Integrating Art Into Pediatric Health Care: A Collaborative Approach

The Artist-in-Residence office at UCSF Benioff Children’s Hospital Oakland is located in the historic wing of the main hospital. A small window on the west side of my office looks out on the hospital courtyard. I catch a glimpse of a young girl in the courtyard below. She is slowly ambling down the ramp, a physical therapist at her side. Her mother is trailing behind them, pausing for a moment to watch her daughter’s slow and deliberate descent. A teenage boy sits on a wooden bench on the west side of the courtyard. He basks in the sun. His grandmother sits at his side, eyes closed. An enormous magnolia tree rises behind them, branches reaching wide. The white flowers above them bloom skyward.

The Artist-In-Residence program is part of the child life and creative arts therapy department. Unlike traditional Artist-in-Residence programs within museums, universities, or civic institutions that are short term in nature, in our hospital the Artist-in-Residence title refers to a permanent staff position. The program was founded in 2004 with donor funds, supplemented by an initial grant from the Society for Arts in Healthcare. The Artist-in-Residence role offers an arts-informed perspective to complement the work of child life services and the interdisciplinary medical team.
My office is flanked by built-in shelves on both sides. I have labeled bins of acrylic paint, colored pencils, liquid watercolors, sketch books, patterned paper, plastic stencils, and adaptive art tools of all shapes and sizes. My digital art supplies include a stack of iPads, a small video camera, a laptop, and robotic drawing kits. Books on child life, art therapy, expressive arts, trauma-informed practice, and pediatric palliative care line the shelves above the desk. My clinical training includes trauma-informed practice and family-centered care, and my approach is multidisciplinary. I am a member of the unionized staff, and have held this position for more than a decade. Polaroid photos of former patients I’ve worked with fill the walls around my workspace.

Child life specialist Jen Johnson-Geisse, MA, CCLS, knocks on the door and enters the office. She holds a printed census in her hand. She pulls up a chair, and we review the list of current patients on the pediatric rehabilitation unit. We discuss and reflect on the expressed needs of each patient, one by one. Jen and I have worked in tandem on many patient cases over the years.

In one such instance, Jen emerged from a single-occupancy hospital room and approached me from across the corridor. She described her work with a newly admitted teen, Ozzy*, who had sustained an abdominal injury causing him to be placed in a medically induced coma. When he awoke, doctors determined that he had experienced significant damage to his central and peripheral nervous system. At the time of his admission to our unit, Ozzy had lost most of his physical functioning and was unable to speak. It eventually became clear that his cognitive ability was unimpaired and he understood everything happening around him. Jen also learned that Ozzy had a long-standing interest in art. Given his injury and hospitalization, he was no longer able to access his previous methods of artmaking.

We began to discuss the ways in which Jen and I could align our individual skill sets to optimize Ozzy’s care. We identified our primary clinical goal as facilitating outlets for emotional and creative expression while providing comprehensive family support. In order to achieve this goal, we explored a range of therapeutic activities that would offer Ozzy a sense of agency and empowerment during his long-term hospital admission. We agreed that a creative arts intervention, developed in close consultation with Ozzy and his family, could be an ideal point of entry.

Jen led me to Ozzy’s room across the hall and we knocked on the door before entering. Ozzy had his back to us, facing the window. Squeezing behind the power wheelchair and circling around the IV pole, we located ourselves across from Ozzy. Jen greeted him and introduced me. I offered a few examples of ways that previous patients had engaged with the arts. Ozzy responded with interest and we began to explore creative possibilities.

Ozzy experimented with multiple approaches to art-making during his hospital stay, but was most responsive to an adaptive spin art session that Jen facilitated in his hospital room. Spin art is an expressive modality that offers a processoriented approach. The medium provides ample opportunities for creative choice, control, and innovative adaptation. To create spin art, a square piece of paper is secured to a portable spin art machine. With the flip of a manual switch, the platform rotates at a high speed. The artist pours paint onto the paper and the centrifugal force draws the paint outward, creating original designs. Small-scale spin art machines are a low-cost, easy point of entry for children and teens, and they can be adapted to accommodate a range of accessible switches.

