TEACHER’S MANUAL

Section 3 Interpersonal & Social Skills

• A Parent’s Perspective • “How to Make Miracles” • The Nurtured Hearts Approach to Discipline • Interpersonal and Social Tips for Teachers in All Areas • Self-Care Tips • The Self-Care Wheel • Grief Management • Grief Assessment Worksheet

 

a parent’s perspective "Is the art table open?" "Can I go straight to the art table after I get hooked up?" These are the questions Lily is most concerned with when we tell her we are heading to the hospital. It is the reason that after five days of chemotherapy, Lily cried when leaving the hospital. She didn't want to leave. She wanted to stay just a day or so longer. The Arts for Life folks are the Willy Wonkas and the Art Table and Musical Instrument Cart are Lily's chocolate factory. It's a world of pure imagination for her. If she can dream it, they will do it. How about Tinkerbell's House with a tiny flying Tinkerbell? No Problem. How about clay Penguins performing a penguin play on a tiny little stage? Consider it done. Paper chains? Yes! Covered in glitter glue? Oh, YES! With each and every project the final product is so much more than a beautiful piece of art. Lily's ideas are celebrated, her fine motor skills are exercised, someone with a fresh happy face has made her feel like the most important person in the hospital. While art or music is made, Lily has the chance to talk about the wonderful world of Lily and learn more about the wonderful lives of the people she is with. Long days are made shorter and more exciting because of the Arts for Life program. The Arts for Life program is not just wonderful for Lily but for mom's like me too. The art table provides a really neutral and safe environment to meet other parents. We can talk about our struggles and triumphs, give and receive support from each other. We are all there for the care of our children. To connect with other adults while our children are comfortable and entertained is a gift. Recently, Lily and I have spent the day in the clinic observation room with several other children and their parents. Colin Allured's music and instruments brought children who had no other reason to connect, together as a band. During Christmas, we could not help but sing or hum for hours the Christmas Carols we shared with Colin. He is patient and calming. He encourages but is also intuitive, changing pace based on Lily's energy level. We were especially grateful that some of the volunteers were scheduled for evenings during the week. Many times a simple transfusion can take many hours. It was such a great surprise after 5 o'clock to hear, "Would you like to make some art?". Even when there is no one scheduled, Betsey or Lauren make sure Lily has all the supplies she needs to get through the evening. Visiting a new hospital recently, I overheard my mother-in-law ask about the Arts for Life program. They do not have one yet. She explained that Lily has artists and

musicians come to her room at Brenner, making music and art with her each day. They said it sounded fantastic. Lily said, "Oh...it IS!" I am not sure how the staff is able to go from room to room, experiencing each room's particular moment of treatment and remain as composed as they do. There have been days when one child fights for his life while another child is filled with energy. I know the burden their hearts must feel because I have shared my fears and tears with them myself. I know that the next room they enter will never have even a glimpse of what was just shared in my room. They all make us feel like we are the only patient they have or will see today. They carry our pain and joys so discreetly. We have made art, music, and friends for a year now with the Arts for Life program. This special group of people are compassionate and professional, discreet and enthusiastic. In a place where there is so much devastation, frustration, uncertainty and fear, the Arts for Life staff create calm, happy moments and memories. For each of those moments and memories, we are very grateful! Ashton Blackman Mother to Lily 5 1\2 Neuroblastoma IV Diagnosed February 09

