Evaluation of Artworks Royal Aberdeen Children’s Hospital 2006 – 2009 June 2009 Delday and Douglas, rgu insert Insert rach rgu art logo logo

5.1.8 Learning from the experience
The coordinator learned that it is much easier for an artist to engage with children in the Surgical Ward than the Medical Ward and thought this ‘quite understandable’. Children in medical were reluctant to talk about their hospital journey because their conditions were ‘more personal’ and could be ‘more serious’.⁸
One Art Group member learned that it was important to not pre-judge the potential value of a project at the outset of a project (i.e. the brief).
The artist learned that there was tangible value in ‘listening’ to patients (and family members) during the consultation process, even though it might not directly become part of the novel – they were still ‘part of the project by being included’. There tended to be ‘more chatting and not as much drawing’ as she’d imagined, but she felt this was important and addressed the brief in terms of providing an enjoyable or fun experience for the children. Her understanding of how a young person’s unit is run had been ‘broadened’.
5.1.9 Summary of findings

(Focus: 2.1)

1. The impact of the artist on the environment
2. The effectiveness of the creative consultation
3. The appropriateness of the artwork to the users, reflecting the diversity
of age groups attending.)

Process
The staff felt that the artist¹s creative consultations were valuable and important for the children and the staff themselves enjoyed working with the artist i.e. assisting the artist to engage the children.

The staff acknowledged the benefit of the artist contributing to their day-to-day work in terms of keeping children occupied, providing distraction and being good company. It added value to the service provided by the play staff by creating additional activities which some of the children ‘really

looked forward to’. The staff felt it was important to have ‘the stimulation of someone different¹ in the wards ‘providing something different¹.  Play staff felt that the artist¹s working alongside them added to children’s self esteem.  

In response to the challenge of engaging children, the artist adapted her process extremely well. She worked sensitively with the patients and added to their ‘confidence¹ in terms of taking part in an activity. She maximised her time by also engaging younger children who produced material that was

also used in the novel. She also worked with staff and this was also incorporated into the final product.  This was possible because of the excellent support of staff and the coordinator as well as the artist’s ability to be responsive and work flexibly.

Key factors here perhaps might be the preparedness of the artist to be flexible, the preparedness of the staff to support the artist in a full way by giving space and encouragement for their work, by giving them information they required to work in that environment and, in some sense, legitimising the presence of the artist to the young people.

All of these pivot around the selection process of the right kind of person as artist (i.e. not just/more than the ability to make the work) and structured protocols for sustaining contact between the different roles - artist, commissioning agent, staff and patients.

Product
The responses to the novel were mixed and there was a distinct difference between the adult’s and the children’s responses.

The publication is unique in that it does not fit into an established publication genre or type of artwork. It is part information and part peer group experience (children to children), part aesthetic or artistic

production (in being an artist’s interpretation) and is visually ‘fun’, ‘bright and cheerful’, ‘colourful’. The style is a rich mix or collage of language, images, and narratives.  It is interesting that some adults found this ‘mix’ difficult, yet no children suggested that this was problematic.⁹ It differs from mainstream artworks in being consistently cheerful.

There were differing views (from adults) on the target age - from as young as 8 up to 14, the average being 10-12 years. This might reflect the target age consulted, but it is also a direct response to the breadth of consultancy and inclusion, i.e. staff roles being included as factual text (inside front cover) and images.

The analysis could suggest that the work does not appropriately speak to the target age (12+). Equally, by extending the age range (8-12/13), potentially more children will get something from it.

Given the scope of reading ability, the degrees of wellness/unwellness, the ways in which the play staff might use the novel as a tool, the Graphic Novel has, potentially, greater useability than was originally expected. Equally, because of its apparent appeal to younger children, it could seem too young for some adolescents of 12+.¹⁰

Future developments

The sampling in this evaluation can only give a flavour and is in no way definitive of its future value, nor its definitive age range. However, the principal of an artistic intervention taking this unusual form appears to be very successful and can be built on and adapted to different age ranges and perhaps the presentation of different kinds of information. What might one do with different medical or surgical conditions and how these are communicated to children? What are the ethics of creating a consistently positive message? Can difficult areas be dealt with sensitively but realistically?

5.2 Case study 2 CAFMH (Child and Family Mental Heath)

(a) Rosehill House

(b) Lowit Unit
The Child and Family Mental Health Service provides mental health care to children up to 13 years of age. The team comprises psychiatrists, psychologists, specialist nurses, art therapists and

psychotherapists providing out-patient and intensive treatment to children, young people and their families.

