Creative self-expression helps children heal physically and emotionally

Horizon Air Magazine, by Scott Driscoll, December 2006

HorizonAir-AwH_p1-smallSome of the girls are withdrawn and quiet. Some are scowling. Some are openly disruptive. But all of them protect, with their elbows, their Chill & Spill art journals, which are filled with drawings and writings about their feelings.

Ranging in age from 13 to 17, the teens sit at two tables in the recreation room at the Ruth Dykeman Children’s Center in Seattle. Their legs nervously jitter to the rhythm of hip-hop playing on a boom box in the background. In front of them are piles of stuff for making collages: cutouts from magazines, pots of Mod Podge glue, 10″ x 12″ stretched canvases, scissors.

“Please open your books to the page titled “Me, Myself and I.’ Stephanie Good, a volunteer with Seattle-based Art with Heart, opens a copy of Chill & Spill, which the nonprofit has provided to the girls free of charge. This is the fifth of 10 workshops Good is leading for the teens, whose behavioral and emotional issues led Washington state’s Department of Social and Health Services to place them in the center. The residential-treatment home provides therapy and a structured living environment for about 40 children ranging in age from 8 to 18.

Chill & Spill is designed to provide art therapy that helps the teens work through emotional issues and traumatic situations. Subtitled “A Place to Put It Down and Work It Out,” the book has unnumbered blank pages sandwiched between 17 illustrated pages whose prompts offer the user a way to explore inner feelings in a non-threatening way. For example, “I Really, Really Do Feel That Way” is followed by the suggestion that the book’s owner jot down sentences related to prompts such as “I want,” “I wish” and “I fear.” Expressive and boldly colored graphics are designed to make the art journal appealing even to jaded teens. Fifty minutes after starting the “Me, Myself and I” exercise, the girls are showing off collages that represent how they feel, what they look like, who they want to be, or a favorite memory.

“This is fun!” says Diamond, a young teen who’s been expelled from schools and taken out of foster homes for behavioral issues. The girls have chosen their own pseudonyms to be used in this story, and hers, evoking something that endures tremendous pressure to become a brilliant gem, seems particularly apt.

Sasha, whose collage includes challenge lines such as “Stir it up” and “Take the heat,” says the workshops go beyond fun for her. “Doing this takes my mind off what’s stressing me. These activities help me deal with my situation.”

“It calms you and makes you feel like you did something worthwhile,” says Hummingbird, one of the more-shy girls at the center.

Ruth Dykeman self portraitWhen another facilitator takes the girls into a closed session to chat about feelings raised by the activity, volunteer Good notes: “After having five sessions, they’ve opened up hugely. The first night, one of them cried when she looked at the page in the book that asked her to describe herself, and then stormed out of the room. Another said she hated art and refused to participate. Now she’s participating enthusiastically. They all are.”

First published in summer 2005, with a print run of 20,000, Chill & Spill is part of Art with Heart’s effort to serve young people in crisis by empowering them through self-expression and creativity. Art with Heart was founded in 1996 when Steffanie Lorig, a Seattle graphic designer and writer, was doing community-outreach work for the Seattle chapter of the American Institute of Graphic Arts. Organized under AIGA auspices, Art with Heart fed homeless children and sponsored art projects that fostered reflection and expression. Then, in 1999, Lorig had an idea for a book to help chronically ill children.

“One night I literally had a dream about how I could use art and design to help children stuck in hospitals.” At work that morning, Lorig’s manager at the Hornall Anderson Design Works firm had told her about a friend who looked exhausted. The friend had been spending nights at Children’s Hospital and Regional Medical Center, north of downtown Seattle, to provide respite for Reisha Holton. Holton’s 5-year-old daughter, Hallie, was receiving chemotherapy to combat a cancerous growth in her neck. Hallie had been fighting the cancer for four years, and had been in the hospital much of that time.

“I spent a lot of my preteen childhood in and out of hospitals because I have asthma,” Lorig says. “Every time I went in, it seemed that no one talked to me. The doctors would only talk to my parents. Every time, I feared that I’d leave in a body bag. Not understanding what was happening to me, not having any way to express it, made it terrifying.”

Hallie Holton’s situation led Lorig to make the connection that art could help young patients communicate what was going on inside. “I knew that if I could produce something that would enhance their sense of inner peace and contentment, it would help their bodies get better, too.”