how to make miracles! Helpful Information from Colin Allured

Music Teacher at Brenner Children’s Hospital 2005-2016 Questions to ask yourself as you come into the hospital: “How can I bring harmony where there is discord?” “How can I bring soothing where there is pain and worry?” “How can I encourage enthusiasm and upbeat energy?” In his many years of teaching with Arts For Life, Colin continually found guidance in answering these questions from his students. Their body language, their energy level for that day, the expression on their faces—Colin used all these cues to tell him whether to play fast, slow, or medium tempo. To play the drum or the guitar. Which song, which key; to sing or not sing. Walking into the hospital each week, Colin found over and over again that the environment created by the people in it told him what it needed. He approached it with an attitude of helpfulness and humbleness, and as a result, joy and positivity filled the spaces that needed filling. Colin’s approach is not rocket science. It doesn’t require expertise or even previous experience! The only requirements are an open heart, an open mind, and an ability to match your energy with that of your surroundings. In the same way that Colin uses social cues to tell him what instrument to use, you can use the same cues to guide your own teaching practices. Oftentimes, it’s not so much what you teach, but the fact that you are there to teach at all that makes the difference. Colin thinks of himself as “a facilitator of miracles.” But as he says: “the miracles have nothing to do with me, or any magic power. The miracles are when a child smiles for the first time after strumming a guitar or hitting a drum. Or when a parent smiles as their child starts dancing and singing to a drum beat. Music connects us with the force of these miracles. It connects us with each other: child, parent, nurse, patient, doctor, receptionist, all are connected by the music.” It is the art that we help kids create—the drum beat, the pencil mark, the paint stroke, the guitar strum—that makes the miracle. It is our job, as Arts For Life teachers, to recognize, facilitate, and celebrate that process. Colin talks about the emotional aspect of working with Arts For Life: “Probably the most challenging part of this job is what you see and experience vicariously through your students. You will have some students that will pass away, some students that will recover completely, some students that will recover and then relapse. If you work long enough for Arts for Life you will see all possible outcomes from these treatments. And the treatments themselves are a long arduous process for the patients, siblings, and parents.

In some of my early days working for Arts for Life, I used to go home and cry for my students. I couldn’t fathom the weight of what they were going through. For any sensitive and sympathetic person, this is an honest response. But the questions came to me: “What good am I to them in this state?” “How is taking inside myself their sadness and pain useful and beneficial to them?” The answer became very clear to me: Allowing myself this reaction simply increased the sadness and pain. Are you volunteering with Arts for Life to increase the sadness and pain? No! You are the ANTIDOTE! Go there, be happy! Be healthy! Spread joy and love! Increase the smile cells in all those around you! It’s not that you become numb or insensitive to the great difficulties that these children and their families are facing, but it is not your job to take these difficulties upon yourself. And more importantly, it is not useful to them! What is useful to them is your happiness upon seeing them, your joy in making music with them, your warm smile and comfortable presence. When I started to realize these things, it changed everything about going to the 9th floor for me. I realized Life is going on here. And music and art make life rich and fulfilling, no matter what obstacles and hardships stand in the way. Just being there and being happy is a great gift to all you come in contact with: patients, parents, nurses, and doctors. Don’t be in a hurry with your students. Spend time with them. Build a relationship; teach them something new each time - big or small. Be a relaxed, fun, and happy part of their day. Be spontaneous, creative, sensitive and open to your surroundings, humble, helpful and happy! In this way, miracles will occur naturally every time!”

the nurtured hearts approach Purpose: The Nurtured Heart Approach is a social curriculum that transforms children’s character and spirit, giving them a deep conviction that they can cope with problems and succeed socially and emotionally. Basic Perspectives:

1. Difficult children are seeking intense relationship-attention. 2. Difficult kids quickly learn that they can readily engage and control others through

negative behavior. 3. Ordinary parenting and classroom discipline methods make things worse with

children like this, because most normal methods demonstrate more relationship and energy when things are going wrong – and in contrast, little energy and relationship when things are going well.

4. Children who possess sufficient inner wealth do not need negative relationships, because they can sustain themselves by connecting to the world and to themselves through successes. The more inner wealth, the greater the resiliency.

5. There is no way to avoid teaching a social curriculum. We are always sending a message.

Basic Principles:

1. Create a rich relationship by creatively energizing success. We call this “time-in.” Recognize & praise children’s successes no matter how small they may seem.