5.2.1 The brief
The brief was for the artist to produce artwork on two sites within the same department – Rosehill House and the Lowit Unit. Rosehill House provides part of the out-patient service and is in a separate building from the main hospital. This building, formerly nurses’ accommodation, now houses various management offices for NHS Grampian as well as CAFMH. The building was old and refurbishment was planned for the interior including replacing the entrance door. The Lowit Unit (situated within the hospital) provides ‘intensive day-care packages’. It is non-residential and runs alongside educational provision where teachers come into the unit. Some children would visit both sites.
The brief was for the artist to ‘create artistic solutions which will work in both sites and join the sites visually.’ The aim was to ‘create a permanent artistic intervention’. The Rosehill House building with its long corridors and entrance, ‘needed to become more welcoming’. The artist would work with staff, patients and families and an external youth group, based in Inverurie called ‘Studio 77’.
The project resulted in an installation at Rosehill House (end March 2009). The project was withdrawn from the Lowit Unit towards the end of the artist’s consultancy stage (June 2008) and the CAFMH Lowit Unit project budget was re-directed to the Rosehill site.
5.2.2 Summary of the consultation process
The artist visited the sites and met staff (February 2008). The artist (living in London) conducted a series of workshops and consultations in ‘blocks’ of 2-3 days split between the two sites over a period of 6 weeks (May-June 2008). A further block of 3 days (August 2008) at Rosehill House was used for workshops, but primarily involved discussing and gaining feedback on the design options (visuals) with staff, patients and families and Studio 77.
At Rosehill the artist worked one-on-one with the children accompanied by an adult – a parent and/or staff member. In a one-day workshop the artist would work with between 2-6 children. Sessions with patients and parents could be from a half an hour up to 2 hours long. The artist also worked on a one-on-one basis with staff in the workshops and to discuss the design ideas (visuals) prior to installation. (Lowit Unit see 2b).
A note on the external youth group - Studio 77

Studio 77 is a youth group based in Inverurie (approximately 16 miles from Aberdeen).¹¹ The group was formed (2003) to ‘meet, chat and make art’ in the local Community Centre. It comprises 5-10 adolescents generally aged between 16-20 years, meeting once a week. The group had previously taken part in the RACH pilot project to test the process at the beginning of the programme (in the High Dependency Unit). They had really enjoyed the experience and were keen to be involved in another project. They were involved in the CAFMH project from the outset – the funding bid, developing the brief, and the selection of the artist.

The youth group visited both sites. It was decided at the outset (by the Lowit Unit staff and the coordinator) that it was not appropriate for them to work in the Lowit Unit because of the difficulties of the children attending the unit. The artist worked with the group in Inverurie (once) and it was also possible for them to be involved in (three) sessions at Rosehill House. On visiting Rosehill House the group thought that the building was ‘scary’, ‘a bit frightening’ and ‘like a horror movie’. They enjoyed hearing about the service in a question/answer session with the psychiatrist after a tour of the building. (This process was also conducted at the Lowit Unit see 2b.)
5.2.3 Early stage: Hopes and anticipated challenges
The Art Group and the coordinator wanted the project to create ‘a child-friendly’ environment that was ‘calm and welcoming’. The two main challenges were working sensitively with children with ‘multiple and differing needs’ and the fact of there being two sites. It was understood that staff from the two sites ‘rarely met’ and ‘there were potentially differing views amongst staff’ and that the artist would therefore have to be ‘diplomatic’ and try to ‘ensure the final result fits as many requirements as possible’. The coordinator wondered whether one (design) solution or two solutions would be required.
The staff representative for the project at Rosehill House (a consultant psychiatrist) was involved in the interview for the artist (along with the staff representative from the Lowit Unit|). She wanted the project to create a more child friendly atmosphere by being less ‘sparse and clinical and to be more pleasing for staff’. Her main concern was ‘the practical arrangements and keeping everyone engaged to get the project done on time’ and the impact it might have on the day-to-day clinical work. She also made it clear (in the interview) that it was important that the artwork was not too overstimulating as this could be detrimental for the children.¹²
Where an external youth group was part of the consultancy in a project (ie; in four of the nine projects in the programme) they were also invited to take part in the interview for the artist. The youth group leader from Studio 77 (representing the Group as they were unable to attend) considered it vitally important that, in a children’s hospital, young people have a say and that ‘their views were taken on board and acted upon.’ Her question to the artist at the interview was ‘If you were working with the group and they came up with a brilliant idea would you be prepared to change what you had planned to do and to take on board what they wanted?’ The artist that was commissioned was the group’s ‘top choice’ and they were very pleased and excited about this. ³
Case study 2(a) Rosehill House
5.2.4 Staff support and involvement
The art project as an acknowledgment and impetus for change

