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THE CHILDREN’S HEALING PROJECT

How to use theatre arts with critically ill young people

A collaboration between TheatreWorks and Lucile Packard Children’s Hospital

WE WOULD LIKE TO ACKNOWLEDGE...All the school staff from Palo Alto Unified School District who workat the Lucile Packard Children’s Hospital School: Peggy Foiles,Thayer Gershon, Ginger Harkness, Kathy Ho, Joan Stirrat, MarilynTaddey, and Jason Trip;

LPCH Head Teacher, Cameron Sunde, whose support and love havebeen invaluable to the success of this project;

Our wonderful Teaching Artists (past and present): Jennifer Chambers,Michael Champlin, Jenny Debevec, Aimee Guillot, Emily Jordan,Eleanor Scott, Davi Quesada, Kelly Rinehart, and Jennifer Wilkinson;

The staff of Lucile Packard Children’s Hospital:Colette Case-Director, LPCH Child and Family Life ServicesLPCH Recreation Therapy/Child Life Staff: Joel Davidson,

Sheila Bruner, Kristy Dawson and Erin GluthMaureen Sheehan, Pediatric Nurse Practitioner, Neurology and EpilepsyMichelleen Oberst, LCSN, Neurology, Rheumatology, and GeneticsDr. Barbara Sourkes, Ph.D, a Kriewell-Hael Professor of Pediatric

Palliative CareMaryellen Lozzi: Manager of Volunteer Services; and

Ann Rose from the Lucile Packard Children’s Foundation and LucindaTatman, formerly the Director of Community Relations at ALZA.

We would like to thank our funding partners:ALZA CorporationAmerican Century FoundationLifeScanLockheed Martin Space SystemsSand Hill Foundation

This Workbook was made possible by a grant from the Sand HillFoundation.

A very special thanks to Tiffany Cothran for her support and expertisedeveloping this workbook.

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TheatreWorks Silicon Valley matches its commitment to outstandingtheatre with an equally powerful commitment to education. The Education Department at TheatreWroks Silicon Valley uses theatre as a learning tool to build teamwork, encourage creative expression,develop self-esteem, and promote cultural and historical understandingbetween youth of different backgrounds. Our programs serve an average of 25,000 students, 1,800 adult learners, and 975 teacherseach year, reaching 57 schools in 7 counties.

Lucile Packard Children’s Hospital at Stanford is a 240-bed hospitalthat has been devoted entirely to the care of children and expectantmothers since 1991. Providing pediatric medical and surgical servicesassociated with Stanford University Medical Center, LPCH offers patients locally, regionally, and nationally a full range of health careprograms and services—from preventive and routine care to the diagnosis and treatment of serious illness and injury. The PediatricPalliative Care Program provides comprehensive end-life care forchildren and their families facing life-threatening illnesses. The EatingDisorders program is the only comprehensive program in NorthernCalifornia offering both inpatient and outpatient treatment foranorexia, bulimia, and other eating problems.

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THE CHILDREN’S HEALING PROJECTis the result of an extraordinary partnership begun in 2003 betweenTheatreWorks and Lucile Packard Children’s Hospital (LPCH). Theprogram was designed by TheatreWorks staff in collaboration withLPCH child life specialists, palliative care specialists, teachers, doctors, and nurses. It is the only theatre-based therapeutic arts education program in the area serving hospitalized children and theirfamilies. In this partnership, theatre artists work with critically ill patients as well as their families to:

• enhance the quality of life for patients and families;• develop a sense of community among patients and families

who have felt isolated in the past;• provide an opportunity for patients and siblings to find and

express their own voices and to feel empowered by being heard; and

• increase patients’confidence in self-expression, thus increasing their self-esteem and promoting healing.

TABLE OF CONTENTSProgram HistoryFrom the Theatre’s Perspective...........................................................6From the Hospital’s Perspective .........................................................7Current Program Settings ..................................................................8Additional Program Settings ..............................................................9Managing the ProgramGuiding Questions/Timeline.............................................................12Seeking Grants .................................................................................15Documentation .................................................................................17Evaluations .......................................................................................18Implementing the ProgramKeys to Working in a Hospital Setting ..............................................21Boundries and Theraputic Relationships .............................................22Infection Control and Universal Precautions........................................24Letter from a Teaching Artist ............................................................26Selecting Teaching Artists ................................................................27Teaching Scenarios ...........................................................................28Sample Lesson Sequences ...............................................................33Successful Activities .........................................................................34Bibliography of Resources ................................................................45

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P R O G R A M H I S T O RY

FROM THE THEATRE’S PERSPECTIVEAs a theatre artist, I work to build bridges between TheatreWorksand the people in our community. Working in unconventional settingsto create participation on platforms other than our stage has alwaysfascinated me. Exciting theatre can exist anywhere. In its origins itdid. It was a way for the community to celebrate and discuss, teachthe important stories, and simply be together. Theatre can takeplace between two people as well as a full audience. I firmly believeit is a worthy endeavor to bring the art outside the walls of thetheatre and into the lives of people who might not be able to attenda show. In my work, I educate students of all ages about theatre arts.Generally, my objective is to build appreciation, skills and an enthusiasticand dedicated future audience. However, every once in a while, I amprivileged to help create a program in which the making and doingof the art functions simply for its own sake. The Children’s HealingProject is one such project.

On a personal level, I also started this project because I have spent a large portion of my adult life coping with serious illness and I knowfirsthand the healing power of the arts. I know the arts heal by creating enthusiasm, motivating people to pull themselves out ofbed, to spend that extra bit of energy. The arts create laughter, joy,and a place to express sorrow and anger. They offer moments of delight and engagement in a day that can seem dull and gray orpunctuated by moments full of terror. Most importantly, the arts can break through feelings of extreme isolation.

These personal insights combined with the convergence of threeother elements—a visionary funding source, a willing and courageoushospital staff, and a theatre able to value an unconventional yet important idea—made The Children’s Healing Project possible.Through this workbook, it is my hope that other hospitals and artsorganizations will be able to acquire the keys and nitty-gritty stepsto set up their own unique program to bring theatre, or other artswith their unique qualities, into valuable healing environments.

Mary SuttonCreator of The Children’s Healing Project and former Education DirectorTheatreWorks Silicon Valley

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FROM THE HOSPITAL’S PERSPECTIVEIn the fall of 2003 I was approached by TheatreWorks Silicon Valleyabout a pilot program that would bring TheatreWorks artists into the Lucile Packard Children’s Hospital School to work with our student/patients for half the school year. I was cautiously optimisticbecause although many of my students are initially hesitant to trynew school activities, they are usually eager to get out of doingschool work. It didn’t take long to realize that, with the right artists,this program would be a HUGE success. After the initial half-yearpilot project in which TheatreWorks tested ideas in multiple settings,two exceptional young actors were hired to work in the school andat bedside. In the following year, the program’s successes made it possible to extend through a full school year, from October through June.

Over a decade later, The Children’s Healing Project is one of the liveliest and most successful programs sponsored by the LPCHSchool. Children who have so many “adult” problems can lose themselves in theatre games, taking on new personas and forgetting,for awhile, their illnesses. The program enables students to expressthemselves and to control situations. Nurses frequently call to ask if the “Fun People” will be able to stop by patients’ rooms. In theclassrooms, shy smiles and quiet giggles come from some of the students, while shouts and loud guffaws engulf others. Laughterand learning combine.

It has been said that “laughter is the best medicine.” We see thisevery time our TheatreWorks actors arrive to work with our students.The sun seems to shine and the kids are just kids having fun. It istruly a joyous experience!

Cammy SundeHead TeacherLucile Packard Children’s Hospital School

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CURRENT PROGRAM SETTINGS

THE CLASSROOMThe Lucile Packard Children’s Hospital School serves critically illyouth, who are often in the hospital for an extended stay, and theirsiblings. The school has three classrooms, split into grades K–4, 5–8,and 9–12. TheatreWorks’ Teaching Artists are “in-residence” at theschool one day each week and lead two age appropriate sessions,shifting the middle school students into sessions with the younger or older students as determined by the make-up of entire group and in consultation with the LPCH teachers. They lead students, siblings, and sometimes parents in theatre games and improvisationsthat meaningfully involve and engage even the most shy and recalcitrant students.

BEDSIDEA significant part of the Teaching Artists’ work is to perform bedsidevisits with patients who are too sick to attend classes or group sessions.These visits have a profound effect on the children’s health and well-being and are creatively productive. Based on the positive results ofthese visits during the pilot program, hospital staff encouraged TheatreWorks to increase the amount of hours dedicated to bedsidevisits the following year.

GROUPThe Comprehensive Care Program (CCP) is an eight-bed unit thatuses a multidisciplinary approach in the treatment of eating disorders.Patients admitted to this service are medically compromised as a result of their illness. TheatreWorks’ activities at the CCP includesimilar theatre games and improvisations to those offered at theLPCH School. Patients and Teaching Artists sometimes read full-length plays and participate in casting and creating characters.These activities stimulate the teens and connect them with eachother and with people who are outside of the hospital environment,thus enriching the healing process. Additionally, parents, doctors,and therapists sometimes participate in a group session of The Children’s Healing Project in the CCP.

“It is amazing to seehow high school kidswho normally chooseto work alone and sitby themselves get so involved in theTheatreWorks groupactivities each week.”

Thayer Gershon,LPCH School Teacher

“I tell all of my patients, ‘You should try having TheatreWorksvisit you. It’s lots offun and you’ll smile.’"