2. Create an empty, boring “time-out” that consists of the child missing out on life’s energies and relationships when they misbehave. The child is out of the loop; you are refusing to give energy and relationship to negativity. Instead, you are giving an unceremonious consequence. In other words, if a child is misbehaving, do not give them energy, correct the behavior with complete objectivity.

3. Always let students be fully responsible for their problems. Don’t deny them the result of a poor choice – a consequence – when a rule is broken.

4. Always treat them as though they are fully competent, RIGHT NOW. 5. When interacting with children, control your mood and direction of conversations.

Do not leak negativity by giving energy and relationship to poor behaviors. 6. There is nothing we can do to stop bad behavior, but we can consequence or

celebrate whatever behavior occurs. We have exquisite control when we are strict (consequence for any rule broken) and positive (create and celebrate successes and acknowledgment and recognition).

7. Most importantly, reward and recognize good behavior. Determine what the “good behavior” is and praise it when you see it. For example, as a teacher you may want to be conscious of praising all acts of sharing you see on a particular day. By giving yourself a focus to your praise, you can help direct the outcomes of your time with the students.

(Excerpt from The Inner Wealth Initiative: The Nurtured Heart Approach for Educators, by Tom Grove and Howard Glasser, 165-66, c.2007)

Interpersonal and Social Tips for Teachers in All Areas

1. Take cues from kids and families and adjust your demeanor accordingly. Kids will be feeling differently each time you see them. Some days they will feel great and have lots of energy, others they will be weak and tired and feeling yucky. Make sure your energy level is compatible with their mood.

2. Try to avoid under- or over-estimating a child’s age. Although the age is listed on the census, sometimes there are mistakes, which make misjudging age and abilities easy to do on the pediatric floor. Please begin communication and interaction with the child and then decide what project is appropriate. You will need to be able to alter your activities, projects, and teaching methods to meet the distinct and special needs of each child.

3. Be sensitive to physical and space boundaries. Do not initiate physical

contact or assume that a child is comfortable with you sitting close to him/her. Kids are likely to be sore, achy, itchy, and irritable due to their treatments. Read the physical cues you receive from the kids (and their parents) to know what is appropriate.

4. It is common for new patients to be anxious about being in the hospital. Your

role is to give them a positive, non-threatening interaction. You are there to offer kids (and families) a safe space in which they can be in control, as well as the opportunity to ease anxiety with positive activities. Being overly enthusiastic or trying too hard to get them to engage with you may end up only increasing their anxiety.

5. Always maintain a professional relationship with the kids. Always act as

their teacher rather than their friend or peer.

6. Avoid talking about patients as if they are not present. Sometimes parents do this without noticing – just make sure to bring the attention back to the patient.

7. Be supportive of parent’s decisions. Do not interfere with disciplining by

parents. However, it is important to set limits with pediatric patients. There are some rules we have in place to keep them safe (no sharing of supplies, etc.), it is important to reinforce these rules.

8. Be consistent and dependable. Do not make promises you may not keep!

9. Establish basic rules (like always saying “please” and “thank you;” never

putting down anyone else’s artwork.) Discipline within reason using the Nurtured Hearts philosophy.

10. Give kids a chance to try something before deciding that they can’t do it (even

if a parent assures you they can’t!)

11. Put yourself on eye-level with children; avoid standing over them.

12. Be positive and welcoming with all kids. Be energetic and enthusiastic in trying to engage them.

13. Be an interested listener. Find out what your student is interested in and tweak your project to be more engaging to them.

14. Give regular praise to the kids you are working with, recognizing their

individual triumphs and acknowledging their successes.

15. Work to build good relationships with the patients and parents you meet. You will work with many patients repeatedly, and they will come to expect you each time – be dependable.

16. Give students choices and let them decide what projects they want to create.

17. Whether you always accomplish a project completely or not, just being

present with the child means the world! You may find that some patients say yes to an art project, but once they get started, they are more interested in conversation and company.

