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Journal of Infant, Child, and Adolescent Psychotherapy

ISSN: 1528-9168 (Print) 1940-9214 (Online) Journal homepage: http://www.tandfonline.com/loi/hicp20

“Vamos a la Escuelita Arte Terapia”: An Art TherapyProtocol for Promoting Resilience with LatinoFarm Worker Children

Theresa Van Lith, Angela Quintero, Elissa Pizzutto & Joseph G. Grzywacz

To cite this article: Theresa Van Lith, Angela Quintero, Elissa Pizzutto & Joseph G. Grzywacz(2018): “Vamos a la Escuelita Arte Terapia”: An Art Therapy Protocol for Promoting Resilience withLatino Farm Worker Children, Journal of Infant, Child, and Adolescent Psychotherapy

To link to this article: https://doi.org/10.1080/15289168.2018.1490068

Published online: 24 Jul 2018.

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“Vamos a la Escuelita Arte Terapia”: An Art Therapy Protocol forPromoting Resilience with Latino Farm Worker ChildrenTheresa Van Lith, Ph.D., ATR, AThR , Angela Quintero, Elissa Pizzutto,and Joseph G. Grzywacz, Ph.D.

ABSTRACTChildren of Latino farm worker families risk experiencing emotional andbehavioral issues. Yet mental health resources are often inaccessiblebecause of transportation and communication disparities. Subsequently,there is a need for accessible therapy-based programs which cross lan-guage and cultural barriers. The pilot study, la Escuelita Arte Terapia, soughtto address the compounding needs of the children by running a six-weekart therapy protocol within a Latino farm worker community in southernGeorgia. The average attendance was 95 percent, with approximately 25children between the ages of 2 and 7 attending each session. Observationaldata revealed that several therapeutic goals were successful in buildinginternal resiliency while working to reduce risk factors and improve theparticipant’s school-readiness. Specifically, participants displayed increaseddevelopments in their fine and gross motor skills, creative development,emotional expression, behavioral focus, and social engagement. Severalfactors contributed to the success of la Escuelita Arte Terapia, whichincluded how the promotores acted as mediators between the art thera-pists and the families, the art therapists’ supportive role, the art therapymilieu, and the community connections. It is hoped that future endeavorswill build on the intervention proposed to help determine how art therapycan address emotional and behavioral disparities with Latino farm workerchildren.

Introduction

Although they are now dated, the most comprehensive estimate indicates nearly 1 million (880,000)children live in farm worker families (Mines, 1999). Nearly half the children (44 percent) in farmworker households were 6 years old or younger, and 75 percent were younger than 12 years (Mines,1999). Accurate estimates are difficult, but advocates contend there are more than one million Latinochildren in farm worker families in the United States. Extending Mines’s estimate, there are morethan 440,000 preschool-age children in farm worker families; fewer than 10 percent (n = 31,907)access routine prevention and intervention through Migrant and Seasonal Head Start (Schmit, 2014).

The emotional and behavioral health of young children in farm worker households is virtuallyunknown. Estimates from one sample drawn from a Migrant and Seasonal Head Start in Texas

CONTACT Theresa Van Lith tvanlith@fsu.edu Department of Art Education, Florida State University, 1033 WilliamJohnston Building, Tallahassee, FL 32306-1232, USA.Theresa Van Lith is Assistant Professor of Art Therapy and Clinical Coordinator at Florida State University, Department of ArtEducation, Tallahassee, Florida.Angela Quintero is a Current Art Therapy Masters student at Florida State University, Department of Art Education, Tallahassee,Florida.Elissa Pizzutto is a Current Art Therapy Masters student at Florida State University, Department of Art Education, Tallahassee,Florida.Joseph G. Grzywacz is Chair & Norejane Hendrickson Professor at Department of Family & Child Sciences, Florida State University.Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/hicp.© 2018 JICAP Foundation, Inc.

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPYhttps://doi.org/10.1080/15289168.2018.1490068

reported that greater than 1 in 10 (11.5 percent) children were classified as “at risk” (5.5 percent) or“clinical” (6.0 percent) based on maternal reports to the Child Behavioral Checklist (de Leon Siantz,Coronado, & Dovydaitis, 2010). No other research could be located, but the stressors confronted bychildren in farm worker families are well documented. For instance, 82 percent of farm workerhouseholds along the U.S.-Mexico border had low food security, and 49 percent experienced hunger(Weigel, Armijos, Hall, Ramirez, & Orozco, 2007).

The burden of poor emotional and behavioral health among Latino farm worker children isexacerbated by underdeveloped and underutilized mental health-care services. More than four offive (88 percent) Latino children in need of mental health care are not receiving appropriate care(Kataoka, Zhang, & Wells, 2002). Key barriers to receiving mental health support include stigmafor help-seeking (Nadeem et al., 2007), lack of health insurance (Acevedo-Garcia & Stone, 2008),and multiple language barriers (Lebrum, 2012). When left unaddressed, poor emotional andbehavioral health in early childhood increases the risk of experiencing social isolation (Choi,Meininger, & Roberts, 2006), higher rates of internalizing problems (Polo & Lopez, 2009) duringthe school years, and development of subsequent mental health disorders through adulthood(Céspedes & Huey, 2008). High rates of mental health need and low service utilization amongLatino families call for strategies that are intertwined within community and school systems andthat focus on building internal resiliency while working to reduce emotional and behavioral riskfactors.