LPCH nurse

“This program is anexceptional programfor patients witheating disorders inparticular because itallows them to expressthemselves creativelyas well as emotionallywithout fear of recrimination or judgment.”

Joel Davidson,Child Life Therapist

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ADDITIONAL PROGRAM SETTINGS

During our pilot program and the years that followed, we workedwith groups of patients in three additional settings: The ForeverYoung Zone, an afternoon drop-in recreational room at the hospital,and The Teen Van, a mobile health unit on site at the Bill Wilsonschool serving homeless families, and an offisite program designedspecifically for siblings of children with life-threatening neurologicalillness. Although we ultimately chose to focus our resources in theclassroom, bedside, and comprehensive care unit, we learned valuable lessons from these additional programs. Following are descriptions of the type of programming we used in each setting, the challenges we encountered, and the reasons we chose to eliminate this setting going forward. It may help you in designingprogramming for your project.

THE FOREVER YOUNG ZONE (FYZ)Activities: Participants took part in mask-making, puppet-making,costume play, hat-making, dance, storytelling through puppetry, simple acting exercises, making a tribal scepter, face painting, andstick-and-rod puppets.

Challenges: The broad age range of patients, the fact that patientswere used to having free choice in terms of activity participation,and the limitations of space made it difficult to plan activities. Ultimately, we found that the projects that worked best in this settingwere craft and visual art projects such as puppet making. In a moretypical setting the puppet making session would be followed by a storytelling session with the puppets. Due to time limitations, we did not always get to that second step and as with all of our programming in the hospital, you cannot count on having the sameset of patients for the follow-up session a week later.

Reason for eliminating program: We actually ran programming inthe Forever Young Zone beyond the initial pilot program; however,the Teaching Artists in the second year were less inclined towardsthe visual arts and more inclined towards performing arts. The programming did not work as well the second year, so when thehospital requested more bedside visits from the Teaching Artists, we decided their skill sets were better matched to that.

“As the patient put his picture up on theprojector, a huge smileappeared on his faceand his eyes lit up. Asa child life specialistI know the diagnosisand prognosis of thepatients that comethrough the FYZ, andseeing that patient’sresponse I strongly believe it had a hugepositive impact onhis psychologicalwell-being.”

Sheila Brunner,Child Life Specialist

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THE TEEN VAN AT THE BILL WILSON SCHOOLActivities: Participants attended a production of the play Nickel and Dimed at TheatreWorks and then participated in a series ofplaywriting workshops. The program culminated in a day with professional directors and actors rehearsing and performing theirone act plays.

Challenges: The school serves as a homeless shelter and providesinstruction to teens with various challenges such as drug addictionand unstable home lives. Student attendance varied greatly day to day.

Reason for eliminating program: Although this program was incredibly successful with 100% of the students completing a one act,it can also be very expensive (facility rental fees for the performance,actor/director stipends, incidentals such as food and drinks for theday of rehearsal/performance). Some of these costs can be offsetusing volunteers; however, the program requires a lot of outsideproject management to organize the final performance day—a daywe consider crucial to the process. We simply did not have the timeto manage the process on a continuous basis. Some consideration wasgiven to continuing at this site with a different type of programming,but we ultimately decided to focus on sites that had more obviousties to the hospital.

OFFSITEThe SIBS Program was created for siblings of children with life-threatening neurological illnesses. While one child in the family suffers medically, their siblings are often suffering psychologically.The program was designed to improve the quality of life of the siblings by providing opportunities for socialization and self expressionwith peers who are growing up in similar family situations. The SIBSProgram took place outside of the hospital setting at TheatreWorks’costume and scene shops as well as at the theatre itself.

Reason for eliminating the program: The SIBS Program ran successfully until 2009, when staffing changes and increasing workloads at the hospital made it impossible to continue.

“Because an outsiderrecognized my daughter it made myhusband and I paymore attention to herneeds and to ask herabout being the ‘normal’ child.”

Parent of a childin the SIBS Program

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M A N AG I N G T H E P R O G R A M

GUIDING QUESTIONS / TIMELINEWhile The Children’s Healing Project can serve as a model fororganizations interested in developing similar programming, you willneed to tailor your programming based on the resources of your artsorganization, the skill set of your Teaching Artists, and the needs ofthe health care organization. In this section we outline our course ofaction while planning programming, securing funding, and evaluat-ing programming. We offer tips along the way based on our experi-ence and what we learned (some of it the hard way!). This is by nomeans the only way to go about implementing a project of this nature, but we hope reading about our experiences is helpful.

BEFORE YOU BEGINNow is the time to identify the possibilities for what you’d like to accomplish in your community. You should be contacting the peoplewho can help make this a successful program. We worked with ourinitial contact at our first funding source and met with potential partners to share our initial ideas.

Questions to ask yourself:• What is your inspiration for the program?• Who do you need to talk to in the community?• What funding sources are at your fingertips to begin with?• Who are your supporters?• Why are your supporters interested in the program?• Will you collaborate in the planning process? If so, with whom?

If you are associated with a hospital or health care organizationand are the program’s initiator:

• Identify the arts resources in your community.• Decide if it is feasible or desirable to set the program up as a

cooperative project with a local arts provider.• If you are hiring independent artists, determine the extent to

which they will be involved in the planning process.

If you are associated with an arts organization and arethe program’s initiator:

• Identify the health care organizations within your community.• Meet with individual contacts at those organizations to

determine the appropriate environment for your programming. (Recreational therapists are good initial points of contact.)

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Questions to ask as collaborators:• With what populations will the program take place?• What are the goals for the program?• What will a pilot project look like and is it needed?• How long should the pilot last in order to gain adequate

information to implement a full program?• Who ultimately decides what the programming will look like?• Who will serve as the program director?• Who will administer the program?• What is needed to adequately administer the program?

i.e. payroll, time sheets.• How and by whom will the program be evaluated?• How will success be measured?

FIELD RESEARCH / DO YOUR HOMEWORKIn this step you should be establishing trust and building relationshipswith potential partners. During the meetings with your communitypartners it is important to encourage them to discuss their needsand make action plans to meet those needs. They may or may notbe able to visualize your ideas, so it is important to throw ideas backand forth in order to flesh out the specifics.

Anticipate lots of meetings, even meetings that might not turn outany results. We cannot stress enough the importance of observationat prospective activity sites. Go on site and be a “fly on the wall”—be willing to simply observe. We started this phase in early spring of 2002 and we had developed our action plan by that fall.

Questions to ask as you plan:• What work spaces are available?• What programs and groups already exist in the hospital with

which you can partner?• Are there social workers and therapists to whom you can talk?• Who can pay for the planning process?• Will the program have basic support from hospital funds or will

it rely on outside funding?• Who is responsible for securing that funding?• Are you hiring independent artists from the community? If so,

to what extent will they be involved in the planning process?• What is the hospital clearance process for the artists?• How long will that process take?• What is your time-frame for implementation?• Do you know who your contacts are for each unit or department?

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PILOT PROJECTThis step is all about trying all of your ideas. Keep in mind not everythingwill work! Some activities will work but cost too much, some will taketoo much time, some will guide you to other more effective ideas.Stay open and note when something isn’t working. Be prepared foranything. You should be collecting evaluations and assessments.Schedule time to discuss what you learned, share success stories anddefine what did not work and why. Remember, this is still preparationfor the formal start of the project. During this phase we found it useful to create an interim report with many photographs to presentto additional funders.

Questions to ask as you implement:• Overall, what is working and what isn’t working?• Are the activities helping you achieve your stated goals?• How do you know this?• Is the appropriate amount of time allotted to serve each population?• Are your Teaching Artists on track? How do you know this?• Are you documenting your process successfully?• Do you know how many people you are serving and at what

capacities?• Is there opportunity and/or need for expansion of the program?

If so, what types and will that require additional hours and funding?

GO FOR IT!It’s time to formally implement programming. Once you know whatworks and what doesn’t based on the pilot project, ask yourself:What is sustainable given your time and money? Also implement waysof gaining funding from additional sources. By now your relationshipswith partners should be concrete. Be certain that both you and yourpartners can sustain the program. On-going funding should be secured and adequate assessment should be in place.

Questions to ask as you finalize your project:• Are the relationships with partners concrete and solid?• Will they sustain over time?• Is there room for changes, if needed?• Can both partners logistically sustain the program?• Can you assess Teaching Artists on an ongoing basis?• Do you have the appropriate Teaching Artists?

AN AFTERTHOUGHT...There are three programs that we have discontinued following thepilot program, for different reasons: The drop-in program at the Forever Young Zone, the playwriting project at the Bill Wilson Center,and the SIBS Program. The drop-in program was swapped for bedsidevisits because the hospital already had a great arts and crafts programin place, and it was determined by all partners that bedside visitswere a more beneficial use of our time. The others were discontinuedbecause they were no longer logistically possible.

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SEEKING GRANTSFinding resources to start and sustain your program will take timeand deserves your full attention from the start. The reality is that theamount of money you are able to secure will most likely determinethe initial parameters of your programming. We suggest you secureenough funding to allow for a pilot program that is broad in its exploration. Ultimately, this results in more solid program implementation.

Though your program doesn’t have to follow our steps, we offerthem as a starting point:

STEP 1: RESEARCHOur initial funding source was a local pharmaceutical company’s community relations officer with whom both TheatreWorks andLPCH had an established relationship. This was a fortunate opportunityfor partnership. Without such an advantageous set of relationships,our advice is to focus on your local resources whenever possible. Organizations who invest in their own community are historicallyeasier to approach and more receptive to innovative ideas that enhance the local quality of life.

