976719692 n
Brussel Event4
Brussel Event3
Brussel Event2

Healthcare clown organizations are creating new artistic approaches for children on the autism spectrum

Read in Croatian.

Healthcare clowns from seven different European countries gathered from 29th January until 3rd of March in Zagreb, Croatia, as part of the ClowNexus project in order to share their previous experiences and artistic learnings in working with children on the autism spectrum. As part of the five-day laboratory, the international working group of clowns interacted with the children of the Zagreb Autism Center.

ClowNexus Crveni Nosovi 2 scaled

The collaboration with the Zagreb Autism Center shows the need to create new artistic forms of engagement, adapted to the needs of autistic children. Director of the Center, Žarka Klopotan, described the benefits that the presence of a clown has on children: „The children who have met the clowns, are happy to interact with them and open up to them. They learn from clowns by imitating movements, which is good for their motor development. They are happy and relaxed, which contributes to their emotional development. Healthcare Clowns show that words are not necessary for communication, because communication is also established by touch, gesture, and gaze. This is exactly why the ClowNexus project goes well with what we are working on at the Autism Center. We know that the number of children on the spectrum is increasing. Children require special attention and that is our responsibility. It’s good that clowns are looking for ways to connect to children on the autism spectrum and know how to do so. The activities the clowns bring are stimulating and motivating.”, explained Žarka Klopotan, director of the Zagreb Autism Center.

ClowNexus Crveni Nosovi scaled

After the ClowNexus laboratories held in Finland in 2021 and Lithuania in 2022, the final laboratory in Zagreb brought together the knowlegde about the tools necessary for creating the new artistic format. From the very beginning of the project, ClowNexus activities are monitored and evaluated to measure performance. Clowns who work in organizations in Finland, Spain, Austria, Hungary, Lithuania and Croatia came together in Zagreb, with expert Riska Wijgergangs from the Netherlands.

ClowNexus Djecji vrtic Utrine Centar za autizam scaled

“The third laboratory is the completion and unification of the tools we have created since the beginning of the project. These are different art forms, such as dance, music, movement therapy, theater of the senses, with the aim of creating formats adapted to the specific needs of children with autism. In order to develop a successful collaboration with children on the autism spectrum, it was necessary to learn more about how they perceive the world. Only then can we develop mutual understanding and joyful interaction,” explained Nina Sabo, a clowndoctor in CRVENI NOSOVI klaunovidoktori (Croatia) who has participated in the ClowNexus project from the very beginning.

ClowNexus Zagreb laboratorij 2

Director of the Zagreb Autism Center, Žarka Klopotan, shared her reflections on the visit of the international group of clown artists to the children of the Autism Center at the Utrina Kindergarten: “Every child’s participation in playing with clowns and exchanges that may seem trivial are extremely important for the development of children on the autism spectrum and their learning. This is exactly what we witnessed. Activities that are cheerful, playful and relaxing bring emotional well-being to children and open up space for easier teaching. Clowns can truly improve the work of our institution and add value to everything. Clowns are always welcome in our institution,” she said.

ClowNexus is a three-year European project that aims to facilitate the access to art and contributes to the social inclusion of children and teenagers on the autism spectrum and elderly people with dementia. The project provides space for the development of new artistic formats and approaches in cooperation with the co-creators, our target groups and their environments. The art of clowning allows trained artists to support, encourage and connect with audiences by recognizing their specific needs, exploring their wishes and offering space to express their creativity.

ClowNexus Zagreb laboratorij 1
Picture frames, foot choreographies and subtle movements:
The ClowNexus Artistic Laboratory in Austria

Read in German

Wednesday morning, 9 am at the Grillhof educational institute in Innsbruck, Austria. It is the third day of the “Clownexus” Artistic Laboratory.

Dementia Clowning on silent sole_1

ClowNexus is a three-year project (November 2020-October 2023) in which eight European healthcare clown organisations explore how clowns and humor can build and facilitate social connections and better communication with people with dementia and children on the autism spectrum.