The epidemic of poor emotional and behavioral health affecting children of the Latino farmworker community is more than just a family-to-family issue. Rather, it is the accumulation of publicpolicy, public opinion, and social phenomenon, manifesting in significant adverse outcomes for anentire population within the United States. Such a systemic issue of structural vulnerability calls forcreative strategies that are integrated into community and school systems, and those that focus onbuilding internal resiliency while working to reduce risk factors and improving school-basedoutcomes.

Art therapy as a tool to build resiliency

The term resiliency is largely used to describe an individual’s ability to persevere or rebound fromtraumatic or adverse scenarios. In the field of art therapy, creativity plays a major role in theresiliency-building process. Art therapy is a nonverbal form of emotional expression that enablesaffected persons to attend to the negativity associated with their adverse experiences by anchoringthem in a safe context of the present using symbols and metaphors in their creative images. Forinstance, using art therapy as a nonverbal and culturally sensitive platform helped family membersexpress their feelings and the challenges of adapting to a new culture (Linesch, Aceves, Quezada,Trochez, & Zuniga, 2012).

Simultaneously, participants can also experience self-affirming feelings as they master art-makingtechniques, develop connection and meaning from their imagery, and learn to process sensationsusing kinesthetic and sensory skills (Hass-Cohen & Findlay, 2015). Together, these help form acoherent personal narrative of their experience, which demonstrates neural integration in the brainand therefore awareness and regulation among cognitive thought, emotion, and behavior (Gantt &Tinnin, 2009; Siegel, 2015).

The therapeutic practice of art uses neuroscience foundations for the treatment of traumatic andadverse life experiences (Schouten, Gerrit, Knipscheer, Kleber, & Hutschemaekers, 2015). Forinstance, neuroscientific art therapy researchers have highlighted that traumatic memories resultingfrom adverse experiences are stored and accessed in the brain nonverbally (Lusebrink, 2010;Lusebrink & Hinz, 2016). Brain studies have begun to support this theory by showing how arttherapy creates visual-spatial-cognitive connections in the brain (Belkofer & Konopka, 2008; Kruk,Aravich, Deaver, & deBeus, 2014). In the case of adult participants who made art versus evaluatingart, adults had greater spatial improvement in functional brain connectivity, which is related to stress

2 T. VAN LITH ET AL.

resistance (Bolwerk, Mack-Andrick, Lang, Dörfler, & Maihöfner, 2014). Studies focused on arttherapy and childhood trauma indicated improvement in stress, anxiety, and regulation of affectivestates (Gantt & Tinnin, 2007, 2009; Hanney & Kozlowska, 2002). A randomized clinical trial withchildren hospitalized for posttraumatic stress disorder examined how art making decreased stressreduction and suggested this occurred through integrating brain pathways related to distressingexperiences (Chapman, Morabito, Ladakakos, Schreier, & Knudson, 2001).

Implementing art-based practices with children to provide building blocks for resiliency has beenemphasized in human development fields for several decades (Kim, 2015). However, using specificart-therapy practices to target certain characteristics of resiliency, such as flexibility, originality,confidence, social skills, emotional recognition, and regulation as well as a greater ability to problemsolve with young children, has not been previously examined (Metzl, 2009, 2015).

Method

This pilot program sought to determine if art therapy was a feasible therapeutic method forpromoting an increase in these resiliency characteristics and skills. Furthermore, we wanted toinvestigate if integrating community resources and health promotion material within an art therapyprogram would not only help with personal expression of ongoing adverse experiences but alsoprovide accessible strategies for the participants.

The research team

La Escuelita Arte Terapia was envisioned and implemented by an interdisciplinary team. The teamcomprised the project facilitator, four promotores, two graduate-level art-therapy students, and aregistered art therapist.

The promotores’ role was integral to helping the art therapists become aware of the needs andimbalances impacting the participants’ community (Otiniano, Carroll-Scott, Toy, & Wallace, 2011).Promotores are community health workers whose values are intrinsic to their Latino communitiesand who work to diminish health inequalities. A promotor may have various duties to supporthealth, education, and the community’s wellbeing as well as serving as educators or providing homevisits in the community (Schwingel et al., 2017). Therefore, they can serve as a bridge for hard-to-reach populations such as those who are undocumented or have limited English or literacy skills(Otiniano et al., 2011).

Before the sessions began, the promotores were briefed on the tasks and art experientials of thatday, and they were provided with some broad guidelines for helping during art-therapy sessions.These included: “It is okay to be messy, it is about the art-making process, the participant’s art workmay not look like what is expected, try not to make assumptions about the art work content, and askthe participants for their interpretation for what they created.” At the same time, these meetings alsoprovided an opportunity for the promotores to educate the art therapists about the culturalsensitivities to working with Latino farm worker families, such as honoring their environment andparental trust.

Sample

We were careful not to collect specific descriptive information on the participants that may identifytheir families’ identities. Nevertheless, the promotores explained that the majority of participants hadnot entered a voluntary prekindergarten or kindergarten classroom and were unfamiliar with astructured or educational environment. There was a total of 25 children between the ages of 2 and 7,and the average attendance was 95 percent.