• Identify individuals and organizations that already support the hospital and/or arts organization.

• Look for natural connections. Does the hospital have a foundation? Does someone on your Board have a connection to that foundation or the hospital in general? Do you already know a member of the Board at the hospital?

• As you move beyond your current supporters, identify organizations and foundations in your area that might be a natural funding match.

• Also consider local, state, and federal arts councils that might have interest in, or know of, potential funders for a project of this nature.

STEP 2: ESTABLISH CONNECTIONSBegin to build relationships between yourself and the people whoare connected to resources.

• Remember that as you articulate your idea, you are seeking to build and gauge support.

• Elicit and listen to their perspective. For example, through someof our initial meetings we learned of hospital settings of particularinterest to funders that resulted in specific pilot programming.

• Determine the hospital’s needs and research their schedules andlimitations. In this step you are fact finding to determine what isactually possible. Throw out ideas that don’t seem to resonate with hospital staff.

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STEP 3: CREATE YOUR PROJECT AND WRITE THE GRANTSAfter all those meetings it’s time to finally design the particulars forthe project.

We took into account:

• the needs of the patients as articulated by the hospital staff;• the needs and limitations of the hospital staff; and• what was actually possible for our arts organization to deliver.

Finally, we followed the guidelines of the funding sources.

There are books and seminars in abundance about seeking fundingfor your specific projects. We urge you to reference the resourcepage for some helpful websites that can guide you in your fundingprocess.

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DOCUMENTATIONDocumentation is a necessary component of the project for both assessment and fundraising purposes.

• As the project manager (not always on site), you need documentation in order to evaluate the efficacy of programming, and to plan for future implementation and growth.

• As the teaching artist, you need it to refine and improve weeklyactivities—not everything will work.

• As the grant writer, you need it to secure funds and/or report back to funding sources who provided you with money for the project.

Despite the necessity of solid documentation, most people hate to doit, and it is often left undone. We advise you to give documentationadvance thought, keep it simple, and stress its importance to everyoneinvolved. It will save you time and headaches in the long run.

WAYS IN WHICH WE DOCUMENT OUR PROCESS:Required weekly reports from Teaching Artists that include:

• a list of activities performed for each group served;• brief anecdotal stories reflecting on the engagement of the

patients, families and staff; and• numbers of patients, family members and staff served. (In

particular, this will prove to be very important to funding sources.)

Collect feedback from Program Participants* in the form of:• surveys• questionnaires• letters of support• dialogue

*Participants include patients, siblings, parents/ guardians and hospital staff. Feedback from all groups is important to collect atvarious times throughout the process, although it is not appropriatefor each activity/session.

Types of data:Generally speaking, we define data as quantitative if it is in numericalform and qualitative if it is not.

• Examples of quantitative data include percentages calculated from yes/no responses to questions as well as numbers of participants.

• Qualitative data is anecdotal and includes observations from Teaching Artists, hospital staff, parents, and the patients themselves.

• Student work (written or artistic), photographs, videos, and sound recordings are also forms of qualitative data and are excellent ways to articulate what you are doing in the program.

NOTE:

While images are extremely telling andvaluable forms of documentation, youmust have legal permission by the participants to usethem in any promotional or documentary materials.

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EVALUATIONSThere are many ways to design and implement assessments for yourprograms. In some cases you may want to enlist an outside agency toimplement a more formal assessment process; however, this can becost prohibitive as well as time consuming. In this section we identifysimple strategies that you can implement yourself to help you articulate and evaluate programming.

TIPS FOR DESIGNING ASSESSMENTSWork backwards from your established goals and projected outcomes.For example, one of the stated outcomes for The Children’s HealingProject is to enhance the quality of life for patients and families. Acorresponding question on an evaluation could be as simple as“Do you feel better after this class/bedside visit? Yes or No?”

Keep it simple and quick.Patients and family members in this setting do not have a lot of timeand/or emotional energy to fill out a long, detailed survey. It is best tostick with simple Yes/No questions or provide multiple choice answersfor them to select.

Be aware of your environment.Sure, you want to collect as much data as possible, but not at the expense of the patient. If patients themselves are unable to answerquestions because of illness, fatigue or any other number of reasonsyou may encounter, gather the information from staff or family members when possible.

EXAMPLES OF SIMPLE ASSESSMENT QUESTIONS• Would you participate in another class?• Do you want the actors to visit you again?• Did you learn something new today?• Did you feel better after this class/bedside visit?• As a child life specialist, would you do this activity again?• Was your child impacted by the program in a positive way?

Using the above Yes/No questions, you can calculate percentages foryour responses. This is an easy way to capture quantitative data andarticulate your impact to a funding source.

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COLLECTING ANECDOTAL STORIES AND FEEDBACKWays to paint a picture of what you are doingCollecting anecdotal stories and quotes is equally important. Thistype of more specific feedback is what helps you identify programareas in need of improvement and provide insights on how to improve them. That is why it is important to leave space followingquestions in which people can elaborate. For example:

• Would you participate in another class? If so why?• How would you rate this activity on a scale of one (poor) to five

(excellent)? Would you do this activity again? Please explain yourrating. If you gave this activity a low rating, how might it be improved?

Not only are these anecdotes informative, they are also fun to read.You can often use parts of anecdotes as quotes along with photographsto create a more vibrant and telling document for current and futurefunding sources.

COLLECTING LETTERS OF SUPPORTConveying support of your workRequesting letters of support from key staff and administrators at the end of the project creates an opportunity for a more synthesizedreflection of the program. Participants may not fully understand thevalue of a program on a week-to-week basis, but at the end they cansee the cumulative effects more clearly. This is an opportunity to lookat the program from an entirely different perspective than the day today you have been living with over the duration of the program.

Continue to investigate ways in which you can create successful assessments for your programming by visiting the websites listed on our resource page.

Management Tips for Implementation• Have a specific hospital point of contact for Teaching Artists (TAs)

to check in with every visit.• Have a specific form for TA evaluations that clearly outlines the

type of data that needs to be collected. Explain in the beginningwhy this data is important and necessary. Make it clear to the artists that it is imperative that evaluations are done directly following every session so they don’t table them for a rainy day when the particulars are fuzzy.

• Maintain a calendar that all parties review in advance (arts organization, hospital, and TAs).

• Schedule quarterly observations followed by face to face meetings between the arts organization and TAs to check in, discuss problems, and acknowledge successes.

• Schedule quarterly face-to-face check-ins between arts organizationadministrators and hospital administrators.

• Establish a policy for sick/missed days. Is there extra compensationfor the Teaching Artist left flying solo? Is the TA who cancelsdocked? Communicate that policy at the start. 19

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I M P L E M E N T I N G T H E P R O G R A M

KEYS TO WORKING IN A HOSPITAL SETTINGIt bears repeating that working in a hospital setting is unlike any other environment in which arts organizations generally implementprogramming. The following pages provide information on some ofthe administerial aspects of programming in a hospital, as well asgeneral safety and confidentiality regulations that will protect you aswell as the patients that you serve.

KNOW YOUR CLEARANCE PROCEDURES!Every hospital has different regulations regarding clearance for workingwith patients. Program administrators and Teaching Artists (even peoplewanting to observe the program in action) may need to go throughan extensive clearance procedure prior to interacting with patients.This may include, but is not limited to:

• Fingerprinting clearance• Proof of Immunity to:

Rubella (German Measles)Rubeola (Red Measles)Varicella Zoster (Chicken Pox)

• Recent negative TB test and/or clear chest x-ray• Volunteer orientations with hospital staff

Know your clearance procedures and approximately how long theclearance process will take for ALL of your Teaching Artists. Failure toanticipate all of the necessary steps can seriously delay programming.

CONFIDENTIALITYYour work in the hospital may involve access to highly sensitive and confidential information about patients. Any information you obtain by discussion, observation, and/or direct access to records is confidential. Confidential information may be shared only with co-workers who require information to perform job-related duties.Please exercise extreme care in selecting the time, place, and circumstances for engaging in confidential discussions. Casualconversations overheard by others may violate another person’s privacy. Releasing or misusing confidential information, accidental ornot, is serious misconduct and in some cases illegal.

This confidentiality extends to photographing patients for documentationof your work. You must obtain written permission from the parents/guardians of patients (or the patients themselves, if they are 18 orover) to use their photographs in any materials (such as this handbook,reports to donors, marketing materials, etc.). In these cases, thespecifics of their illness should not be discussed.

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BOUNDARIES AND THERAPEUTIC RELATIONSHIPSELEMENTS OF A THERAPEUTIC RELATIONSHIP*

1. A Therapeutic Relationship requires clearly defined and consistentlyapplied professional boundaries in the context of caring for the patient and family.

2. Establishing a Therapeutic Relationship requires that one maintain a clear sense of one’s own distinct identity, emotions, moral principles,spirituality, and personal life while caring for the needs of the patient and family.

3. A Therapeutic Relationship respects patient and family rights andculture differences. This includes consistent adherence to privacy and confidentiality guidelines. (See page 21.)

GUIDING PRINCIPLES TO DETERMINEPROFESSIONAL BOUNDARIES*1. Describe your role to the patient and family.