From 16 to 20 January 2023, the third international artistic laboratory took place in Austria (Tyrol) with a focus on communication with people with dementia. Clowns from six European countries came together to exchange ideas and work together with experts such as Magdalena Schamberger, a pioneer and specialist in the field of artistic work with people with dementia.

Dementia Clowning on silent sole_1

Magdalena Schamberger enters the room this morning with the words “Nice to see you again. Firstly, make yourselves comfortable.”, she says, starting a meditation. “Now, imagine the Australian sun is shining on you,” she continues, inviting all participants to stretch out towards the sun and enjoy the warm feeling of the sun’s rays on their skin despite the cold winter outside.

“Now the sun should also be reaching the backside of your neck and all down your back.” So, sitting on their chairs, the clowns lean far forward, some with their heads almost reaching their legs, their hands either hanging loosely or resting on their knees. When everyone is in position, Magdalena Schamberger asks the group to open their eyes. “Please take a good look at what you are seeing in front of you.” In this position, the participants see their feet, knees, a very limited area. “And that is the visual area that very many elderly people with dementia have almost exclusively in front of them.” The room becomes quiet, this statement and realisation provokes reflection. “With this illustrative exercise, I want to get the clowns attuned for our workshop today,” Magdalena Schamberger explains.

Dementia Clowning on silent sole_1

Working in Frames

And that’s what it’s going to be about today: the limited field of vision of people with dementia and how clowns can use it and “play” with it in the best possible way.

So, the clowns come together in pairs. One person holds the frame and looks through it while the other does a little foot show in the now visible area. The creative artists come up with all kinds of ideas for this: they put on the most colorful, weird and eye-catching shoes or socks and come up with entertaining foot choreographies. Afterwards, the clowns give each other feedback. 

The same principle follows in the later unit, only with a different focus. Now the picture frame is put on the head and shoulder area. Colorful hats, caps, wigs and the like were used, and again, the important rule is: Less is more. “Slow, deliberate movements can be followed and understood much better by people with dementia,” explains Schamberger.

“Clowns are specialists in living in the here and now and that is very important with people with dementia. They retain a sense of creativity, rhythm, and humor despite individual limitations. The clowns can pick up on this wonderfully. The striking red nose leads people directly to the eyes of the clowns, which allows a human encounter to take place. Clowns become allies who share a certain fragility with them,” knows Schamberger, who also teaches as Honorary Professor at the School of Health Sciences at Queen Margaret University in Edinburgh.

The training by Magdalena Schamberger were two very emotional, educational days for all involved, with many new insights and tools that will surely resonate for a long time, not only in the participants but also in care homes in different countries.


The Artistic Laboratory

Dementia Clowning on silent sole_1

The five-day retreat also dealt with other topics: The artists and project managers worked together on a “co-creational map”. This tool box is currently being filled with tried and tested approaches by all participating clown organizations and will serve as an inspirational toolbox to share some of the outcomes of ClowNexus once the project ends. A special highlight was the virtual encounter with the former BBC reporter Willy Gilder, who himself lives with dementia and who shared his story and the challenges he faces with the group.

Dementia Clowning on silent sole_1

Learnings from working with children on the autism spectrum

Read in Finnish.

The three-year project ClowNexus is entering its last third of its period. Therefore, we asked Elina Reinikka from our project partner Sairaalaklovnit in Finland about her learnings and insights about the work with children with autism.

Dementia Clowning on silent sole_1

Dear Elina, what was your experience so far? How did you change as a person and as a clown in working deeper with children with autism?


Elina Reinikka: I could say that I’ve learned to focus on the basics. For me, the most important thing in all human interactions has come to the fore more clearly than before: the moment of contact. It doesn’t matter how “small” or short or through which channel the contact is found, the contact itself, the momentary sharing of connection, is the essence of everything in the encounter between people.