18. Give students every opportunity to achieve success, no matter what that looks like. Help them create art that they can take home or display in their hospital rooms. Remember that art is supposed to be fun! If they become frustrated with their work, help them find a way not to be. Give them guidance, support, and tools to have a positive experience.

19. Take time to gauge the circumstances of each of your students. You may need

to take a parents’ lead when interacting with a patient. If you feel unsure of a patient’s abilities, you can ask a parent about the child’s abilities in a sensitive manner. One intern recently gave the following example to show the importance of talking with parents: When you approach a new child and inquire if they would like to do art with you and you repeatedly get no response, this could be because they do not understand you, because they can not hear you, or they hear and understand you but simply can not respond to you.

self-care tips Being mindful of your own physical, emotional, and spiritual needs is essential in creating a healthy, balanced life. While many aspects of your volunteer experience will be joyful and fulfilling, there will also be times of sadness, stress, and uncertainty. This is inherent when you are working with people who need your help and support. The key is to maintain a steady practice of self-care that allows you to stay focused and attentive during the times you are working with patients and families, and at the same time allows you to work through stress so that it doesn’t carry over to your personal life. You are the expert on your own self-care. We all intuitively know, after years of living with ourselves, what kinds of things relax us and fill us up. Now is the time to tap into those things! In the following pages, you’ll find a Self-Care Wheel, which will help you identify the things you do to take care of yourself in six different aspects of your life. We encourage you to use this as a tool for guiding your own self-care practice. In addition to what you do outside the hospital, there are a few simple things that you can do before, during, and after your teaching shift to manage the stress you may encounter. Before Walking into the Hospital:

• Take a few minutes during your drive, in the car, or on your walk to the art table, to be mindful of what personal stresses you might be bringing in with you. Recognize these things, breathe them in, and let them go. You might even need to shake out your arms, jump up and down, or stretch to let them go completely.

• Arrive early for your shift. Having a few minutes to settle in your space before kids come can help you to feel relaxed and prepared for whatever happens.

• Make eye contact with the people you meet on your way in. Smile. Be open. This will ground you in the environment and bring you to the present.

During Your Shift:

• Remember to breathe, eat, drink, and go to the bathroom. it sounds silly, but sometimes it’s easy to lose yourself in the overwhelming hospital environment. When this happens, take a second to bring your awareness to your body and listen to what it’s telling you.

• Take a (short) walk when you need it. Sometimes the little stresses build up throughout the day. It’s okay to take a minute or two to yourself in between patients.

• Teach kids patience by practicing it. In our teaching environment, kids are constantly arriving and leaving the art table. There will be days when you are outnumbered. There will be days when you could work constantly and still not get to everyone. Relax. You are human. You can’t explain the directions for four different art projects at the same time. Ask kids to be patient with you, and they almost always will.

Before You Leave

• Use your cleaning time to reflect and process. The 15-20 minutes of cleaning that happens at the end of every shift is not normally the best part of any given shift, but it does present the opportunity for quiet reflection while you keep your hands busy.

• Take a few minutes on your walk, in the car, or on your drive to be mindful of the stresses you just encountered. Breathe them in, and let them go, so that you don’t carry them with you in your personal life.

• When possible, allow yourself a buffer between your time at the hospital and your next activity. Don’t schedule yourself too tightly.

Quick Stress Relievers:

• Practice “soft belly breathing” for 3-5 minutes. Once you’ve practiced a bit, even a few breaths can make a difference…add a positive phrase.

• Give yourself a hand massage. • Stretch: Raise your shoulders towards your ears; squeeze shoulder blades

together; stand and rotate arms in wide circles.

Long Term Stress Relievers:

• Limit TV/Electronic time at home-unplug • Get active—walk, run, bike, row, play tennis, etc.… • Become involved in a hands-on non-work project—crafts, car repair, woodworking,

sewing/knitting, cooking/baking, gardening, painting, photography, chess—something which requires your concentration and from which you can see a “finished product”

• Add an extra half hour of sleep to your nightly routine • Sign up for a dance or art class!