2. Provide care only within the scope of your practice.

3. Provide care only within regularly scheduled work hours.

4. Provide consistency in care and support to patients and familieswithout preferential treatment.

5. Refrain from directly receiving gifts of significant monetary value from patients and families.

6. Refrain from providing transportation to patients and families inpersonal vehicles.

7. Refrain from offering gifts or money to patients and families.

8. Refrain from sharing religious and/or political beliefs with patientsand families.

9. Refrain from entering into a business relationship with a patient or family member outside of the scope of one’s position.

* Information excerpted from the LPCH Therapeutic Relationships andProfessional Boundaries Policy

“Sometimes you feellike you can take careof anything becauseyou are seeing suchpositive results, butyou have to realizethat you can’t. Youcan’t be everything toevery family member. You must know yourlimits for your ownsake and for theirs.”

Teaching Artistjournal entry

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BOUNDARIES AND THERAPEUTIC RELATIONSHIPSThis chart* illustrates the ways in which the role of a volunteer differs from that of either a friend or a healthcare professional, and lies between the two. In regards to this chart, consider the role of the TeachingArtist the same as that of a volunteer.

ATTRIBUTE FRIEND VOLUNTEER PROFESSIONAL

HOW RELATIONSHIP Relationship established Relationship deliberately Relationship basedIS ESTABLISHED through normal life planned and promoted on skills and services

experiences in the process through a service of the profession.of social interaction. designated for that

purpose.

NATURE OF THE Relationship is highly Relationship is defined, Relationship is definedRELATIONSHIP subjective and based on objective, purposeful, objective, purposeful,

mutual attraction. and controlled. and controlled.

GOAL/PURPOSE OF Relationship has no goal Relationship has a Relationship has a THE RELATIONSHIP or purpose beyond mutual goal as defined by the goal, based on the

satisfaction. volunteer role. It is based goals as defined byon the willingness of the the professional’svolunteer to help and the role.patient to be helped.

COMMUNICATION Communication is Communication is not Communication isWITHIN THE between co-equals between co-equals. The between laypersonRELATIONSHIP (modified by age, rank, patient is encouraged and professional. It is

status, etc.). Each person to talk; the volunteer to privileged and is has an implicit right to listen. The volunteer based on professionaltalk about him/her self, shares feelings only when expertise.their problems and appropriate to the goal.feelings.

DURATION OF Relationship has no Duration of the relationship Duration of the RELATIONSHIP necessary progression relationship is determined relationship is

or ending. by volunteer’s role. Goal is determined by the for the patient to move attainment of thetowards increased professional goal.independence.

*Chart provided by LPCH

INFECTION CONTROL AND UNIVERSAL PRECAUTIONSGUIDELINES FOR EXPOSURE TO INFECTIOUS DISEASE*1. If you are sick with a cold or a viral syndrome, have a sore throat,

fever or diarrhea, do not come to the hospital to work with patients; wait until your symptoms have subsided.

2. You should not have contact with a patient if you have an outbreak of cold sores or fever blisters.

3. If you are exposed to chickenpox and have never had it yourself, you should let the hospital know as soon as possible. If you develop “shingles” (herpes zoster) you must not come to the hospital. This is caused by the same virus that causes chickenpox. Exposure to this virus can cause severe damage in the patients with whom you work as they are unable to fight infection in the same way as a healthy child. DO NOT RETURN TO THE HOSPITAL until you have been cleared by Infection Control (or the appropriate contact at thehospital in which you work).

4. If you are exposed to any infectious disease, contact Infection Control (or the appropriate contact at the hospital in which you work) to discuss the nature of your exposure before working with patients.

TOY AND EQUIPMENT SANITATIONCheck with the appropriate contact (nurse, recreation therapist, etc.)before using props, costume pieces, and/or puppets with patients.Generally speaking, it is best to clean toys between patients (if goingbedside) and following each group activity. Therefore:

1. Utilize only equipment and toys that can be safely cleaned.

2. Immediately clean toys and playthings that are visibly soiled. If cleaning is not possible (i.e. soft, stuffed toys), discard after use.

3. Generally, stuffed toys are not for communal use. We have found some flexibility with this rule (i.e. puppets) but this should bediscussed with your healthcare contacts.

4. When going into isolation rooms, do not bring any toys or equipment unless it is specifically approved by that patient’s nurse and is cleaned utilizing hospital approved disinfectant.

* Information excerpted from the LPCH Volunteer Policies for InfectionControl

TEACHING ARTISTTIPS FOR KEEPING

YOURSELF HEALTHY

1. Drink your Aiborne or Echinacea, whichever is your health routine. Wash your hands a lot.

2. Know your limitations. Give yourself time duringthe day to process things and decompress. Whenyou have a down moment, take advantage of it.

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GUIDELINES FOR PATIENT CONTACT1. Use “UNIVERSAL PRECAUTIONS” for all bedside contacts.

You will not know which patients have bloodborne diseases, hence UNIVERSAL PRECAUTIONS are a requirement.

2. DO NOT ENTER AN ISOLATION ROOM until you have had specific instructions on how to do this from nursing personnel assigned to that room.

3. DO NOT SIT ON PATIENTS’ BEDS.4. WASH HANDS before entering a patient’s room, or between

patients. Handwashing is the single most important means of preventing the spread of infection.

UNIVERSAL PRECAUTIONSUniversal Precautions are work practices that help prevent contactwith patients’ blood and certain other body fluids. Should you findyourself in a situation in which you may be exposed, these precautionsare your best protection against AIDS, hepatitis B, and other infectiousdiseases. Universal Precautions must be used with ALL patients sinceit’s not always possible to tell who is infected.1. Wear gloves any time contact with blood or other infectious body

fluids may occur. Change gloves when they are torn and after contactwith each patient. Do not reuse disposable gloves.

2. Wear a gown if you anticipate getting blood or body fluids on your clothing.3. Cover open wounds.4. Use masks and eye protection if there’s any chance that blood or

other infectious fluids may splash into your mouth, nose, or eyes.

WASH YOUR HANDS OFTEN• Before beginning work• Before and after handling used equipment• After you remove your gloves• Before and after eating• Before and after using the bathroom

HAND WASHING TECHNIQUE1. Use continuously running water.2. Use plenty of soap.3. Apply with vigorous contact on all surfaces of hands.4. Wash hands.5. Keep hands down at all times, so any run off will go into the sink,

and not down the arms.6. Avoid splashing, rinse thoroughly.7. Dry well with paper towels.8. Discard the towels into the bag for that purpose.9. Use a paper towel to turn off the faucet and open door to leave

the bathroom.

TEACHING ARTISTTIPS FOR GETTING

TO KNOW THENURSING STAFF

1. Learn the nurses’ names.

2. Check in to see if you need to take special precautions before enteringcertain patients’rooms (ie. masks, gloves, gowns, etc.).

3. In shared room situations check with nursing staff to see if you can include patients that aren’t on your call list, what the noise level restrictionsmight be, and if youcan pull the curtain,etc.

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LETTER FROM A TEACHING ARTISTI have been fortunate over the past year and a half to be part of TheatreWorks’ extremely valuable and rewarding program: The Children’sHealing Project at Stanford’s Lucile Packard Children’s Hospital. Forme, the value of the program is evident by the smiles on the patients’faces and the comfort expressed by the parents when they see theirchild laugh. In no small part, the reward is the joy it brings to me andthe wonderful Teaching Artists I am lucky to work with every week. It’sdifficult to describe exactly how this work transforms us all, but I’ll giveit a try.

In Barbara M. Sourkes’ book Armfuls of Time: The Psychological Experience of the Child with a Life-Threatening Illness, an eleven year-old girl is quoted as saying “If kids are normal, not sick, they like to be treated special. But if kids have a disease, they want to betreated normal.” Personally, that’s where I put my focus. Sure, I wanteach and every kid to feel special, but I also really want to help to facilitate that intentional “forgetfulness.” I rarely think about the variousailments the kids have and, instead, aim to help them to do the sameeven if it is just for a moment.

Of course “forgetting” is not always easy, but sometimes we’re able tomake the setting a little more bearable just by engaging with the kidsin our “wacky theatre ways.” One of my favorite stories to date is abouta little 8 year-old boy named Oscar. My teaching partner and I arrivedin his room for a bedside visit to discover upwards of 7 relatives millingabout. Oscar was in pretty good spirits and everyone was amenable sowe found a space to accommodate us all and proceeded to play a fewgames. At one point, we were going around the room naming the oneplace we would go if we could go anywhere in the world. When it wasOscar’s turn, without skipping a beat and with a twinkle in his eye, hereplied “Not here!” The entire room erupted in laughter. There’s a natural performer, if I ever saw one!

So you see, as difficult as the setting can be, in a lot of ways this workis easy. Invariably these children have the most wonderful spirits andpersonalities. It’s the moments when I get to laugh with the kids, learna little about what makes each one of them happy, or see them take achance and put themselves out there for pure fun that I know we aredoing tremendously important work. Fortunately, that happens twentyto thirty times a day—at least.

Michael ChamplinTheatreWorks Teaching Artist

“If kids are normal,not sick, they like to be treated special.But if kids have a disease, they want tobe treated normal.”

An eleven year-old girl inArmfuls of Time

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SELECTING TEACHING ARTISTSA good artist does not necessarily make for a good teacher. Furthermore,a Teaching Artist who is fantastic in a typical setting may not be a perfectmatch for programs in a hospital. You are not only seeking someonewho is good at their craft and skilled at communicating with childrenin general, you will need someone who is physically and emotionallyprepared to interact with children in varying stages of illness. Theymust also be adept at communicating with parents, as well as themany nurses, doctors, therapists, and hospital administrators withwhom they will come into contact.