I have become more open to reading messages from body language, gestures, breathing, gaze direction, mood; people communicate just by being. I no longer get anxious so easily if contact is not found quickly, or it is not found with words or other traditional means, I have learned to breathe and wait and see difficulties in communication as positive challenges: “Hmm… Interesting! Here’s a nut to crack! What will be the route through which the two of us will find connection?”

At the same time, I find that I’ve become more cautious of the use of social games and roles and hidden messages beneath speech because they are not readable for everybody. I find that I enjoy the directness with which children on the autism spectrum communicate. The joy of finding a connection has also grown bigger and I can enjoy it as an independent, absolute value, without any agenda to which the connection should lead.


What have been your three major learnings up to this point in interacting with children with autism?

Elina Reinikka:  First of all – everyone has a desire to communicate and each individual channel for communication can be found and supported. Second, the problems of interaction can be seen as interesting challenges: what different senses can I use when I look for contact? Can the moment of contact be found with the help of music, with the help of rhythm, through the sense of touch, with smells, lights, visual elements, what all different impulses can I offer as communication building materials? Only your imagination is the limit! How do I ease the atmosphere, how can I open up the play and banter between parent and child? How do I remind the parent of the wonderfulness and uniqueness of their child? It’s great to be able to understand more about our own communication with children on the autism spectrum!
Thirdly, the ways of communication need not and should not be judged. Each individual should be treated with empathy, respect and in his or her own “language”.


What has been the most impactful full encounter/the encounter that most stayed in your mind?

Elina Reinikka: It is difficult to choose one encounter, because each one is impressive in its own way… It has been impressive to meet nursing staff who do their work with heart, extensive experience and professionalism, and great intuitive wisdom. It has been great to witness the impact of the work of fellow clowns; how the atmosphere eases, relaxes and the space flows like free air with the clown’s presence. How persistently my clown colleague continues his search to find a connection and what ingenious ways he finds, new ones every day. It has also been a particularly great privilege to be able to meet the children myself, to find a contact to a human being that already faced a long road and many twists and turns. But over time the trust has grown and borne fruits. And suddenly the joy of playing together has flashed forth and lit up the whole room. And every more laborious obstacle has felt like just an important step to reach that miraculous moment of connection.


Here is one touching example:

“The child is playing with cars on the floor.  He lines them up, again and again, immersed in his own world. I lay down on the ground next to him, lining up my own cars. Again, and again. The child doesn’t look at me, doesn’t react to my presence in any way. My hand wanders to one of the child’s cars, I place one in my own row. The child immediately takes the car out of my row and puts it in his own. After a moment, I test the boundaries again and move one of the child’s cars. The child immediately moves my hand away and puts his car back in its place. I start playing with a big car. The big car picks up small cars. Now the child is getting a little nervous, his routine must not be broken. The little cars have to be in a row, not on top of a big car. I’m off to drive one of the little cars along the suitcase. The child watches for a moment and returns the car to its place. After a moment I drive the car along his leg, the child looks at the car and feels for a moment how it feels on his leg. Then he puts the car back in line again. After a while I start driving the car along his leg again, the journey continues on the top of the suitcase. I lift the suitcase in front of the child. I start drumming the case with the car, trying different ways to make noise with the bag. The child watches for a moment, listens for a moment, and reaches for the car again. Then I use the car as a key and open the suitcase. The inside reveals a large blue, semi-transparent canvas. The child looks at it for a moment and picks up his car. I hand one end of the cloth to the father and together we start to lift the light cloth over the child. The child stops as if pinned. First there was some fear and then a squeal of delight. The child sits on the floor and lifts his face towards the cloth. He smiles and makes a little panting noise. The child lifts his arms towards the fabric and enjoys the breeze. His Daddy and I lift and lower the blue fabric and the child lies down and closes his eyes, feeling the breeze and the material of the fabric and was just smiling. We wrap the child in the fabric and tickle him, play the “peek-a-boo” game with the cloth and drive cars against it. The child runs towards the mother and the mother hugs him through the fabric. Everyone enjoys the situation. At the tickling moment, the child watches expectantly, eyes filled with excitement, anticipation, a mi