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 3

Treatment approach

The art-therapy curriculum was based on the fundamental premise that promoting neural integra-tion could lead to enhanced self-regulation and build resiliency. This principle included the com-bined intervention strategy of narrative art therapy developed by Van der Velden and Koops (2005)and trauma processing art therapy developed by Gantt and Tinnin (2007, 2009) and Gantt and Tripp(2016). Narrative art therapy involves using visual means to create a rich description of one’s livedexperiences (Van der Velden & Koops, 2005), while trauma processing art therapy focuses on thesequential organization of distressing material to formulate a coherent narrative (Gantt & Tripp,2016).

The Expressive Therapies Continuum (ETC) was used to frame each of the art experientials,which provides a multilevel framework for implementation and progression the curriculum acrosstime. The ETC framework is broken into four layers of visual communication: Cognitive/Symbolic(C/Sy), Affective/Perceptual (A/P), Kinesthetic/Sensory (K/S), and the final level Creative (Cr)(Lusebrink, 2010). The ETC model proposes that expression involving the combined use of theselevels, and their continuums signifies higher-level creativity. Therefore, the sessions were designed tostart with more restrictive materials (i.e., markers and pencils) that worked at a cognitive level with agradual transition toward more sensory and kinesthetic materials (i.e., acrylic paint and clay). Thenthe final sessions emphasized movement toward the creative level by encouraging imaginative playusing all aspects of the continuum through a collaborative mixed-media mural.

Study procedures

The sessions took place in a community hall located in a Latino agriculture farm working commu-nity situated in South Georgia. The families were notified of the study through face-to-face inter-action with the promotores, which enabled the parents to address any concerns they might havebefore giving their verbal consent. The proximity between the community hall and the farm workerfamilies’ homes meant that the promotores would walk the participants over as a group to attend thesession and then walk them back when the session had finished.

All verbal forms of instruction were presented in both Spanish and English, and the participantswere able to communicate in their preferred language. The four promotores and one graduate arttherapy student were fluent in both Spanish and English. The sessions were held each Saturday forsix weeks between 10 am and 1 pm. The art therapy interventions were provided for three hoursonce weekly for the duration of the six weeks.

Overview of la Escuelita Arte Terapia

An overview of each session and the specific experientials can be found in Table 1. Each sessionbegan in roughly the same way, with the participants standing in a circle and asked to introducethemselves by name, with the members responding; “hola, (participant’s name).” This first taskhelped encourage social engagement among the participants as well as build confidence in speakingto a large group. Then the group rules were shared. These were: 1. Compartimos los materiales contodos – We share the art materials; 2. Alza la mano si necesitas cualquier cosa – Raise your hands ifyou need something; and 3. Prestamos atención cuando las maestras aplauden – We all pay attentionwhen the teachers clap. Next, there was a brief game, such as making facial gestures in response to anemotional prompt to encourage emotional and behavioral awareness. These games also served as aprecursor to the primary art activity.

Each session was designed to build on the skills developed in the previous session, moving frombroad to more specific goals with each session. Therefore, the objectives of the first session were tobuild rapport between participants and the art therapists, to build group cohesion, and to experimentwith art-making materials and processes. For example, the participants created front and back covers

4 T. VAN LITH ET AL.

Table1.

Sessionou

tline.

SessionNo.

Introd

uctio

nArtTherapyExperientials-Part1

Sharing

and

Cleanu

pSnack

Commun

ityActivity

ArtTherapyExperientials-Part2

Sharing

time

Cleanu

pand

Closing

Session1

●Shared

names.

●What’s

your

favoritemove-

ment?

game.

●Established

rules.

●Create

Fron

tCo

vers-

Participants

decoratedthefron

tcover

oftheirbo

okusingcollage

materials

anddraw

ingsupp

lies.

●Create

Your

Life

StoryActivity-

Participants

createdimages

basedon

theprom

pts:Who

amI?Who

isin

my

family?Where

does

myfamily

come

from

?

●LocalFirefig

hter

●Co

ntinue

toCreate

Fron

tCo

vers.

●Create

Your

Life

StoryActivity-

Participants

createdimages

basedon

the

prom

pts:Where

doIlive?

Who

aremyfriend

s?

Session2

●Shared

names.

●Pass

theball

game.

●Review

edrules.

●Create

Back

Covers.

●Create

Your

Life

StoryActivity-

Participants

createdimages

basedon

theprom

pts:Whatdo

esatypicald

ayat

homelook

like?

Whataremyfavor-

itethings

Iliketo

do?

●Pa

perBa

gPu

ppets-

Participants

createdpu

ppetsof

their

favoriteperson

oranimal.

●Scienceteacher

●Create

Your

Life

StoryActivity-

Participants

createdsculptures

basedon

theprom

pt:W

hat

upsets

youor

makes

youfeel

sad?

●Create

aSu

pportProject-

Participants

createdimages

basedon

the

prom

pt:W

hatmakes

youfeel

happ

y?

Session3

●Shared

names.

●Posesto

emo-

tions

game.

●Review

edrules.

