Abstract

The Periwinkle Arts in Medicine Program at Texas Children’s Cancer and Hematology Center partners with local arts organizations to connect and engage patients and families with a variety of art experiences, including music, creative writing, film, drawing, painting, and theater.  These experiences with artists enrich the lives of the families served, normalize the healthcare environment, and create positive memories for patients and families.

“The primary purpose of arts in healthcare is to use creative activities to lessen human suffering and promote health, in the broadest sense of the word” (Sonke, Rollins, Brandman, and Graham-Pole 2009). Art encourages self-expression, and it is particularly helpful to children, adolescents, and families at Texas Children’s Cancer and Hematology Center. Making music, singing, dancing, watching plays, writing poetry, or creating visual art can be an important part of the healing process. These participatory arts activities are embedded within the program and offered to patients and families as an integrated element of the care and treatment provided at Texas Children’s Cancer and Hematology Center. Patients and families report high levels of satisfaction with and benefit from engaging with the Periwinkle Arts in Medicine Program. This chapter will showcase the program and its implementation within a large quaternary healthcare setting in Houston, Texas.

Keywords: Houston, community art partners, arts and medicine, arts in health, arts and health programming, arts programming

Introduction

“At Texas Children’s Cancer and Hematology Center, we provide personalized, high-quality care for each patient. Caring for children with cancer or life-threatening blood disorders requires a family-centered approach to treat the child’s underlying medical condition as well as to attend to their psychosocial needs. The Periwinkle Arts in Medicine Program is instrumental in attending to the psychosocial needs of our patients and their families. Many different art experiences are offered, including visual art, songwriting, performing arts, creative writing—all tailored to the patient to enhance the healing environment and treatment experience.”

—Dr. Susan Blaney, Director, Texas Children’s Cancer and Hematology Center

There is strong evidence that investing in the arts can positively impact healthcare programs, patient morale, and recovery, as well as foster a safe and warm environment (NOAH, 2018). According to the World Health Organization, the creation and enjoyment of the arts can positively impact recovery and improve healthcare outcomes (Fancourt and Finn 2019). The Periwinkle Arts in Medicine (P-AIM) program offers patients the chance to participate in crafts, performances, songwriting, visual arts, music, photography, and writing in both inpatient and outpatient settings. The P-AIM program’s partnerships with local arts organizations provide unique and personalized opportunities for patients and their families. This chapter surveys the P-AIM program’s implementation, impact, partnerships, and outcomes. The program is presented as a model for community-based arts programming in a healthcare setting.

The Benefits of Arts Programming in Healthcare Settings

Arts in health is an emerging field used to improve healthcare outcomes, contributing to patient and hospital staff satisfaction (Clift and Camic 2016). Art has the power to enhance health and wellbeing in several arts-in-health contexts, including the healthcare environment (musical performances in lobbies, healing gardens, and permanent art displays), clinical creative therapy for patients, and arts programming for patients, families, caregivers, and hospital staff (NOAH, 2018). Artists in healthcare and creative art therapists play a critical role in enhancing patient experience, reducing pain, and improving wellbeing. While research in arts in health is limited, the World Health Organization has found that arts-in-health programming leads to a positive correlation between healing and the arts (Fancourt and Finn 2019). The benefits of arts and medicine working together in healthcare are critical to fostering healthy communities and patient wellbeing.

Arts in Medicine Program at Texas Children’s Hospital

Established in 1997, the P-AIM program has become an integral part of Texas Children’s Cancer and Hematology Center’s (TXCH) commitment to providing personalized, high-quality, family-centered care to children, adolescents, and families that addresses their unique emotional, social, educational, and medical needs. The program’s mission is to provide enjoyable and educational art activities that give children, adolescents, families, and caregivers affected by pediatric cancer and blood disorders the opportunity for self-expression, empowerment, and healing through the arts.

All who participate in P-AIM do so voluntarily. This choice empowers children at a time when many do not have choices about treatment, going to school, or seeing friends. These activities provide opportunities for children and siblings to interact with each other and the artists on a level playing field, as an artist, audience member, or participant. These activities also provide the many benefits of arts education that children in the hospital would otherwise not receive.

P- AIM video

Caption: P-AIM program video. Video courtesy of The Periwinkle Foundation.

For nearly three decades, the P-AIM program has contributed to building a safe, welcoming, and joyful environment for patients and families at TXCH. This would not be possible without the support of the Periwinkle Foundation and local arts organizations.

Beginning in February of each year, professionals representing various art partners, staff, and volunteers work with children in the clinic to develop artwork such as paintings, drawings, photographs, and creative writing pieces that are submitted to Making A Mark®, TXCH’s annual art exhibit presented by the Periwinkle Foundation. The display features works by children, adolescents, and long-term survivors whose lives have been touched by cancer and blood disorders. The art provides a unique focus on their personal issues. The art is displayed throughout the year at the hospital and in various locations in the community such as museums, office buildings, shopping centers, and schools.