Following his initial engagement in spin art, Ozzy and his mother proposed the idea of working on a larger scale. We immediately took the opportunity to follow their lead. I began to work with Ozzy’s mother, who put me in contact with the robotics club at his school, a club he had participated in prior to his injury. In response, the robotics club offered to build him a large-scale spin art machine for use at the hospital. I communicated directly with the club about infection control and storage size requirements in order to build a device specifically designed for our medical setting.

When the customized machine was built, Jen was able to collaborate with Ozzy’s physical and occupational therapists, who set up a mobile arm and grip-support system. This allowed Ozzy to utilize his own body to manipulate and apply the art materials with significantly less assistance. Over time, he also began to utilize a form of “yes” or “no” response through head movement. This evolved to the use of an automated voice to indicate an auditory “yes” or “no” response.

During our first collaborative session with the large-scale spin art machine, Jen and I took turns offering acrylic paint bottles one by one. Ozzy indicated a “yes” or “no” reply in response to each color choice. We repeated the process and he indicated his next color. He was deliberate, thoughtful, and self-assured in the curation of his painting palette. 

After selecting his color combination, Ozzy decided on the location of color on the page. He then determined the amount of paint based on the length of time it was poured. He was able to activate the spinning of the device using adaptive switches initiated by subtle movements, including turning his head, rotating his wrist, and bending his fingers.

Ozzy soon expressed interest in sharing this creative resource with other patients. In response, Jen and I began addressing the emergent clinical goals of supporting Ozzy’s socialization with peers, engaging in community-building activities, and reinforcing his sense of identity within the hospital. Jen offered large-scale spin art sessions as a group activity. I worked with two teen patients who filmed and edited their own video about the spin art process, with Ozzy positioning the camera on his lap to serve as the cameraman. Patients of all ages began to share their own spin art creations with hospitalized peers across multiple units. The large-scale spin art was featured on our weekly patient television show, the CHO Show, aired live to every hospital room. I was also able to arrange an opportunity for Ozzy to display his spin art at the University of California Berkeley Art Museum. The opening of the art exhibit attracted a full house at the museum, with Ozzy’s family members and interdisciplinary medical team in attendance.

Group art session with Child Life Specialist Jen Geisse that inspired the decision to make t-shirts for Ozzy’s interdisciplinary medical team. One of Ozzy’s signature designs is pictured on the bottom right.

I arrived at the Berkeley Art Museum with an iPad in hand. Jen and I knew that Ozzy would be unable to attend the exhibit in person, so we coordinated to allow him to attend via video conference. While I walked through the museum, filming the exhibition as I went, the video was screened live in the teen lounge at the hospital. Ozzy’s family members were at the exhibition and congratulated him over the live video feed. Museum attendees could watch Ozzy’s spin art activity at the hospital, which was facilitated by our child life staff. Jen was available in the teen lounge to assist Ozzy with the video conference and help him interact nonverbally with those attending his exhibition throughout the evening. His virtual presence had a powerful impact on the museum attendees viewing his work on display.

As Ozzy approached discharge and prepared to return home, he and his mother suggested the idea of a farewell spin art session where he would be able to make wearable artwork on t-shirts for members of his medical team. This final session served as an important transitional intervention for Ozzy to say goodbye to his primary team of clinicians and leave his mark on the hospital community.

While working in tandem, Jen and I regularly come together to talk about next steps in a creative intervention. Our aim is to work in partnership with the patient and their family members. We believe that artwork can serve as a powerful medium to share the first-person perspective of the patient, while also connecting with a community of hospitalized peers. In Ozzy’s case, spin art was not only an accessible tool that enabled creative expression and empowerment in the inpatient setting, but it also provided a way for Ozzy to foster deep connections between his interdisciplinary hospital team and home community. Ozzy has since returned home from the hospital, but his large-scale spin art machine continues to be a valuable resource for new patients and families.

Looking out my office window, Jen and I pause as a helicopter lands on the nearby helipad. The wind picks up. The stretcher crosses the parking lot. We can see a small child tucked under the blanket. The medical team surrounds the child as they enter the back entrance of the hospital. Jen and I take a brief pause to acknowledge the new family entering the emergency department below, before turning our attention back to the next child on our list.