Staff support and involvement in this project was extraordinary and reflected their desire for art to really make a difference to the building. The fact that the art project was happening was described by the staff representative as ‘an acknowledgment’ of how unfit for purpose the building was and helped the flagging staff moral because of the long wait for a promised refurbishment. They were motivated and ‘determined to make the art project work’ and ‘willing to put up with a lot of the inconvenience’ in order for the project to succeed. The art project made the promise of positive change a reality. The staff representative, together with her secretary, ‘as a team’ took ownership of the project from the outset and their support for the artist, their involvement and enthusiasm filtered out (during the project) to prompt almost all of the Rosehill House staff (7+) to become involved and supportive.

The artist was given her own room, and she was also able to work in other areas of the building, such as meeting rooms. The staff representative encouraged children and family members to take part in the workshops and kept her colleagues informed on the project as it developed. She advised the artist on the children with whom it might be suitable to work and supported her with any background information that might be useful (e.g. autism, learning disabilities, ADHD).¹³ She would often stay at the beginning of a workshop to make sure everyone was comfortable and ensured that there was always

an adult (family member and/or staff) with the child and artist.¹⁴ The artist displayed a poster at the reception area giving dates and times of the workshops so that people could book in advance (with the help of the medical secretary). Working closely with the clinicians she was able to work with patients before, during and after their meetings with the clinicians.

Most of the staff took part in the workshops particularly the first workshop, ‘Making Words’ – enabling the artist to get a feel for how they felt about the building and what they wanted it to feel/be like. Almost all the staff were involved (again working one-on-one) in the final session discussing the initial design ideas. Some staff brought their own children along to take part in the workshops.
5.2.5 The artist’s process and responses (youth group, staff, patients and families)
Engagement in the creative process as a sequence of activities

The artist’s process involved engaging people to think about and explore the interior spaces of the building in playful ways. She began (Workshop 1) by asking two questions – ‘How does this space make you feel?’ and ‘How would you like the space to feel?’ Participants responded to these questions by thinking of a word(s) and making that word out of found objects from within the building (e.g. toys). The next workshop was to choose a favorite colour (from paper swatches) and find objects that matched this colour and take photographs. Workshop 3 involved using the work from the two previous workshops (a colour spectrum, words and photographs) and making a ‘colour journey’ through the interior spaces by putting up the work as ‘trails’ onto the walls doors etc. The fourth (and final) workshop was to extend this ‘colour journey’ by transferring it onto t-shirts (making stencils from found objects and spray painting). The idea here was to continue thinking about images in spaces but with movement (i.e. imagery on people).

Each workshop built upon the previous one(s) - the artist had used this same process in other commissions she had undertaken. It was clear she was skilled at engaging people not normally involved in the creative process. She understood that often people equated art with drawing which people were not usually confident about, also that people did not tend to think of themselves as ‘visual’ and so her specific techniques were to encourage people to begin thinking visually, and to simultaneously see the interior space differently. She also thought it important to produce and display high quality material quite quickly (from Workshop 1), so that when people came back (by Workshop 3) the space would ‘already be changed’ with participants’ work up on the walls. It was a way of giving the project a visible presence/reality in the building and had value for those who didn’t want to take part as they could just look/watch. She felt it important that the process ‘was not a hidden thing’ that it was ‘open’ where people could come and leave when they wanted to. This series of workshops meant people were ‘slowly telling her’ how the space might be improved and participants were giving her ‘the ingredients’ for developing the final work.¹⁵
Youth Group expectations

Studio 77 had been involved in the pilot project in the High Dependency Unit (HDU) and they were asked to reflect on that experience and compare it with this project. They were asked to do this because it was becoming evident they were having some difficulty in understanding the process. This was evident when they arrived at Rosehill House (Workshop 3) and were a bit confused at seeing the photos they’d made previously displayed on the wall (as developmental work) and wondered why, and whether this work would be used as the actual final artwork.¹⁶