Making A Mark Online Gallery

Artwork from Making a Mark. Images courtesy of The Periwinkle Foundation.

Local Arts Organizations, Community Art Partners

For more than 20 years, the P-AIM program has been building partnerships with arts and arts education organizations in the city of Houston, from nonprofit organizations that specifically support children, adolescents, and families at Texas Children’s to nationally renowned arts institutions in the Houston community. The P-AIM program refers to these organizations as community art partners. Cultivating relationships and leveraging partnerships with arts organizations in the local community has significantly contributed to the success of the P-AIM program. According to the National Organization for Arts in Health, securing professional artists for arts in health programming is critical to ensuring a robust program (NOAH, 2017).

The P-AIM program follows a unique template in that it is rooted in collaborations with local arts organizations. Artists from the program’s community art partners are encouraged to treat each child not as a patient but as a participant. The artists work in collaboration with the P-AIM staff to share outcomes from the visit.  Each artist reports to the P-AIM coordinator at the end of their shift. These outcomes include the work created (such as a song, poem, or painting), the child’s level of participation, thoughts the child shared during the session, and the artist’s overall impression of the visit. The P-AIM coordinator meets and shares this information with the Child Life and Creative Arts team on a weekly basis. As necessary, feedback is conveyed to this team, which includes staff from psychology and social work.

Art encounters may take place at the patient’s bedside (in-person or virtually), in playrooms, through closed-circuit television, or in the outpatient clinic. P-AIM programs are offered at all four TXCH campuses and through patient, family, and long-term-survivor events and camps. COVID-19 precautions led to programming being offered first virtually and, later, through a hybrid model of in-person and virtual. The P-AIM program continues to offer a hybrid model, which increases accessibility. The hybrid model also creates an opportunity to expand programming as Texas Children grows, including expansion into sub-Saharan Africa, the location of our Global HOPE program to treat children with cancer and blood disorders.

Overview of Community Art Partners

The P-AIM program works with a variety of local community art partners in diverse artistic disciplines. An overview of each community art partner’s mission statement is shared here, along with a description of how each partner implements their mission at TXCH. While not all mission statements include specific language centered around healthcare, all community art partners expand their programming to fit within the scope of a healthcare setting to further their organization’s mission.

Aurora Picture Show is a nonprofit media arts center that presents artist-made, noncommercial film and video. The organization is dedicated to expanding the cinematic experience and promoting the understanding and appreciation of moving image art.

Aurora Picture Show artists help children, adolescents, and families at TXCH to create short films utilizing stop-action animation and claymation techniques with various prompts such as “create a magic machine.”

Periwinkle Family Film Camp: The Case of the Magic Marbles

Caption: Short film from Periwinkle Family Film Camp. Video courtesy of The Periwinkle Foundation and Aurora Picture Show.

Young Audiences of Houston is committed to educating and inspiring children through the arts, to make the arts an integral part of the school curriculum, and to advance the field of arts in education through teacher professional development training and community partnerships.

Artists from Young Audiences of Houston provide children, adolescents, and families at TXCH opportunities to actively participate in or watch educational cultural arts performances that include music, theater, dance, puppetry, and visual arts. 

A clip from a visiting artist in ZTV, Mr. Tom

Caption: Young Audiences of Houston, Teaching Artist. Video courtesy of Child Life Media Production TCH and Young Audiences of Houston

Purple Songs Can Fly’s mission is to positively affect the lives of pediatric cancer and hematology patients and their families through writing, recording, and sharing their original songs.

Professional song writers from Purple Songs Can Fly work with children and adolescents at TXCH to write and record their own song. They also work with parents to make personalized lullabies for babies. Over 3,000 songs have been created in the hospital-based music studio.

God Help all the Kids

Caption: “God Help All The Kids On The Planet” Written and Recorded by Mia Spargo with Anita Kruse and Purple Songs Can Fly © Purple Songs Can Fly/All Rights Reserved

The Museum of Fine Arts, Houston, is dedicated to excellence in collecting, exhibiting, preserving, conserving, and interpreting art for all people.

An artist from the Museum of Fine Arts, Houston (MFAH) Learning and Interpretation Department helps connect TXCH children with the art displayed at the MFAH. Photos of works in museum exhibits are shared with patients. In response, patients interpret the art and create unique artworks of their own.

Let’s Make Monsters inspired by Antonio Berni

Caption: Hands-on art-making activity for families is inspired by Antonio Berni’s monumental sculpture “La sordidez (Sordidness)” from the MFAH collection of Latin American art. Video courtesy of Museum of Fine Arts Houston.