Oodles spreadOver the next 2-1/2 years, Lorig researched what art-therapy books were available, talked to hospital Child Life Specialists””whose role is to engage patients in normalizing play and provide psycho-social support and began to write copy and collaborate with artists.

In 2002, after devoting almost every spare hour to the project when she wasn’t at work, she produced a 124-page book, Oodles of Doodles, with help from 97 illustrators, including Mary GrandPré, who lives in Minnesota and has illustrated all the American editions of the Harry Potter book series.

Oodles includes a colorful collection of activities, such as a “Welcome” page that features four children reacting to their hospital admission in four different moods; a “Three Wishes” page; and a “What? Where? How? Why?” page for writing down questions for doctors and parents””all designed to help children understand what is happening to them and personalize their clinical environment.

Other pages invite the children to imagine building a robot, flying like a bird, eliminating one bad thing in the world and using magical powers to determine what their doctor is thinking. There’s even a page for thinking of small things they can do during the week to make a difference in the lives of others.

The first and second print runs, totaling 20,000 copies, were distributed to more than 150 children’s hospitals in North America and to other institutions serving children.

“Dealing with needles, dressing changes, IVs; being awakened every two hours to have vitals taken; pain recovery – it’s hard,” says Ann Miller, a Children’s Hospital child-life specialist. “These kids need something to help them feel like kids again. Oodles helps give them back a sense of control over their environment.”

The book proved to be so popular that in 2003 Lorig left her design job to devote more time to Art with Heart, and it became a nonprofit independent of the American Institute of Graphic Arts.

In 2004, Jeanean Jacobs, an art therapist and the senior director of young-adult services at downtown Seattle’s YMCA, where she works with foster-care youths, partnered with Lorig to produce Chill & Spill, which was printed in August 2005. Twenty-thousand copies are being distributed to nonprofits dealing with teens in crisis. Also in 2005, Oodles of Doodles was reprinted, this time in Spanish, and this past spring, another 10,000 English copies were produced.

Hallie & KatieHallie Holton got to see the first Oodles book when it came out in March 2002. She was 8, and two years past a stem cell transplant that seemed to finally have cured her cancer.

“It was a Saturday-afternoon party hosted by Steffanie [Lorig] with donors and contributors to bring out the book,” says Reisha Holton. “Steffanie gave Hallie a copy and told the story of how Hallie’s long stay in the hospital when she was 5 had inspired the dream. There were grown men crying. Seeing Hallie really brought it home for the donors, some of whom had given $25,000 toward the book project.”

Worried that the book might bring back unpleasant memories, Reisha watched Hallie’s reaction closely. “She was captivated. It was really something to see how it grabbed her attention like nothing else. She sat down and started going through it page by page. I thought, ”˜What kind of magic spell has this put over her?’ She cradled that book all night.”

Now 12 and in middle school, Hallie still likes to pick up the book in quiet moments. “She’s still using it to try and figure out what happened to her,” her mom says.

To help maximize the effectiveness of Oodles of Doodles and Chill & Spill, Lorig, who runs Art with Heart with just one part-time administrative assistant, relies on a database of 3,000 volunteers she can call to facilitate workshops in schools, group homes, residential-treatment centers and hospitals.

Stephanie Good, the volunteer leading the Dykeman Center workshop, came to love Oodles of Doodles when her late son, Patrick, stricken with leukemia, had Many long hospital stays starting in 1999. He had begun a regimen of chemotherapy at age 3. At age 7, he was in the Children’s Hospital of Wisconsin, in Milwaukee, where the family lived at the time. That’s when he received his first Oodles book.

My first reaction was, “Oh, no, another boring activity book,’ Good says. “Then I opened it and saw this was different. This was the book we kept.”

Good has an art-history and studio-arts background and found the quality of the graphics to be superb, but what impressed her even more was the way the book took into account the isolation and impersonal environment children are forced to cope with in hospitals.

“Patrick immediately went to “All About Me’ and filled it out, and posted it on his door so the doctors and nurses would know how much he loved to play soccer. He cut out flowers with faces and used them to decorate the walls, commenting on their funny expressions, which helped lighten his mood.”

In 2004, the Good family moved to Seattle, where Patrick underwent a bone marrow transplant at the Fred Hutchinson Cancer Research Center. While he was confined to the hospital, he and his younger brother, Brendan, attended the Hutch School, which is attached to a seven-story residence that serves families displaced because of long-term cancer treatment. At the time, Art with Heart offered workshops at the school for patients and their siblings.