Depending on the goals of your program, you should seek a personwhose creative expression is in line with your desired outcomes. Wefound that our program was the most effective when we used artistswith a performance background as our lead teachers. Though wemight include secondary artists/volunteers with backgrounds in otherartistic expression such as the visual arts or dance, the LPCH staffnoted that the students responded more enthusiastically to the energyof a performer.

Our most successful Teaching Artists are:

• EXCELLENT LISTENERS• FLEXIBLE• CREATIVE IMPROVISERS• COMPASSIONATE, YET GROUNDED• PROFESSIONAL

On the following pages we will go into more detail about these attributes, share stories of our Teaching Artists’ real life experiences,and provide scenarios for your Teaching Artists to think about and discuss before working in a hospital environment.

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EXCELLENT LISTENERSWhile the Teaching Artist often needs to bring the “energy of a performer” to the room, this does not imply that s/he should alwaysbe the one performing. Take a moment to review a couple of the keygoals of the project:

• Increase patients’ confidence in self-expression, thus increasing their self-esteem and promoting healing.

• Develop a sense of community among patients and families who have felt isolated in the past.

• Provide an opportunity for patients to find and express their own voices and to feel empowered by being heard.

This is an extremely vulnerable time for the children with whom we work.It is important that they are encouraged to participate in activities, butare not forced to do so. It is vital to their emotional and physical healingthat the artist listens to and takes cues from the patients. Sometimes a conversation or activity will take an unexpected turn based on aseemingly insignificant suggestion by a patient. In allowing for suchvariances, the artist may have provided the one moment in that day, or perhaps week, in which a child felt they could control their fragileenvironment. It is also extremely important that the artist know whento take centerstage and when to step back and allow the patient (orsibling or parent) to take the stage.

TEACHING SCENARIOSFor use when selecting and /or training Teaching ArtistsYou arrive for a bedside session with a 10 year old girl and find hermother outside of her room. As this is a patient with whom you havenot worked in the past, you introduce yourself to the mom and ask ifshe would like for you to work with her daughter. Her mom replies,"Yes please; you can try. It has been a very rough day. We got thenews today that she is going to die and that it will be soon."Take a moment to consider how you might respond to the parent.

• Would you choose to work with the child?• If so, how would you approach your session with her?• If you do choose to work with the child and find her unresponsive

and completely closed down despite your best efforts, what are your next steps?

Our Teaching Artists chose to try and work with the patient. They entered the room and introduced themselves, said that they knew shewas having a bad day and asked if she would like to play a game orsimply talk. They found her completely “shut down” and told her thatthey would visit her again soon. The next week they came back andasked again if they could work with her. The 10 year old was willingand when they invited the other patient in her room to play, she assumed a big sister type role to the younger girl, even joking andlaughing with her. It was a positive session. She passed away twodays later.

“This program givesus an opportunity to meet with otherfamilies like ours at a time when we arenot all in the middle of a medical crisis. We can share storiesand somehow feel alittle less alone.”

Parent involved in the SIBS Program

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FLEXIBLEAny good teacher must employ a certain amount of flexibility in workingwith his or her students. In a hospital setting this is taken to an entirelydifferent level. Artists will often not know what size of a group they will be working with on any given day, what physical limitations theirparticipants may be experiencing, and what kind of emotional energythey may bring to the table.

TEACHING SCENARIOSFor use when selecting and /or training Teaching Artists1. When working bedside, there are often interruptions with nurses

and doctors coming in and out to check on patients, adjust monitors,etc. How would you handle these interruptions?

Though it may be frustrating, these “disruptions” are necessary andoften time sensitive for the patient. Use your best judgement regardingwhether or not you need to leave. If a nurse is discreetly checking amonitor, continue with your activity. If a doctor needs to talk with thepatient, excuse yourself and check back in later if you have time.

2. You arrive and are given a daily schedule that looks like this:10:00-10:20 Sandy, bedside patient10:30-10:40 Jim, bedside patient10:45-11:30 elementary group11:30-12:30 break12:30-1:15 middle school group1:30-2:15 high school group2:30-2:50 Eric, bedside3:00-3:20 Steve, bedside

In reality, Sandy was out of her room for a routine MRI when youstopped in to visit, the otherwise successful session with Jim was cut short because his doctor dropped by, there was only one middleschool student in school that day, and Eric was asleep when you arrived for his session. How might you rearrange your day so that you can serve as many patients as possible?

We combined the middle school student with the high school group,leaving us with some flexibility mid-day to check back in with bedsidepatients we had missed.

“When we went bedside to Cheryl, wewere planning to startwith the “favoriteslist” activity, but beforewe could begin, Cherylspied the giant bag of puppets we broughtand became so excitedshe proceeded to useEVERY puppet in thebag. With Cheryl asdirector and fellowpuppeteer, we produced upwards of10 different storiesin 30 minutes. She was laughing HYSTERICALLY. ”

Excerpted from a TeachingArtist journal

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CREATIVE IMPROVISERS

We have found a background in or natural inclination towards improvisationto be a necessary skill for our Teaching Artists. Improvisational gamesprovide the structure for most of our programming. The TeachingArtists must serve as participants and models in these games. Armedwith a suitcase of costume pieces, hats, and puppets, a good TeachingArtist can transform a hospital room into a castle, a disco party, orouter space. Again, although lessons are planned in advance, much ofwhat our Teaching Artists bring to the patients is created organicallyand on the spot.

TEACHING SCENARIOSFor use when selecting and /or training Teaching ArtistsYou arrive for a bedside session with a six year-old boy who you discover playing Go Fish with his mom. He is wearing what appears to be a helmet with multiple wires connecting it to monitors near hisbed. Although you were given no specific information regarding thepatient’s condition before entering the room, his mom informs youthat he has epilepsy and is also “a bit obsessive-compulsive” but isthrilled that you will be working with her son. You begin your scheduledactivity, a game that consists of you asking the patient about some ofhis favorite things. Within a short amount of time, the child exclaims,“Wanna get down!” and forcefully tries to get out of his bed, pullingthe wires from the monitor and creating multiple alarms to sound.What do you do?

Our Teaching Artists reported stepping away from the situation whilethe parent and nurses helped to restore order. It was obvious to themthat the patient was eager, but was clearly overwhelmed by the newactivity. In order to interact with him safely, they asked him about hisgame of Go Fish and proceeded to play with him in that manner.

“A nurse asked us tostop by Estefany’sroom because she wasvery withdrawn andapparently hadn’tsmiled in a few days.She didn’t speak English very well butunderstood everything.We immediately leapt into an improvisationfollowed by a sightgag using the dividingcurtain. By the end ofthis she could notstop giggling and aswe left we passed hernurse who quietlymouthed ’Thank you!’”

Excerpted from a Teaching Artist journal

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COMPASSIONATE, YET GROUNDED

Teaching Artists in a hospital setting such as the LPCH must preparethemselves for the emotions that they may experience through interactions with very sick children. As Teaching Artist Michael Champlinquoted in his letter on page 26, “If kids are normal, not sick, they like to be treated special. But if kids have a disease, they want to betreated normal.” Certainly the time our Teaching Artists spend with thechildren at LPCH is a special time; however, the approach is one thathelps to normalize an environment and situation that is not typical. It isa time of creative expression; it is a time of play. The children need theTeaching Artist to treat them with compassion, not pity. They need tobe “treated normal.” A Teaching Artist may encounter a child whosephysicality shocks them or whose experience deeply saddens them. ATeaching Artist in a hospital setting must know how to check theiremotions at the door so that they can be a strong, positive presencefor the child. (Discussed in further detail on page 22 in Boundaries andTherapeutic Relationships.)

TEACHING SCENARIOSFor use when selecting and /or training Teaching ArtistsDuring sessions (bedside or group) a patient may suddenly becomephysically ill or emotionally overwhelmed. Consider how you wouldhandle...1. A seven year-old who suddenly begins to vomit during a bedside

session in which you and your teaching partner are the only two adults present.

2. A sixteen year-old who suddenly begins sobbing during a group session.

3. A ten year-old who becomes combative during a group session because her suggestion was not chosen for the improvisational activity.

In each of these scenarios the best thing to do is to get help.

In scenario #1, one Teaching Artist rang for the nurse while the otherTA stepped out to find the child’s mom. Once another adult was in theroom (the parent in this case), they told her they would check in laterto see how things were going, and they made good on that promise.

In scenario #2, one TA escorted the teen outside and found a child lifespecialist while the other TAs continued with the group session.

In scenario #3, one TA immediately called in a child life specialist while the other TA calmly informed the child that he was not operatingwithin the established norms of the group and that he would have toreturn to his room. They made sure to check in with him before theyleft for the day.

“This was a great bedside...the last timeI saw Sam he lookedperfectlyhealthy. Nowall his hair was goneand he was also missingan arm from his cancer,but his spirit was justas bright and full asthe last time I saw him.”

Excerpted from a TeachingArtist journal

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PROFESSIONAL

As in other settings, you want your Teaching Artists to be prompt andreliable. They must be adept at communicating with a variety of peoplein addition to the patients they directly serve, including doctors or administrators unfamiliar with their programming. They must be ableto negotiate the often complex bureaucracy of a hospital in order toget clearance to work with patients. They should also be familiar withand abide by all confidentiality rules that are in effect at the hospital,as well as any infection control procedures that are in place. (Seepages 21–25 in Working In A Hospital Setting.)