The Houston Symphony’s mission is to inspire and engage a large and diverse audience in Houston and beyond through exceptional musical performances and create enduring impact in our community.

The Houston Symphony’s community-embedded musicians visit patients at the bedside and play live mini-concerts based on the request of the child, adolescent, or family.

Writers in the Schools’ mission is to engage children in the joy and power of reading and writing.

Professional writers from Writers in the Schools provide prompts and work with children and adolescents to facilitate the creation of poems and stories that are printed individually and included in a print anthology that is later mailed to the family.

Splendid Review

Caption: P-AIM and Writers in the Schools Splendid Review, an anthology of poems, short stories, and autobiographies by the talented young writers at Texas Children’s Cancer and Hematology Center. Materials courtesy of The Periwinkle Foundation.

Houston Center for Photography’s mission is to increase society’s understanding and appreciation of photography and its evolving role in contemporary culture. The center strives to encourage artists, build audiences, stimulate dialogue, and promote inquiry about photography and related media through education, exhibitions, publications, fellowship programs, and community collaborations.

Professional photographers from the Houston Center for Photography work with children and adolescents to teach camera skills and help children create art though activities such as scavenger hunts. Participants receive printed copies of photographs they took.

ROCO is a nonprofit that is shaping the future of classical music through energizing, modernizing, and personalizing the concert experience.

ROCO created playlists for TXCH children, adolescents, and families to access via QR codes. The QR codes are available throughout the hospital.

Artists from the community art partners must apply, meet criteria, and complete the hospital volunteer orientation program. Before working independently with children and adolescents, artists also complete an orientation specifically for the P-AIM program. This orientation provides education and instruction on infection control policies and procedures, patient safety and confidentiality, each unit’s environment, the P-AIM program’s philosophy, therapeutic relationships and boundaries, psychosocial support, engaging with children, wrapping up a session, session reporting, and co-visits with P-AIM program staff.

Building relationships with arts organizations in Houston has been paramount to the success of the P-AIM program. From theater performances and listening to music to filmmaking, drawing, and songwriting, community organizations enrich participants’ experiences with a plethora of arts programming.

COVID-19 and Virtual Programs

During the first two years of the pandemic, Texas Children’s Hospital guidelines limited visitation by outside organizations. Because of this restriction, the P-AIM program worked with community art partners to plan and deliver safe and meaningful virtual arts programming. Despite the challenges of the pandemic, it presented an opportunity for the P-AIM program to offer programming to all age groups and to expand to other hospital campuses like Vannie E. Cook Jr. Children’s Cancer and Hematology Clinic in McAllen, Texas. An overview of programming adapted or introduced during the pandemic is shared here.

iAIM is a unique program that was created and added to the P-AIM program to deliver arts in medicine programming through technology, such as tablets, virtual programs, and closed-circuit television.  iAIM virtually connects P-AIM’s art partners with children, adolescents, and families at TXCH. This innovative approach has ensured P-AIM programming could continue amid the evolving policies and procedures set during COVID-19. The Periwinkle Foundation partnered with Purple Songs Can Fly, ARTreach,  Writers in the Schools, Houston Center for Photography, and the Houston Symphony to implement this critical and creative programming safely during the pandemic. In addition to iAIM, the following programs were developed or adapted as creative solutions to safely provide programming to participants:

• Creativity Connected – A weekly electronic newsletter sent to TXCH patients and families. Creativity Connected increased P-AIM’s visibility and awareness among the community while delivering meaningful art programming and opportunities. The newsletter not only served as a way to engage current participants but created an opportunity to reengage past participants positively impacted by P-AIM.
• ZTV – A closed-circuit media program for patients and families. ZTV broadcasts live shows and special events from an in-house studio. Patients and families are welcome to participate in these child-friendly shows directly from their rooms. Four unique programs are created, recorded, and streamed monthly. One such program is Carol’s Book Buddies.

• Making A Mark® Artapalooza – A weeklong art making event where participants created artwork to submit to Making a Mark®. Each day focused on a different theme and/or medium of art, such as mixed media, tempera, watercolor, torn paper collage, and self-portrait.

• Pablove Shutterbug –This signature arts program of the Pablove Foundation teaches children living with cancer to develop their creative voice through photography. Learning photography concepts alongside other kids undergoing similar experiences empowers these children to express themselves, exercise their independence, and practice new ways of seeing the world. Classes were provided online for pediatric cancer patients ages 6 to 18. Camera equipment was provided to participants and families to practice photography skills learned in their sessions.
• Periwinkle Family Film Camp in collaboration with Aurora Picture Show – A virtual family camp to teach families how to make their own films at home. Each participating family received a filmmaker kit consisting of a tripod for a smartphone, a lamp, supplies for creating animation, and special treats. Over WebEx, Aurora Picture Show gave live instruction and tech support throughout the camp session. To conclude the session, participants came together virtually to premier their films.