Good says that Brendan, then in kindergarten, may have needed Oodles even more than Patrick did in order to open up. “He acted like everything was fine, but the art he did at the Hutch School workshops told a different story. He drew a self-portrait with a skewed face, half in water and half out. The top is off the head, and an animal is crawling out.”

PatrickOne of the last things Patrick did at the Hutch School before he died last January was to create a painting for a holiday card, based on an Art with Heart workshop.

He won first place in the Fred Hutchinson Cancer Research Center’s December 2005 holiday contest with his watercolor painting of a yellow sky with an orange sun setting behind a snowy peak in the Olympic Range, the view from the Good home in West Seattle. The artwork was reprinted on cards sold at the hospital’s annual fund-raising auction.

“The biggest benefit of having Oodles was that it helped him create his own world,” Good says. “It took away the sterility of the hospitals.”

Seattleite Diana McKune, now 18, says she benefited from both Oodles and Chill & Spill. McKune had spent many months in hospitals dealing with health issues that started with a brain tumor when she was 2 years old and included heart problems that were diagnosed when she was 17. She’d also been in and out of foster care since she was around 8 years old.

She got her first Oodles in April 2005 from a Children’s Hospital art therapist. Despite being older than the target audience for Oodles, McKune found the book comforting.

“You get pretty lonely with nothing but lab coats coming in and out of the room. I had no family to visit me,” says the teen, who was living in a group home last year. “Oodles became my friend. It helped me conquer my loneliness.”

Taking her cue from masks in the book that can be displayed to adults to reveal a child’s mood, McKune drew her own mask, titled “Inpatient Mask.” She’d meant to write “Impatient,” but found the error telling and kept it. The mask shows a volcano wreathed with brown clouds of smoke, with red lava pouring out of the top.

The Chill & Spill book complemented Oodles, helping her to express her feelings even more, she says. “This matters because it’s unhealthy to hold everything inside. I wouldn’t write in a regular journal. They’re too dull. Chill & Spill has cool color, which stimulates the whole process. When I can’t get things off my chest, I get stressed, and then I get physically sick. Getting it out in the book helps me get well and stay well.”

On one page, McKune wrote, “I can’t just lie around all day because I’ve got a life to live.”

“I wrote that in green marker””I felt barfy that day,” she says with a laugh.

Diana donating booksMcKune likes Chill & Spill so much that she scraped together $55 from her monthly $603 Social Security Administration check to buy five books at the wholesale rate so that she could give them to other teens at Children’s Hospital. When other Art with Heart supporters heard what she was up to, three of them paid full price for a total of 15 books and refused to let her spend her savings.

This fall, McKune started her freshman year at Seattle University, where she plans to study pediatric nursing. She got accepted on her own merits, then wrote an essay, inspired by her journaling in Chill & Spill, that led to a full-ride scholarship from Treehouse, an organization that supports foster children.

Chill & Spill’s funky graphics don’t initially appeal to everyone. Terasa Asher, a 16-year-old foster-care child, was asked to write a review of Chill & Spill for the February 2006 issue of Mockingbird Times, a publication sponsored by The Mockingbird Society, which advocates for children and teens in foster care. “My first reaction was, ”˜This looks corny,’ ” she remembers. “I thought I wouldn’t be into it.”

C&S spreadThen Asher came across the “Your Place” page, which asks teens to draw a place where they feel safe and then write down who or what they might invite into that place.

“I drew a house. My boyfriend’s. It was a touching experience. It helped me realize I do have people who care about me.”

Asher says she used to feel angry about being taken away from her mom and being put into foster care. “I didn’t feel like a regular person. I didn’t make friends because I couldn’t have anybody over. Having
the book changed me. It helped me think about how I’m just human, like anyone else. I started spilling my anger into the book instead of being rude and flashing on people for no reason. I started being less violent in my life. It gives you release and calms you down.”

This past spring Asher went back to living with her mom. She plans to give a copy of Chill & Spill to her sister, who she says still holds onto her anger over being put in foster care.

To ease angry, reserved and lonely youngsters into expressing their feelings, Chill & Spill is arranged from the least threatening to the most challenging exercises. For instance, “Your Place” is at the beginning of the book. “Action/Reaction,” toward the end of the book, notes that every now and then things happen that bring up bad memories, but we have a choice whether to react out of fear or respond from a healthy place. The journaler records his/her typical reaction, then fills in the blank in the statement “I want to ________ instead.”