TEACHING SCENARIOSFor use when selecting and /or training Teaching Artists

You are asked to go bedside with a seven year-old boy who is dying.You are told that many members of his family will be present and thatthe mood of the room is somber; the adults seem unable to engagethe child because they are so focused on their own grief. They sit in theroom all day, staring at her and crying. The hospital staff notes that thechild is shutting down emotionally and hopes that you can help lift thespirits of the room in general. What do you do?

Our Teaching Artists reported that when they approached the child,he did not respond to their introductions at all so one Teaching Artistsimply began to tell an improvised story. As she told the story, the boystarted to respond, first with tentative smiles, then full belly laughter,and finally offered his own suggestions for the story. As the story continued, the father saw the response of his son and also began toengage. By the end, both father and son were laughing and the fatherhad joined the story in his own way with an improvised rap song. Thismoment brought so much joy in a time of unbearable sadness, that itwas mentioned at the boy’s funeral later that month.

“One challenge weexperienced was aparent who indicatedhe wanted us to workwith his son at bedside. However,during our session thefather became quitehostile...making snidecomments about actors...This negativityseemed to be fueledby the fact that wewere able to engagehis son and make himlaugh... something hewas not able to dohimself. We continuedto focus our attentionon the child and reported the incidentto our hospital contact immediatelyfollowing our session.”

Excerpted from a Teaching Artist journal

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SAMPLE LESSON SEQUENCESOur Teaching Artists use a variety of activities in various settings intheir hospital work. Following are sample lesson plans for the differentsettings we serve. On pages 34–44 you can find descriptions of theseactivities and others. Most of the activities are modified versions of traditional theatre games.

BEDSIDE1. Introductions2. Favorites (Exercise #14) Sometimes you may only get this far

depending on the amount of time you have and the energy of the patient

3. Bad Audition (Exercise #4)4. Superhero (Exercise #32)

GROUPYounger Patients (elem/middle)1. Name Game (Exercise #25)2. Actor’s Tool Box (Exercise #1)3. Pass the Face (Exercise #26)4. Clap Game (Exercise #7)5. Walk Around (Exercise #24)6. Tableau with Story (Exercise #17)7. Superhero (Exercise #32)Note, exercises 4–6 would work for a fairly mobile group. Replacementexercises to accommodate groups with mobility issues include:

4. Alien Interpreter (Exercise #2)5. A to Z Story (Exercise #3)6. Students with mobility issues direct students without mobility issues

to create tableaus from the A to Z story

Older Patients (middle/high school)1. Two Truths and a Lie (Exercise #35)2. Question Only/Statement Only (Exercise #28)3. A to Z Story (Exercise #3) (variation using only dialogue)4. Rose & Thorn (Exercise #29)Note, an extension exercise for the A to Z Story would be for patientsto extract a line of dialogue from the improvisation and use it to writea story of their own creation.

TEACHING ARTIST PLANNING TIPWhen planning for a variety of groups, structure your day’s lessonsaround a theme, such as scene work, character work, or plot development, then tailor the lessons for the individual groups.

TEACHING ARTIST’SBAG FOR THE DAY

• Personal notebookand pens

• Evaluation forms• Loose plan for

the day• Lunch

(hospital food may

not be the best!)

• Water bottle• Possible bedside

props*• Chart paper• Markers

(lots of colors)

• Masking tape• Washable hand

puppets**• Washable hats*

* There may be some rooms in which you can’t bring anything dueto the safety of the patient. Check withnurses.

** See toy sanitation guidelines page 24.

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SUCCESSFUL ACTIVITIESFollowing is a sampling of activities/improvisational games that TheatreWorks’ Teaching Artists use with success in The Children’s Healing Project at LPCH. Activities were culled from a number of differentTeaching Artists’ experience and adapted for use in groups at the LPCH School and in the Adolescent Unit.Teaching Artists use many of the same activities with modifications when they work bedside.

In all improvisation games, it is important to teach and emphasize the Three Rules of Improv:1. Always say “yes, and…” instead of “no” because a “no” kills the scene.2. Don’t think! Say the first thing that pops into your head.3. Make your partner look great.

Indicates activities used in group settings

Indicates activities used bedside

1. ACTOR’S TOOL BOX(Voice, body, and imagination)Outcome(s): Provides a working vocabulary for theatre games.Level: Elementary & middleDescription: This is the way we begin every session with the younger and middle school kids. We discusshow voice, body, and imagination are the three things we need to be actors and actresses. Have students use their imaginations, voices, and bodies to become an old person, a dog, a tea kettle.Modifications/Extensions: Students with mobility issues can use puppets.

2. ALIEN INTERPRETEROutcome(s): This activity can be used simply as an icebreaker and intro activity. It is fun and entertaining. It can also be used to start more meaningful discussions in a nonthreatening way.Level: All

Description: One person is the Alien who speaks gibberish, the next person is the Interpreter who translateswhat the Alien says; the third person is the Host who asks the Alien questions. When working with a largergroup, the Host can also take suggested questions from the audience or depending on the desired outcomesof the activity, the Teaching Artist, classroom teacher, or therapist can play the Host and ask questions related to the participants’ experience. (Needs minimum of three people.)Modifications/Extensions: This game can be played with puppets if participants are reluctant.

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3. ALPHABET OR A to Z SCENEOutcome(s): Storytelling, pre-writing exercise.Level: Middle and high schoolDescription: The Teaching Artist asks the group to pick a location, characters, and a task for the characters.Then a scene is created using sentences that begin with the corresponding letter of the alphabet. The story is told going round-robin in the circle, each participant adding one sentence.

4. BAD AUDITIONOutcome(s): Icebreaker with especially reluctant participants.Level: Middle and high schoolDescription: Bedside—One Teaching Artist goes into the room and establishes the patient as the Directorand themselves as the Director’s Assistant. The Teaching Artist should explain that they are casting for theDirector’s upcoming play and they have a new actor in to see him/her. The Director’s Assistant tells theActor (a second TA) to come in, at which time the other Actor enters in VERY low status and immediatelybegins groveling over the Director and saying things like, “Oh my God! I love your work! This is an honor!etc.” The Director’s Assistant then asks the Actor to sing a ballad/up tempo song, perform a Shakespearemonologue, etc. The Actor proceeds to perform the task but goes way over the top delivering an excruciatinglybad (but hopefully funny!) audition for the Director.Group—Same scenario, with group participants taking on the varying roles.

5. BEAR HUNTOutcome(s): Icebreaker, creative movement, developing imagination.Level: ElementaryDescription: The group sits in a circle and keeps rhythm by drumming on their knees while singing/chantingthe following song. They also act out the lyrics to the best of their abilities. The Teaching Artist leads withstudents repeating each line. Sample lyrics (which can be modified) include:Goin’ on a bear hunt / I’m not afraid / Got a real good friend by my side.

(Children hug each other/shake hands, high five.)What do I see? / Oh look! It’s some tall grass! / Can’t go over it. Can’t go under it. Can’t go around it.

Got to go through it. (Make motions with arms like you are clearing a way through grass.)Start back at beginning replacing tall grass with other obstacles including:

Oh look! It’s a tall tree. (Make motions like you are trying to climb it.)Oh look! It’s a wide river. (Make motions like you are trying to swim through it.)

You can also insert your own lyrics or ask students for suggestions. Finish the song with:Oh look! A deep, dark cave. / Can’t go over it. Can’t go under it. Can’t go around it. / Can’t go through itGot to go in it. (Close your eyes as you pretend to enter the cave.)Oh,oh! It’s dark in here. / I feel something / It has lots of hair! / It has sharp teeth! / It’s a bear!! (Children love to scream this part.)

(At this point, increase the speed of your thigh slapping and swim back through the river, back up and downthe tree, back through the tall grass, till you get safely home and lock the door.)

I’m not afraid!

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6. BIBBITY, BIBBITY, BOP!Outcome(s): Warm-up.Level: Elementary and middleDescription: This is a great warm-up game for days when patients have more mobility or with siblings. Kidsstand in a circle and the Teaching Artist stands in the middle. The TA has three choices of dialogue: “Bibbity,Bibbity, Bop!;” “Hippity, Hippity, Hop;” and “Bop.” He/she picks one line to say while pointing randomly atthe students. If the TA points and says, "Bibbity, Bibbity, Bop!", the student must say "Bop!" before the TAdoes. For "Hippity, Hippity, Hop!", the student must jump and clap once before the TA finishes speaking. Finally, if the TA says "Bop!" the student must do nothing.

7. CLAP GAMEOutcome(s): Concentration, warm-up.Level: All levelsDescription: Students stand in a circle. To “send” the clap, one student pivots to his/her right or left, lookshis/her neighbor in the eye and they clap simultaneously. The student that has “received” the clap then turnsto his/her neighbor and repeats. The clap travels around the circle. The Teaching Artist (or chosen student)can change directions by yelling “Switch!” The game can become more advanced by sending multiple claps.

8. CONDUCTING A STORYOutcome(s): Students participate in improvised storytelling.Level: All levelsDescription: This game employs the same principles as “Alphabet Scene,” only in this version the TeachingArtist acts as the Conductor and points to different students in the circle at random who must pick up thestory where it left off with the next corresponding letter of the alphabet.Modifications/Extensions: This exercise could be used as a writing prompt. After participating in the exercise,students can elaborate on the scene in writing.