●Create

Your

Life

StoryActivity-

Participants

createdsculptures

based

ontheprom

pts:Whatworriesyou?

and

whatmakes

youfeel

scared?

●Create

aSu

pportProject-

Participants

createdimages

basedon

theprom

pt:W

hatmakes

yousm

ileor

laug

h?

●LocalS

heriff

●Create

Your

Life

StoryActivity-

Participants

createdsculptures

basedon

the

prom

pt:W

henyougetmad,w

hatdo

youdo

?●

Create

aSu

pportProject

Participants

createdimages

basedon

the

prom

pt:W

hatdo

youdo

topu

tyourselfin

ago

odmood?

(Continued)

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 5

Table1.

(Con

tinued).

SessionNo.

Introd

uctio

nArtTherapyExperientials-Part1

Sharing

and

Cleanu

pSnack

Commun

ityActivity

ArtTherapyExperientials-Part2

Sharing

time

Cleanu

pand

Closing

Session4

●Shared

names.

●Posesto

emo-

tions

game.

●Review

edrules.

●Create

Your

Life

StoryActivity-

Participants

createdsculptures

based

ontheprom

pt:W

hatmakes

youangry

ormad?

●Create

aSu

pportProject-

Participants

createdimages

basedon

theprom

pt:W

hatdo

youdo

forothers

whenyouwantto

say“Iam

sorry”

oryouwou

ldliketo

dosomething

kind

?

●LocalG

ymInstructor-

●Create

Your

Life

StoryActivity-

Participants

createdsculptures

basedon

the

prom

pts:Whathapp

ened

whensomeone

was

angrywith

you,

orhu

rtor

upsetwith

you?

●Create

aSu

pportProject

Participants

createdimages

basedon

the

prom

pt:W

hatmakes

youfeellovedor

caredfor

bysomeone?

Session5

●Shared

names.

●Posesto

emo-

tions

game.

●Review

edrules.

●Create

aSu

pportProject-

Participants

createdimages

basedon

theprom

pt:H

aveyouever

hurtor

shou

tedat

someone?Depictwhat

happ

ened.

●Create

aSu

pportProject

Participants

createdimages

basedon

theprom

pt:W

hatnice

things

doyou

doforpeop

le?

●LocalH

ealth

Center

●Create

aStoryProject

Participants

createdimages

basedon

the

prom

pt:H

owdo

youreactwhenyoudo

n’tget

whatyouwant?

●Create

aSu

pportProject

Participants

createdimages

basedon

the

prom

pts:Thinkof

atim

ewhenyouhadto

work

hard

toachievesomething

impo

rtantto

you....

whathapp

ened

andho

wdidyoufeelwhenyou

achieved

your

goal?

Session6

●Shared

names.

●Who

isin

your

family?game.

●Review

edrules.

●Create

aGroup

Mural

-Participants

createdmuralsbasedon

thethem

e:Whatdo

esbelong

ingand

acceptance

meanto

you?

They

were

encouraged

tousecollage

materials.

●Prom

otores

●Create

aGroup

Mural

–Participantscreatedmuralsbasedon

thethem

e:Whatdo

escommun

ity,fam

ily,and

homemean

toyou?

They

wereencouraged

tousecollage

materials.

6 T. VAN LITH ET AL.

for their books that would include all their paintings and drawings created during the program. Theywere given collage materials and drawing supplies. They were also asked several prompts to helpelicit drawings representing themselves and their family. The anticipated outcomes were that theparticipants would begin the process of developing personal sharing of their current life events andwould demonstrate their graphic, emotional, and behavioral developmental stages.

Then, sessions two through five moved toward exploring and processing stressors, providing anopportunity for emotional expression, and enhancing mastery over art-making materials andprocesses. The participants were first asked to create a clay sculpture on a prompt that wouldevoke an emotional-based response, such as, “when you get mad what do you?” The purpose of thislife story activity was to help evoke a personally meaningful story. Then, the participants were askedto create a support project using acrylic paint that would help build resilience and coping skills, forinstance, “what do you do to put yourself in a good mood?” The participants were able to take theirclay sculptures with them after each session as a reminder of the emotional content explored and as away to affirm the completion of the task. The anticipated outcomes were that participants wouldidentify how they internalize stressors, work on awareness of personal strengths, develop copingskills, and gain a sense of validation through emotional expression and recounting meaningful lifeevents.

Finally, the last session focused on building group support, team building, and social skills to helpparticipants become aware of external coping resources through a mixed media mural, based on thefollowing questions: “What does it mean to be in a community? What does it mean to be acceptedand feel like you belong? What is Family? What does family mean to you?” They were asked to placetheir artworks on a communal board to create the group mural. The anticipated outcomes were thatparticipants would develop a sense of achievement over completed art work; understand how to seekout external resources, such as friends and family, as a coping skill; and build awareness about howto strengthen social support in their lives.

At the end of the final session, each participant was given a book of their art works to take home.These were distributed along with a certificate of accomplishment. The participants were each askedto share their favorite art work with the group as a way to help reinforce the notion of sharing theiraccomplishments.