“It is all about their growing aware of how they react emotionally when triggered,” says Jeanean Jacobs, who now serves on Art with Heart’s advisory board. “Writing from the prompts helps them get control over their reactions. They learn to recognize their patterns and see them coming.”

Teenage victims of Hurricane Katrina have been using the book to process their feelings about being forced to leave their homes, she says. In October 2005, less than two months after Katrina hit, Art with Heart was contacted by the Arts Council of Central Louisiana, which requested 1,500 copies of Chill & Spill to help refugee families forced to evacuate New Orleans. Jacobs and Lorig immediately went down to Louisiana to teach community workers how to use Art with Heart with kids who were experiencing post-tramautic stress syndrome.

“They took participants through Chill & Spill page by page, explaining how each exercise helps,” says Crystal Borrel, a social worker at the Renaissance Home for Youth in Alexandria, Louisiana, which provided shelter after the hurricane, and provides emergency housing for young people with behavioral and family issues. “I used the book to work with eight teens who were not used to expressing their feelings. They came in quiet and scared and closed off. Many of them had rarely if ever heard the words ”˜Good job.’ By asking them to list their strengths, in a way that feels both fun and safe, the book helps them understand that they really do have a lot to be proud of.”

Jacobs says “Any time someone has an opportunity to increase self-awareness and to get reflective distance from the really large problem they can’t handle””when they create that mental space, they realize, ”˜I can work out a solution for this.”

“You realize, ”˜I really do have choices.’ What we’re doing at Art with Heart is helping to give kids more control over their situation. The books give the kids a chance to start that process.”

Diana McKune says that recognizing she had choices changed her life. She plans to become an Art with Heart volunteer as soon as she feels comfortable with her freshman course load. “Art with Heart deserves all the support it can get,” she says. “It really helps kids.”

Filling a Need

The need for art-therapy books such as Oodles of Doodles and Chill & Spill is great, says Steffanie Lorig, executive director of Art with Heart.

She notes that at any given time, up to 17 million children in the United States are experiencing special healthcare needs, or chronic illnesses and disabilities, according to a report by the federal Agency for Healthcare Research and Quality.

In addition, evidence compiled by the World Health Organization and reported by the U.S. Public Health Service in 2000 indicates that by the year 2020, childhood neuropsychiatric disorders will rise by more than 50 percent worldwide to become one of the top five causes of death, disease and disability in children.

There is a direct negative correlation between stress and brain development as well as stress and physical wellness, Lorig says. “Children need a safe way to communicate their fears, and often the best way to cope can be found in the trappings of childhood: crayons, paper, paint, clay.”

A four-month study of oncology patients at Chicago’s Northwestern Memorial Hospital, reported in January 2006, showed that eight of nine symptoms related to pain and anxiety were significantly reduced as a result of art therapy. Improvements included relief from pain, tiredness, depression, anxiety, drowsiness, lack of appetite, lack of a sense of well-being, and shortness of breath. The only symptom not decreased was nausea. The report concluded: “Art therapy provides distraction that allows patients to focus on something positive instead of their health for a time, and it also gives patients something they can control.”

Institutions and clinicians using Art with Heart’s Oodles of Doodles and Chill & Spill books report that the books provide effective art therapy.

In a January 2006 Art with Heart survey of Child Life specialists using Oodles of Doodles to help ill children in hospitals in 12 states – including Washington and California– as well as in Edmonton, Alberta, and Toronto, 78 percent of the specialists reported that the children were more engaged, and 39 percent said the book made the children happy. Fifty-eight percent said the book reduced patient anxiety, and 90 percent reported that it helped keep the kids active.

In February 2006, Art with Heart surveyed counselors and mental-health professionals in six U.S. states, including Washington, and in Ontario, Canada, who had given a total of 796 Chill & Spill journals to teens considered “hard to communicate with” and “anxious.” Twenty-five percent reported that the teens they worked with were happier, and 38 percent said the teens were easier to communicate with.

This is significant improvement, Lorig says, considering that 67 percent of the teens given the book had been expelled from school and were considered to have significant behavioral problems. Thirty-eight percent of the survey participants said the book reduced symptoms of depression; 50 percent said it increased the teens’ personal insights; and 75 percent said it allowed for greater expression of self.

Chill & Spill and Oodles are making a difference in the mental health of children and teens across North America,” says Lorig. “That’s important, because our children’s mental health will have effects that reach into their adulthood. Helping them now will impact their future in a positive way.”