9. COOKIE JAROutcome(s): Wrap-up.Level: ElementaryDescription: Group sits in a circle and sings the refrain, “_______ stole the cookies from the cookie jar!” The Thief in question replies, “Who me?” The group answers back, “Yes you!” The Thief says, “Couldn’t be!”The group replies “Then who?” A new name is substituted until all the names have been said. Song endswith, “We all stole the cookies from the cookie jar!”

10. COUNTING GAMEOutcome(s): Focus exercise, team building.Level: All levelsDescription: The group sits or lies down with their eyes closed. The goal is to count as high as possible without two people saying the same number at the same time. A pattern cannot be established. If a patternis detected, or two people speak at the same time, the counting starts over at one. Instead of counting, thiscan also be done with the ABCs.

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11. THE DOT GAME

Outcome(s): Space and relationship exploration game, focusing exercise, character building exercise, sharing feelings.Level: All levels

Description: The Teaching Artist asks everyone to reach into their pockets and pull out an imaginary“dot.” The TA guides the students through visualization and imagination exercises using their “dots.” Variations include: placing the dot at different points in space (high, low, near, far), giving the dots names,giving and receiving secrets to and from their dots, playing “Favorites” (Exer. 14) with the dots. Studentscan also “become their dots” by stretching them into large shapes and stepping into them. When exploringthe space as dots themselves, students can interact with the other “dots” around them. Once students are invested in “being their dots,” explore emotions either by talking about what makes the “dots” feelcertain ways, or by dreaming as dots. The “dots” can show how they feel by using different emotive faces(sad, confused, happy, etc). The game ends by stepping out of your dot and rolling it back into a smallerdot that can return to your pocket for safe keeping.

12. EXPERT INTERVIEW IMPROVISATIONOutcome(s): Creative Improvisation.Level: Middle and high school

Description: Two people from the group sit opposite each other “on stage,” or next to each other if the group is in a circle. One person is the talk show Host and one is the Expert. The Host gives a lovelyintroduction for the Expert, announcing their expertise. This is the first time the Expert hears of his/her expertise. (Model selecting silly expertises, i.e. “kissing bricks, teaching watermelons how to surf, or shoesto speak Spanish".) The Host then conducts an interview with the Expert and, after some time, the Experttakes questions from the audience as well.

13. FACIAL WARM-UPSOutcome(s): Warm-up prior to improv or interactive storytelling exercises.Level: All

Description: All actors warm up prior to performances and it is always fun to bring that element into aclasslike setting. There are tons of warm-ups available that include simply making your eyes/mouth verybig/small with contrasting images. For example: for big—the Teaching Artist tells group they are seeingthe biggest ice cream sundae ever; for small—the Teaching Artist tells group to put their face on top oftheir nose. Kids love tongue exercises as well. Again, there are lots of simple things you can do that include sticking your tongue out, then touching tip to top of nose, ears, chin, and making circles in the air.A round of tongue exercises can end with everyone wiping in mock disgust. These warm-ups are great inthe hospital setting because everyone can participate (even the patients wearing masks will find a way tomake it work). It is a way to bring a little physicality into the room if you have a number of patients withmobility issues because it feels active despite the fact that you are only using your face. Once you havewarmed up, you can top it off with a fun tongue twister.

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14. FAVORITESOutcome(s): Icebreaker (works with reluctant patients), provides running list for improvisation games.Level: All levels

Description: Group—Begin with everyone saying their name and a favorite (movie, color, sound,etc.) This sometimes turns into, "If you were a color today, what would you be?"

Bedside—The Teaching Artist and patient (and sometimes parents/grandparents) make a list of their favorites—animal, place, food, sound, movie, etc.) The chart provides a safe way to find common groundamong participants, brings a little joy into the room, and when left with the patient serves as a reminder of things outside of the hospital setting that they love.

Extensions: A great bedside extension uses the list to create short improvisations with the patient as thedirector. Pulling ideas from the list, the patient assigns the Teaching Artists characters (who), a setting(where), an activity (what they are doing), and one thing each character has that the other one wants (conflict). The Teaching Artists then improvise a scene based on those parameters. As the director, the patient has the power to yell "Freeze!" and change the scene entirely, or have the actors do the scene inslow motion, fast-forward, or in a new genre (musical, opera, tragedy, comedy, etc.)

15. FREEZE

Outcome(s): Improvisational storytelling.Level: All levels

Description: The audience (when in group) or the patient (when bedside) assigns the Teaching Artists characters (who), a setting (where), an activity (what they are doing), and one thing each character has thatthe other one wants (conflict). The Teaching Artists then improvise a scene based on those parameters. Asthe Teaching Artists perform, a patient can yell “Freeze,” take the position of one of the players, and start an entirely new scene.

16. PEOPLE HUNT

Outcome(s): Icebreaker, getting to know you activity that is great for finding common ground.Level: All levels

Description: The Teaching Artist prepares a list or chart in advance that includes things like “I have threepets,” and “I have traveled to four foreign countries.” When the group gets together for the first time theyeach get a copy of the list and have to attach names of group members to whom it applies. At the end of theround, you can share what you learned about one another.

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17. TABLEAUS IN PAIRS

Outcome(s): Exploring space, imagination, emotional expression, team building.Level: Elementary, middle

Description: In groups of two, students find a space in the room where they can explore movement together.Start with students shaking hands and making eye contact. Then ask them to freeze. The first time you dothe exercise, have students create a nonsense tableau (pictures with their bodies) in which you cue them tomove while maintaining some point of contact until you say freeze. They can name their tableau if they wantto. This just gets them used to moving together. Then instruct them to create a tableau that depicts an emotionin relationship to one another. Use words to cue them such as joy, sadness, anger, grief, love, pain, despair,weariness, etc. This can also be explored in solo tableau if the group is small or reluctant/shy.

18. TABLEAUS IN GROUPSOutcome(s): Imagination, visualization, storytelling.Level: Upper elementary, middle, high school

Description: Put students into groups of four or five. Tell them they are going to create a tableau with theirentire group (it helps to have done TABLEAUS IN PAIRS beforehand). For this exercise, they do not have tohave a point of contact with each group member, rather they are trying to create the most interesting picturewith different people playing different roles. Start with the “title” of their first picture, i.e. “a secret meeting.”Have each group create a tableau depicting a secret meeting. Discuss how the more interesting pictures in-clude people doing varied activities such as someone “guarding the door,” or someone trying to sneak intothe meeting, someone on the phone and someone writing down a message in secret code. Once they havean understanding of how to create the picture, guide them through creating a series of pictures. Examples include: a wedding, discovering a treasure, a long journey, parents’ disapproval. Have groups practice transitioning from one picture to another so that they memorize their body positions in each tableau. Present each group’s tableaus.

Modifications/Extensions: Once groups have established each tableau, have them work together as a groupto put the tableaus in order so that it tells a story that makes sense to them. Each group can then presenttheir story to the larger class. If you are working with groups on a regular basis, this can be a great pre- orpost-reading exercise as well as a really fun writing prompt.

19. GIFT GIVINGOutcome(s): Warm-up/Icebreaker.Level: All

Description: Person A turns to Person B sitting next to them. Person A says, “I like you so much I broughtyou this.” A hands the gift to Person B who replies, “Oh! I’ve always wanted a ____”, and says the first thingthat pops into his/her head. Person A and Person B can improv for a moment over the gift, and the sceneends with Person B saying, “Thank you so much!” This can continue around the circle.

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20. HEY BUDDY!Outcome(s): Imagination, visualization, concentration.Level: Middle, high school

Description: This is a game played in teams (usually even numbers of no less than 4 people). It is based onpantomime games, like charades. The two person teams are split into two lines, Line A will do the pantomiming,Line B the guessing. The first person on Line A pantomimes using an object, trying to get his/her partnerto guess what the object is. If s/he figures out what the object is, s/he says, "Hey buddy, leave my _____alone" (filling the object in the blank). If the guesser is correct the pantomimer high-fives him/her and thetwo switch sides. This continues until either all players have gotten one turn on each side or a time limit expires. If done with enough people, there should be multiple teams, and the team who was able to havemore correct guesses wins. (There are endless variations on how one team can “win” the game—or theredoesn’t have to be a competition at all!)

21. HONEY IF YOU LOVE MEOutcome(s): Icebreaker, concentration.Level: All levels

Description: Put students in pairs. Person A will attempt to make Person B smile and/or laugh. Person Aturns to Person B, makes eye-contact and says "Honey if you love me you’ll give me a smile," while doingwhatever she/he needs to make Person B “break.” (In theatre when you smile or laugh it is called “break-ing.”) Person B has to maintain eye-contact throughout with person B and say WITHOUT SMILING, "Honey Ilove you but I just can’t smile."

22. “I LOVE YOUR EXPERTISE" IMPROVISATIONOutcome(s): Creative improvisation.Level: Middle and high school

Description: Improvisation set-up: Two people meet by chance for the first time in years. They adored eachother years ago. One of the scene partners says they loved how the other person was so good at _____ andnames a silly expertise like “kissing bricks.” The second person says s/he is thrilled because s/he has becomea professional brick kisser and tells his/her story. When the brick kisser finishes, s/he says s/he remembersthat the other person was great at _______ and names another wild expertise such as kicking fire hydrants.Of course the second person exclaims that s/he is a world renown fire hydrant kicker and tells his/her story.This is a great game to build on Expert Interview.