Child-led practice framework

The art therapists followed a practice framework similar to that of Vygotsky’s (1978) zone ofproximal development, which was child-led and involved the art therapists infusing themselveswithin the existing participant dynamics to model encouraging and positive behavior. This wasparticularly noted with sensory-based activities, such as finger painting and hand washing, whichaccompanied both a mixture of playfulness, yet feelings of uncertainty among the participants.Initially, the participants required more assistance from the art therapists, then the art therapistsremained on the periphery to be a support when needed, and then finally served more to validateand reinforce the experimentation process. While the art therapists had familiarity using thisapproach with children before rather than relying on verbal cues, they were more cognizant thateach participant had plenty of art materials to choose from and that there was a nonjudgmentalatmosphere, so that messiness could be valued as part of the creative process. Ultimately, the corevalue embedded in the art therapists’ practice was not to be imposing but rather invite the childrento establish their own culturally driven mode of expressing themselves.

Monitoring progress in resiliency-building through art therapy

In this study art therapy interventions were used to foster the participants creative traits to buildresiliency through, fine and gross motor skills, creative development, emotional expression, beha-vioral focus, and social engagement.

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 7

Fine and gross motor skills are developed through the manipulation of art materials to create newforms based on their own personal thoughts, beliefs and ideas. This concept of changing things outof existing realities into new entities is considered combinatory construction. In Vygotsky’s (1987)theory of children’s development, the combinatory assembly is integral because its process requiresimagination, which is “the basis of creativity” (Ayman-Nolley, 1992, p. 78).

Creative development accounts for the participants’ ability to problem solve, think innovatively,engage in imaginary play and attempt symbolic representations (Alfonso-Benlliure, Meléndez, &García-Ballesteros, 2013; Goncu and Kessel, 1988). By reinforcing these skills and providing oppor-tunities to be creative, children are able to become more resilient and increase their emotional andbehavioral health.

Emotional expression occurs through how the children use the art materials to convey theiremotions with color, form, and movements in a routine way (Case & Dalley, 2008). By being given acreative outlet to express and explore various emotions, children can become more connected to thephysical properties of their emotions (Waller, 2006). The participants of this study were known tohave heightened emotional concerns (Céspedes & Huey, 2008). Therefore, it was a priority that partof the art-making process was used to address their emotional expression to increase resiliency.

The behavioral focus skills noted in social learning theories are pertinent for the attainment ofdevelopmental milestones (Mahone, 2005) and academic achievement (McClelland, Acock, Piccinin,Rhea, & Stallings, 2013). Attention involves the ability to direct and maintain control of one’sbehaviors across cognitive, emotional, and social domains (McClelland et al., 2013). Attention is anespecially significant milestone for completing tasks and problem solving with preschool children,whereby there is an increase in the “ability to shift attention more fluently and inhibit unnecessarymotor behaviors to allow for responses” (Mahone, 2005, p. 217). Finally, there are compoundingconcerns related to behavioral development with the Latino farm worker child population (Polo &Lopez, 2009). Due to the urgency to increase behavioral growth to mitigate likelihood of futuredevelopmental or mental health disorders (Céspedes & Huey, 2008; Polo and Lopez, 2009), it isnecessary to also focus on increasing the participants behavioral competencies and in turn build theirresiliency.

Additionally, the children’s level of social engagement was of particular concern, due to theimplications of their predisposed risk of isolation from poor emotional and behavioral health (Kim& McKay-Semmler, 2013). The concept of Familismo or “familyism” is important when examiningsocial engagement within the Latino community (Guardado & Becker, 2014; Martinez, 2013). Whenobserving children within a family the older siblings often demand certain communication styles andsocial behaviors from the younger siblings, such as waiting one’s turn, to maintain the expectedsocietal standard displayed at home (Killoren, Rodriguez De Jesus, Updegraff, & Wheeler, 2017).Familismo can also be regarded as an ecological mental health support system (Ayo, Flavio, &Bermudez-Parsai, 2010; Smith-Morris, Morales-Campos, Castañeda Alvarez, & Turner, 2012).Where family members rely on each other for signaling their concerns and seeking out help whenneeded, particularly to counteract negative stressors they may experience as a culture (Corona et al.,2017).

Observation and analysis procedures

As we were working with an age group that could not yet verbalize noticeable changes withinthemselves, the researchers opted to use observation methods instead. Unobtrusive observation wasalso used because record keeping during sessions was seen as potentially impacting participantinvolvement (Patton, 2015). Therefore, the art-therapy graduate students and art therapist collabora-tively wrote clinical notes at the conclusion of each session about the session’s events. For anonym-ity, group changes were noted rather than individual changes.

Specifically, the observation notes contained the following information: first, an overview of theparticipant’s initial presentation of behavior and mood and an outline of the art-therapy procedures;

8 T. VAN LITH ET AL.

second, the length of time participants spent on art making, color choices, commitment to the artactivities, overview of engagement with art materials using the media dimensions variable(Lusebrink, 1978) (i.e., restrictive-fluid, simple-complex, structured-unstructured, and mediated-unmediated), expressive therapies continuum (Lusebrink, 1978) (i.e., cognitive/symbolic, affective/perceptual, kinesthetic/sensory, and creative), and graphic developmental levels (i.e., scribble, pre-schematic, schematic, dawning realism; based on Lowenfield & Brittain, 1987); third, participants’verbal descriptions of their art works. Finally, overall observations were provided, such as level ofindependence/dependence during sessions, mood changes, and significant interactions during thecommunity activity and snack time.