Practicing Mindful Breathing http://www.grief-healing-support.com/meditation-relaxation.html

1. Sit in a comfortable position that will allow you to maintain concentration (a sturdy chair with a straight back). Hands resting comfortably in your lap, head straight

2. Close your eyes 3. Focus on the area of skin on your top lip just under your nostrils 4. Feel the air passing over this area with each breath in and each breath out 5. Breath into your stomach, let it fill up like a balloon or as a baby breathes. Let your

stomach soften and deflate as you breath out 6. Follow your breath and let it happen naturally, gently, slowly, completely 7. With each breath out relax and let go of tension and resistance. Relax into the

moment 8. Maintain focus on the air passing over your lip into and out of your nostrils. If your

mind wanders, bring it back to your breath 9. To start with it may help to breath in - count one and count two as you breath out.

Breath in and count one, breath out and count two. 10. Feel the energy of the universe heal your heart and your grief with each breath 11. Your focus and attention stay with each and every breath. Do not think about

breathing, just feel the breath as it enters the nose, fills the lungs, nurtures the body and returns to the atmosphere

12. Continue for 10 to 15 minutes

SELF-CAREWHEEL

L I F E

B A L A N CE

�is Self-Care Wheel was inspired by and adapted from “Self-Care Assessment Worksheet”from Transforming the Pain: A Workbook on Vicarious Traumatization by Saakvitne, Pearlman & Sta�

of TSI/CAAP (Norton, 1996). Created by Olga Phoenix Project: Healing for Social Change (2013). Dedicated to all trauma professionals worldwide.

www.OlgaPhoenix.com

self-care wheel

grief management One unfortunate reality of working with children who are critically ill is that death is always a very real possibility for them. And when a child passes away, the loss is so great—for the parents, siblings, families, friends, and other the caregivers of that child—and also for us. While you can never know how you will deal with such a loss until you have experienced it, it’s important to know that it is ok to grieve and it is hard work to grieve. Give yourself permission to grieve.

• Take time out. It’s perfectly reasonable to need a little time to process the news of a child’s passing. Some teachers write, some teachers walk outside, whatever your inclination is, honor it.

• Teaching can be healing. It may be daunting at first to think about

returning to the hospital for your regular shift, but it helps to remember that there are kids who need you! There is still as much joy and laughter and learning that will happen at the art table as there ever was. Realizing that—experiencing that-- can be very helpful in the healing process.

• Lean on your support system. Continue to do what you do to take care of

yourself, and do it more often if you need to. Talk with your Arts For life colleagues. Spend time with friends and family doing things you love.

• Ask for help if you need it. If you are dealing with a particularly difficult

time, or just feel you need some help processing an experience, call or email your Program Director to discuss counseling options.

Myths and Facts About Grief MYTH: The pain will go away faster if you ignore it. Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing it is necessary to face your grief and actively deal with it. MYTH: It’s important to be “be strong” in the face of loss. Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you. MYTH: If you don’t cry, it means you aren’t sorry about the loss. Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain just as deeply as others. They may simply have other ways of showing it.

MYTH: Grief should last about a year. Fact: There is no right or wrong time frame for grieving. How long it takes can differ from person to person. However, people can become “stuck” in different points in grief and may need help in moving forward. Source: Center for Grief and Healing

Grief Worksheet Use this as a self-led activity to help you reflect, get centered, understand where you stand with your grief, and remember your natural stress relieving tools. 1. What are the ways you express feelings? Example: music, art, poetry, reading, talking, singing, crying, dancing, exercising... Plan time to do this today. Tomorrow… 2. Are there any cultural, spiritual or philosophical issues that you wrestle with as you face this grief? Just understanding this can help you let go of guilt or other issues that are in your way. 3. Where do you draw hope from? Focus on your hope. 4. What are 10 things that are going well and you are thankful for today?