23. MACHINESOutcome(s): Physical warm-up, ensemble building.Level: All levels

Description: Start with one student in the performing area. That student must start the machine by choosinga sound and action that they can repeat for a long time. Instruct other students to add onto the machine with their bodies and voices. Encourage students to explore different levels, interesting ways to connect with other students, etc. Note: You will probably need to have a safety talk about how to connect with other students.

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24. MAGIC CARPET RIDEOutcome(s): Exploring environment, character and emotion, using imagination.Level: Elementary, middle school

Description: Have students gather onto the Magic Carpet, which is any floor space in the room. Studentstake out their sunglasses, buckle their safety belts, take out their keys, start the carpet and take off. Onceairborne the Teaching Artist or “head pilot” makes sudden turn alerts, turbulence, etc. After a big landing,the TA leads the class through different environments, (very cold/hot, swamps, ocean, etc.,) and hasparticipants react physically to different climates. This is a no talking exercise (ideally) and TA can yell outat any time "Freeze!" and the class freezes in place at which time the TA can switch the activity to becomingan animal or exploring characters via age-range (man of 101 or baby of one year), etc. The game endswith everyone hurrying back to the Magic Carpet and riding back to the classroom.

25. NAME GAMEOutcome(s): Icebreaker, introductions.Level: Elementary, middle school

Description: Students stand in a circle. Each student steps forward and says his/her name while performinga motion that everyone can reproduce safely. After each individual, the class repeats the name and motion. After one round, the Teaching Artist can add a circumstance or emotion to the game, i.e. say yourname and make a gesture as if you just opened a door and saw the largest, hairiest spider ever.

26. PASS THE FACEOutcome(s): Icebreaker.Level: All levels

Description: This game is similar to the classic “Telephone Game,” but using facial expressions instead.The leader makes a face and then passes it to the person on his right or left. That person has to pass theface he/she received to the next person and so on. Warm-up by going around once with eyes open andthen a couple of rounds with eyes closed. When it is your turn to pass a face, nudge the person next toyou to get their attention.

27. POISON PEEPERSOutcome(s): Icebreaker.Level: All levels, middle school best

Description: The group sits quietly in a circle with heads down until the Teaching Artist counts to three.On “three” everyone looks up and looks straight at someone else in the circle. If anyone makes eye contact the pair screams and everyone puts their heads down again.

28. QUESTION ONLY / STATEMENT ONLY SCENE(With Teaching Artist working as partner)Outcome(s): Can serve as character or scene development.Level: Upper middle, high school

Description: Put students in pairs. Instruct them to conduct a conversation using Questions only. Alternate with scenes using Statements only.

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29. ROSE AND THORNOutcome(s): Reflection, assessment.Level: Middle, high school

Description: This is a simple but effective way to get feedback at the end of a session. The Teaching Artistasks everyone to share one “rose” (something they really liked about the group) and one “thorn” (somethingthey weren’t crazy about).

30. SNEAKY STATUESOutcome(s): Icebreaker.Level: Elementary

Description: This game is similar to Red Light/Green Light. The Teaching Artist stands in center of the room,closes his/her eyes, and counts to ten. The students meanwhile get into frozen poses or "statues". The TAopens his/her eyes and stands in place while turning in a circle watching all the statues. When the TA’s backis to a group of statues they can move position, but if anyone is caught moving or speaking they’re out.

31. STORY, STORY, ESCAPEOutcome(s): Story building.Level: All levels

Description: You can do this as a whole group or using smaller groups. Each person says a word to build astory. If someone pauses too long or repeats a word or says TWO words, s/he is out. That means s/he has toact out an escape story. The escape story is created by the most recent person to get knocked out of thegame, or by the Teaching Artist.

Modifications: If the student can’t or shouldn’t move, the Teaching Artist can act out the escape while the“out” person narrates.

32. SUPERHEROOutcome(s): Session ender.Level: Elementary

Description: While sitting in a circle everyone says “I’m a superhero because_____”, and ending the statement with the first thing that pops into your head. This is a great way to end a session. Everyone leaves feeling great, like a superhero.

33. THINK BIGGER!Outcome(s): Warm-up.Level: Elementary

Description: The Teaching Artist picks one student to come up with an everyday activity (eating a bowl ofcereal, taking a shower, etc.), and then pantomime the activity the way he/she would normally do it. Thegroup then turns to the next person and in unison tells him/ her to “Think Bigger!” and that person does thesame activity a little bit bigger. And then the group tells the next student to “Think Bigger!” who does thesame activity even bigger, and so on until the activity has become so big that a new one needs to be chosen.

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34. THREE-WAY CONVERSATIONOutcome(s): Concentration game.Level: Middle, high school

Description: You need three participants, preferably sitting side by side. The person in the middle must carryon two simultaneous but separate conversations with the remaining two people. The goal for the person inthe center is to fluidly move from each conversation without missing a beat or asking any questions. The twoon the outside however, can ask as many questions as they like.

35. TWO TRUTHS AND A LIEOutcome(s): Warm-up, introductions.Level: Middle, high school

Description: Each person tells two truths and one lie about themselves. The group then tries to guess whichis the lie. It’s a great way to get to know the group.

36. WANNA BUY A…?Outcome(s): Warm-up.Level: Middle, high school

Description: The group is seated in a circle. The Teaching Artist turns to Student A seated next to him/herand asks, “You wanna buy a car?” or the first thing that comes to mind. The student then asks a yes/no question, “Does it run?” or “Is it new?” etc. The TA responds, “Of course it runs,(etc.)”. Student A then turns to Student B next to him/her and asks, “Wanna buy a radio?” and fills in an item off the top of his head. When Student B asks a yes or no question, “Does it play?” instead of responding, Student A turnsback to the TA and asks his/her yes/no question to the TA who replies with his/ her original “Of course itruns,” and Student A turns and replies to Student B, “Of course it plays.” This continues around the circle.

37. WHEN I GO TO____, I’M GONNA BRING MY____Outcome(s): Concentration.Level: All levels

Description: The Teaching Artist asks the group to decide on a travel destination. If the destination is Paris,the TA begins by saying, “When I go to Paris, I’m gonna bring my toothbrush.” The next person adds to the list by saying the first thing off the top of their head, “When I go to Paris I’m gonna bring my toothbrushand my fur-coat.” The next person adds on his item after listing the previously listed items. Variations includegesture only, and speaking in gibberish.

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38. WRITING EXERCISESOutcome(s): Written storytelling.Level: Middle, high school

Description: a.) A to Z SCENE is similar to Exercise #3. Scene partners are chosen and then groups disperseand write a scene with corresponding letters of the alphabet after deciding given circumstances (who, what,when, where).

b.) ONCE UPON A TIME Students write a short story about an event from their life that involved them, butnarrated from the perspective of someone else involved in the story. Stories are read aloud at the end ofclass if the writer wishes.

c.) WRITING “BADLY” The Teaching Artist makes a list with the help of the students. The list is of whatmakes writing “bad,” then everyone composes stories written as badly as possible. Great trick to get students thinking and writing creatively.

39. YOU CAN’T TELL BY LOOKING AT MEOutcome(s): Getting to know you exercises, safe way to share feelings, experiences, start discussions.Level: All levels

Description: Going around the circle, each person says “You can’t tell by looking at me, but _________” andfills in the blank to make the statement about themselves true. This is an exercise that often starts out lightand fluffy but with the proper facilitation can foster deep discussion around sensitive issues.

40. ZOOM, ZAP!Outcome(s): Warm-up.Level: Upper elementary, middle school

Description: Students stand in a circle. There are three coordinated sounds/movements that travel throughthe game. A “ZOOM” is when a player turns to the person to the right or left of them, makes eye contact,points and says “ZOOM.” A “ZAP” is when a player takes a step into the circle leaning towards anotherplayer (excluding the ones to their immediate right or left), makes eye contact with that player, points tothem and says “ZAP.” The motions and words are produced simultaneously. A player can reverse by holdingboth of their hands in front of their bodies and producing a screeching brakes sound. You have unlimited“ZOOMS” and “ZAPS” but only one brake. Once players get the hang of it, you can play with elimination. If a player does an action with the wrong word, hesitates or brakes twice, they are out and sit in the middleof the circle. You always end with three players as the winners since you can no longer “ZAP” at that point.

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BIBLIOGRAPHY OF RESOURCESFUNDING RESOURCESFoundation Centerhttp://foundationcenter.org/

The Chronicle of Philanthropyhttp://philanthropy.com

Council on Foundationshttp://www.cof.org

ART THERAPY RESOURCESAmerican Art Therapy Association, Inc.http://arttherapy.org/

National Coalition of Creative Arts Therapies Associationshttp://www.nccata.org/

Arts and Healing Networkhttp://artheals.org/home.html

The C. Everett Koop Institutehttp://geiselmed.dartmouth.edu/koop/programs/healing/

BOOKS WITH ACTING EXERCISES FOR CHILDREN101 Drama Games for Children by Paul Rooyackers

Acting Games: Improvisations and Exercises by Marsh Cassidy

Kids Take the Stage by Lenka Peterson & Dan O’Connor

Show Time! Music, Dance and Drama Activities for Kids by Lisa Bany-Winters

Special Talents, Special Needs: Drama for People with Learning Disabilitiesby Ian McCurrach & Barbara Darnley

Theatre Games for the Classroom: A Teacher’s Handbook by Viola Spolin

Theatre Games for Young Performers: Improvisations & Exercises for Developing Acting Skills by Maria C. Novelly