Consequently, the art therapists formed an analysis team to examine the findings in relation tothe aims of the study. As the research was a naturalistic inquiry (Beuving & de Vries, 2015; Lincoln& Guba, 1985), the purpose of the analysis was to identify descriptions of significant issues andchanges that occurred throughout the sessions, with the intention of identifying elements thatcontributed to participant improvement.

Findings

Since this was a pilot study, there wasn’t a clear baseline to draw upon as a comparison. We werealso aware that assessing participants’ developmental progression based upon our previous experi-ence with children would not be fair because of the differences in accessibility and language barriers.Subsequently, we chose to examine how the participants progressed across the six sessions and thechanges that were demonstrated. In particular, we were interested in how participants developedmastery over a particular skill they had previously not been able to accomplish. Therefore, thefollowing section explains how the use of the art materials and art-making process affected thefollowing five developmental areas: fine and gross motor skills, creative development, emotionalexpression, behavioral focus, and social engagement.

1. Fine and gross motor skillsThroughout the sessions, the participants were able to work expressively with the art materials to

increase their fine motor skill and gross development. During the first session, participants were eachgiven their own drawing utensils, glue, and precut colored paper. The children were initially hesitantto touch the art supplies and required demonstration of how to use things like the glue. This meantthat the art materials were used sparingly and the images were small in comparison to the paper size.This tentativeness continued with the introduction of clay. Many of the participants expressed theirconcern with touching the earthen clay and with some resistance to manipulating the clay into newforms.

As the sessions continued, the participants began displaying their increased confidence in pickingup art materials without much encouragement and no longer needed assistance in using them. Bythe fourth session, the majority of the participants could identify the particular colors, shapes, andmaterials they preferred. While some participants still had limitations in how they verbalized theirart-making process, all participants had expanded the content of their images, increased the com-plexity of their compositions, and were creating multiple art works in one sitting. For instance, onefemale participant started out having difficulty holding a paintbrush, often becoming distracted andneeding redirection to art tasks. However, in the last session, this participant displayed adept finemotor coordination in holding the paintbrush by creating strokes with the paint and dipping thebrush in water to clean and repeat. Her attention also expanded and her art works involved layeringand multiple color choice.

2. Creative developmentThe participants worked on various levels of the ETC in each session to engage in different

creative processes. The behaviors that marked their increased creativity were noted through theirimproved confidence with art materials and experimentation, use of imagination, and the develop-ment of symbolic meanings associated with their art works.

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 9

Several participants’ art works highlighted an increase in exploring a variety of subject matter,schema formation, and ability to create symbolic representations, such as using a variety of shapesfor different human figures and animals. These participants were also able to manipulate the clay tocreate various forms that responded to the experientials. For example, one male participant created aspider out of clay to indicate what made him angry.

During the making of the mural in the final session, the participants displayed their ability toadapt and assimilate new ideas into their existing schemas. Thereby, creating new schemas related tothemselves rather than the object. For example, many of the participants repurposed art materials toaccomplish more complex forms like strings to hang their pieces, used sticks to make arms and legs,and layered paper to build towers. The participants also spent time viewing and playing with their artmaterials to enhance their existing creations, often as their storytelling unfolded, indicating anincrease in imagination and problem-solving skills.

3. Emotional expressionWhile, familismo and sibling roles remained vital to how the participants responded emotionally,

the art therapy activities gave an opportunity for each of the participants to express a range ofemotions they never explored. For instance, one participant conveyed her frustrations with hermother for watching scary movies with the volume turned up while she was trying to sleep by usingjagged lines in her painting. This liberty to disclose feelings alleviated some of her frustrations andgave her the newly acquired skill of using art making to process and acknowledge emotions.

At the end of each session, the participants were asked to share an art work they created amongthe large group. In the first two sessions, all the participants struggled to make statements about theirart works or to give their art works a title. To promote confidence about storytelling and meaningmaking, the art therapists encouraged the participants to try out different storylines about theirartwork. This reassurance meant that the participants gradually shifted to where they were able touse brief storylines for what they depicted toward creating more extensive range of labels for their artworks.

One participant who was part of an 11-person household, living in a two-bedroom trailer, begancomposing art works he would take home. After completing the assigned art-making activity, hewould create art works that required folding the paper over or using paper flaps to conceal or hidespecific images. Although he communicated the meaning of these art works, his folding techniquedifferentiated the art works that he wanted to share with others and those he had made for himself.The art therapists noted his ability to self-care and prioritized his own emotional needs by providingextra art materials, further encouraging his emotional awareness. The participant’s ability to deter-mine when to share and keep his emotions is evidence of developed resiliency dependent onenvironment and circumstance.

4. Behavioral focusThroughout the sessions, the participants displayed an increase in behavioral focus, assessed

through improvements in their attention span, task completion accuracy, and help-seeking, whichare key behavioral indicators of kindergarten readiness. As part of the art-therapy sessions, theparticipants were asked to attend to art materials and directions for extended periods of time. Thecontinual need to be attentive proved difficult in the first two sessions, and many participants lostfocus of the art process in a relatively short time, requiring prompting and redirection.