While the pandemic created immense challenges, new virtual programs allowed the P-AIM program to reach more children, adolescents, and families.

Program Evaluation 

Evaluation is critical to the success of arts-in-health programs. According to Mark White (2006), “Process evaluation may provide a framework in which community-based arts in health projects, especially if they are networked together to share practice and thinking, can assess their ability to address health inequalities and focus better on health outcomes.”

TXCH has conducted two survey-based program evaluations to improve the experience of patients and families engaging in P-AIM. In 2010, the first program evaluation yielded a large response, with 460 patients and family members completing the survey. The survey looked at familiarity with the art programs offered, participation in art activities, perceived helpfulness of art activities, and barriers to participation. An astounding 80.5% of patients and family members found arts and crafts to be very helpful, with music, photography, plays, and creative writing all scored as very helpful. These findings reinforce other evidence suggesting that art activities are beneficial for children and adolescents (Cowell, Herron, and Hockenberry 2011).

Next, Texas Children’s worked with Young Audiences of Houston, Baylor College of Medicine, and the University of Texas to determine the feasibility of further measuring the impact of the P-AIM program on children, adolescents, and families. The results of this study indicated that a majority of children enjoyed and positively reacted to the performances in theater, dance, and music. Furthermore, a majority of the children and families studied reported that the performances helped by calming them, cheering them up, and/or providing a positive distraction during their hospital stay (Taylor, Eckert, Herron, and Frugé 2017).

The third program evaluation was completed in 2019, building on TXCH’s earlier work. This evaluation included a survey that was completed by 286 families. Results showed that those who participated in P-AIM programming reported continued high levels of satisfaction, with the highest satisfaction derived from music and arts and crafts, and lower satisfaction from theater (Weisert, Franklin, and Herron 2019).

Families also reported that they were not aware of P-AIM by name, which pointed to an opportunity for P-AIM to explore how to build awareness and name recognition (Cowell, Herron, and Hockenberry 2011; Weisert, Franklin, and Herron 2019).

It is clear the P-AIM program is essential to the care and emotional wellbeing of children, adolescents, and families at TXCH.

Conclusion

While reflecting on her time at Texas Children’s Cancer and Hematology Center, a patient shared her thoughts about the P-AIM program’s impacts on her.

“The way the art program has impacted me is that it clears my mind of having to take medications, having to be in the room for a  long period of time, being able to express myself in many different ways without being judged. I am able to express how I feel when I draw or paint without actually having to say how I feel. I appreciate everything the art program has done for me and I appreciate the staff always being patient with me when I would have my bad days, but somehow when they come in I am able to let that go and focus on what they have brought in to enjoy.”

—14-year-old patient

The arts are critical to the human experience. Thanks to the long-standing support of the Periwinkle Foundation and a robust roster of community art partners, the P-AIM program has considerably impacted the children, adolescents, and families of TXCH by providing the joy of art and engaging participants through a variety of artistic disciplines.

References

Clift, S., and P. Camic (Eds). 2016. Oxford textbook of creative arts, health, and wellbeing: International perspectives on practice, policy and research. New York: Oxford University Press.

Cowell, E., Herron, C., and Hockenberry, M. 2011. The impact of an arts program in a children’s cancer and hematology center. Arts and Health 3(2): 173-181. https://doi.org/10.1080/17533015.2011.561356

Fancourt, D., and S. Finn. 2019. What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. https://www.who.int/publications/i/item/what-is-the-evidence-on-the-role-of-the-arts-in-improving-health-and-well-being-a-scoping-review. Accessed December 29, 2023.

National Organization for Arts in Health. 2018. Addressing the future of arts in health in America.

National Organization for Arts in Health. 2017. Arts, health and well-being in America.

Sonke, J., J. Rollins, R. Brandman, and J. Graham-Pole. 2009. The state of the arts in healthcare in the United States. Arts and Health 1(2): 107-135. https://doi.org/10.1080/17533010903031580

Taylor, H., S. Eckert, C. Herron, and E. Frugé. 2017, September 18-20. Characterizing arts in medicine performances and the impact on audience engagement and mood at a children’s cancer center [Conference session]. National Organization for Arts in Health, Austin, TX, United States.

Weisert, E., Q. Franklin, and C. Herron. 2019. Quality improvement project to improve engagement in a pediatric hematology and oncology arts in medicine program [Poster presentation]. University of Texas Medical Branch, Houston, TX, United States.

White, M. 2006. Establishing common ground in community-based arts in health. Journal of the Royal Society for the Promotion of Health 126(3): 128-33. https://doi.org/10.1177/1466424006064302