During the second and third sessions, the participants began to adjust to the framework ofsessions by responding to the hand-clapping game when art therapists required their attention andremaining seated for extended periods of time. By the final session, each participant could remain inthe circle during introduction and closing. The majority could remain seated for the durationallotted, would notify art therapists if they needed assistance by raising their hands, and did notrequire prompting or redirection toward tasks.

10 T. VAN LITH ET AL.

The skill of help seeking is a necessary milestone for childhood development to increase skillacquisition and learning new tasks. For instance, at the beginning of the sessions, the participantswere tentative in asking for assistance to complete tasks or how to use various art materials. As aresult, many of the participants’ art works did not reflect the assigned art experiential. Nevertheless,as the participants became familiar with the art therapists, the art materials, and the session process,most of the participants began to display behaviors such as hand raising, question asking, andattending to the art therapists’ modeling on how to use the art materials. The participants alsostarted to ask for additional supplies, such as more paper or glue, to create multiple art works. In thelast two sessions, the children began to ask each other for assistance with tasks. This step alsoindicated a desire to complete the task with a level of proficiency and accomplishment.

5. Social engagementWe initially decided to arrange the larger group into smaller groups according to age range for

ease of facilitation. However, we quickly noted that the older participants became preoccupied withother tables to maintain responsibility for their younger siblings and this made it difficult for them toconcentrate on their art making. Therefore, for the remaining sessions, we placed the tables in a largeU-shape and participants were able to sit where they desired. Also, extra seats were provided to helpencourage more movement.

While some participants chose to sit with their siblings during the rest of the sessions, themajority ventured to sit next to a nonsibling. This choice tended to be made when a participantwanted to model a distinct art-making style or use specific art materials that were not availablewhere they were sitting. One such instance included a female participant (who was primarilynonverbal) who chose to move to another table when she observed that another participant waspainting her clay sculpture. She then struck up a conversation and remained with that group ofparticipants for the remainder of the sessions.

The increased level of comfortability of interacting with nonrelated participants was observedwith how the participants played during free time. At first, the participants ran freely around theroom. However, after developing relationships with one another, they turned their unstructuredrunning into games of tag and following each other around in train formation.

Familismo was observed throughout the project in the dynamic the children presented with theirfamily members. For instance, the dynamic between cousins was evident among certain participantswho demonstrated friendly rivalry while maintaining concern for each other’s’ well-being. Forinstance, one participant signaled to an art therapist that his cousin was not managing the art-making task because he was overwhelmed by the messiness of the glue. Rather than pulling aside theparticipant for a one-on-one conversation, the art therapist spoke with both cousins and arrangedfor the participant to work at another quieter table, where there were glue sticks rather than liquidglue. When the art-making activity was over, the cousins reconvened to show each other what theyhad made.

Familismo was also observed in a group of participants who were siblings, in which two sisterswould sit together and their brother would sit with their cousins and friends at a different table.Although they would not share the same table while participating in the art-therapy sessions andpreferred to sit apart, they would always find each other in between activities or during breaks toshow each other what they had created. They also looked out for each other by making sure theyeach had sufficient art supplies or snacks. Another example of familismo was observed with twosiblings who were about a year apart. Often times the older sibling, a boy, would help his little sisterinto her chair and made sure her art supplies were easily accessible.

At the same time, the sense of familismo was so powerful with one participant that it interferedwith her ability to participate in the art-therapy sessions and to connect with the other participants.The participant’s younger brother had been severely injured, and it had taken several weeks for himto receive appropriate medical attention. He would usually attend the beginning of the sessions, butwhen the pain became unmanageable his mother would take him home. When he was present, thesister would remain attuned to him to encourage his engagement in the art-making activity.

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 11

However, when the brother left, she tended to regress, was unable to concentrate, and displayedconsistent frustration with the art materials. She experienced uneasiness when encouraged to “play”with art materials while still feeling a responsibility to act as a mother-like figure concerned with herbrother’s well-being.

During the final session, when the participants were asked to create a mural of their communalvalues of familismo, they exhibited not only the visual qualities of these values but also the socialqualities. Their images consisted of themes of family members, their homes, and of communitymembers they had met during the program, such as firefighters and police officers. Additionally,their social interactions were much more pronounced and took the form of increased spontaneousconversations with each other and the art therapists. For instance, one participant created a planeand then a sword and began to use imaginary play to interact with another participant.

The participants increasingly developed confidence in sharing their art works, and by the end ofthe final session all the participants were able to stand up and provide a title for their images to thelarge group. In this way, the art works served as a vehicle for social exchanges and helped open newforms of communication beyond sole reliance on verbal skills.

Instrumental elements in la Escuelita Arte Terapia

In addition to finding trends in the participants’ personal development, the research team noted severalsources impacting change in the sessions, including promotores engagement, therapeutic rapport,therapeutic milieu, and community connections. To reimplement this program within early interven-tion school-based programs, these four sources are regarded as integral to the art therapy protocol.Figure 1 depicts how these important elements became instrumental for the participant’s developmentduring la Escuelita Arte Terapia. The theoretical foundation of the ETC (Lusebrink, 2010) is at thenucleus of the system. The ETC formed the framework of the art-therapy sessions, the art materialschosen, and the way in which engagement in the art-making process was noted. Personal sharingresulted from the meanings associated with the art works, which helped participants clarify the mean-ings associated with their art works while also providing a vehicle to interact with others.

The circular subsystem surrounding the ETC consists of the development that occurred withinthe participants as a result of the art-therapy sessions. Fine and gross motor skills were enhanced asthe participant’s increased their ability to achieve mastery over the art materials. Creative develop-ment was observed through the participants’ increased problem solving, flexibility, and imagination.Emotional expression was developed through the art-therapy experientials, which encouragedexploration of and the ability to give form to feelings. Behavioral focus was evaluated throughhow the participants became more attentive to the art-making tasks, became more attached to theirart works, and were adept at following through with communication exchanges. Finally, socialengagement was observed through the manner in which the participants moved beyond theirtraditional familial roles and experienced new forms of social interactions using the art-makingprocess and art works as the mediator.

The external square subsystem encompasses the therapeutic and communal factors that wereintrinsic to the participants’ noted development. First, the promotores provided access and oppor-tunities to engage by serving as mediators between the Latino farm worker families and the arttherapists. This role as gatekeeper helped provide the participants with support, assistance, andpositive reinforcement to engage with the therapeutic process through a trusting relationship. Thepromotores also enabled engagement with various community members, which provided them withaccess, education, and the ability to interact with health and educational resources.

Next, the art therapists’ support encouraged connection and motivation by instilling a sense ofexcitement about the art making experiences. Then, the therapeutic milieu fostered routines and asense of safety through the rituals that guided each session, the expressive and enlivening atmo-sphere encouraged by the art therapists, and the transitions among instructions, games, snacks,playtime, art making, and share time. Finally, community connections promoted well-being and

12 T. VAN LITH ET AL.

resourcefulness by providing participants with connections to emergency and health care services.This involved demonstration of equipment and role-playing of help seeking scenarios so that theparticipants could be more informed about when and how to seek the support of these services.

Discussion

The implementation of la Escuelita Arte Terapia demonstrated that art therapy can work as aninnovative strategy to help close the gap in the prevalent mental health concerns of Latino farmworker children. The pilot study addressed numerous barriers impeding their access to services byintegrating the art therapy program within their community and connecting them with health andemergency resources. Several therapeutic goals were successful in building participants’ internalresiliency while working to reduce risk factors and improve their school-readiness.

Due to the brevity of sessions with the participants and dynamics of the project, the sessionstructure and the team dynamic required continuous flexibility. Adaptions included modifying thephysical setup of the room to accommodate the familial characteristics of the participants andallotting extra time for the participants to enjoy their snacks and to further encourage socialinteractions. It became important to include extra time for hand washing, with the participantsgravitating toward it as a centering and soothing activity. The participants were also given additionaltime to complete their art works when they became engaged in the art-making process.

During our debriefing with the interdisciplinary team, several areas were identified for improve-ment for future success, namely, to offer la Escuelita Arte Terapia to a wider age range but with more

The Promotores as Mediators

The Therapeutic Milieu

Th

e A

rt T

he

ra

pis

ts a

s S

up

po

rte

rs

Th

e C

om

mu

nit

y C

on

ne

ctio

ns

Creative

Development

Behavioral Focus

Emotional

Awareness

Social

Engagement

Fine and Gross

Motor Skills

Creative

Cognitive Symbolic

Perceptual Affective

Kinesthetic Sensory

Figure 1. Instrumental elements.

JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 13

art therapists to support the varying needs of each age group. This would take on more of a school-like feel and required accommodation for family dynamics. They also suggested conducting the laEscuelita Arte Terapia in a more child-friendly space with considerations to safety and hygiene, asthe community space was also used for adults to socialize in the evenings.

Finally, it was suggested to consider extending the number of sessions to foster viable changes inthe participants. This issue points to the ethical responsibility to maintain connections with thesecommunities once the study is complete. At an attempt to combat this, a group of art-therapystudents hosted an all-day art-making studio as part of the farming community’s annual festival.Additional strategies for providing ongoing art therapy along with psychoeducation initiatives arealso in the process of being developed to encourage the ongoing use of art therapy with thiscommunity.

In future studies, the art therapists recommend taking pictures to mark the progress of theparticipants’ art work. This may provide a visual representation of the progress made by eachparticipant. In the pilot study, many factors created difficulties in documenting progress. The arttherapists were focused on the pacing of sessions, the amount of art work created by eachparticipant, labeling art works with participants names, drying time for art work, the ratio of arttherapists to participants, and the ratio of art therapists to the larger group.

Conclusion

The present pilot study illuminates the extensive need to provide integrated mental health services inan accessible community-based format to Latino farm worker communities. The promising beha-vioral observations warrant further investigation in the provision of art therapy with Latino farmworker children. It is hoped that art therapy researchers will continue to develop this approach for aprolonged period with the outlined structural modifications to continue serving underserved popu-lations. Based on the success of la Escuelita Arte Terapia, the intention is to integrate this initiativeon a larger scale to determine effectiveness, salience, and acceptance of using art therapy to addressemotional and behavioral disparities with Latino farm worker children.

ORCID

Theresa Van Lith http://orcid.org/0000-0003-3599-4466

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