Asking what they thought of the process at the fourth and final workshop the responses were mixed. Approximately half the group felt the artist was not taking on board some of their suggestions and that she had her own ideas of what she wanted to do with much clearer boundaries (comparatively). Many felt that there had not been enough communication to keep them informed in the time between the workshops, either face-to-face or by e mail, although they were understanding that the artist lived ‘far away’. This meant that they didn’t see a clear connection between what they had done and the artist’s process, although they understood that the artist saw the connections because it had been ‘worked through in sections’ (i.e. workshops).¹⁷ Comparatively, in this project they had less ‘control’ of what they actually did. Others thought ‘it was ‘good fun’ and ‘good to have a goal’ and ‘be told what to do’ (i.e. making words). Two members admired the way they ‘weren’t very arty’, yet she had involved them in the creative process. Others enjoyed working with colours and actually being in Rosehill and trying to make a difference. A few were pleased that an artist respected their opinions by actively seeking their views.
After the fifth and final session (gaining feedback to the design ideas), they were asked if they could see their input into the design ideas and if they had learned anything from the experience. For most of the group the artist’s process ‘seemed a lot clearer at the end where you could see it all coming together.’ A few commented on learning new techniques which they enjoyed such as making colour gradations. They all seemed to enjoy making T-shirt painting and spray-painting. A few could see a clear link between what they had done and the design ideas – the photographs were ‘something definite in the work that was ours’. They all seemed very impressed by the design ideas and entered into the discussion, but there was a general feeling that they ‘could have had more say in the way it looks.’ They would have preferred ‘a bit more doing (art)’ and less talking about art.
Interestingly, the responses from the two young people not involved in the HDU project were less critical. The HDU project was much more in the style of ‘community art’ where their work was taken and developed by the artist into the final artwork which was displayed in the corridor outside HDU alongside their own paintings. This style of working was much more ‘hands-on’ with ‘less explanations’ by the artist, more regular workshops and they were involved in each stage, including seeing their work being put up on the walls.
The artist working sensitively and responsively

All the staff thought the artist was extremely sensitive to mental health issues and skillful in engaging with the children. They had initially been concerned about whether the artist would be able to engage with them and whether they might be confused over what the artist asked them to do. The staff representative described the way she worked as beginning by doing very little with the children until she got to know them, ‘testing the water’, then progressing by gradually giving a little more to do at each session. She also stressed that staff had ensured there would be a huge amount of adult support (parents and/or staff) for the artist and that working with a group of children with mental health difficulties was ‘out of the question’.

A few staff commented that they thought the artist had mental health experience (with adults). One of the consultant psychiatrists described the artist as having ‘a lot of awareness and insight into the service user’s perspective’ and it was ‘not a case of having to educate her’ as she came with a lot of knowledge. Staff thought that she was able to engage children and families really well – ‘she took them in’ and one of the medical secretaries explained that it seemed (to her) that the artist was ‘actually part of the psychiatric team’ and having ‘real insight’ into the users of the building (families and staff).
The staff representative’s early concern that the project could disrupt the clinician’s day-to-day work was not an issue. On the contrary she was impressed by the way the artist ‘fitted in’, was unobtrusive, yet got the work done that she needed to do. The artist had ‘bent over backwards not to interfere’ and no clinics had to be cancelled, which was ‘excellent’.
Each member of staff was consulted individually over the design ideas and most took part in at least one workshop and a few actually brought their own children in to take part as well. Everyone felt fully involved and consulted and thoroughly enjoyed the process. The artist was ‘very approachable’ and ‘an absolute joy’ to work with.
The value of workshops for children and families: two examples

The evaluator observed the artist at work (June and August blocks) and spoke to a few parents with their children who were taking part in the workshops. Two examples illustrate the value of the workshops to service users. Both examples are mums with their sons who had both been diagnosed as being on the autistic spectrum.

Example 1 (June).

They had taken part in the previous workshop and the mum explained that they were both really enjoying the experience as it was interesting and fun. During this workshop the child and mum were sticking ‘colour waves’ or trails of images they’d made in previous workshops along the corridor walls and the artist was asking the boy if this made him look at and walk along the corridor in a different way. She thought she was ‘no good at art’ and neither was her son because he had trouble using his hands (holding things), but the artist had ‘broken things down so they understood’ and the activities were things the boy could manage. She had particularly enjoyed the first workshop(‘Making Words’) on feelings where they had each made a different word and ‘were able to speak about the differences’ that they felt. This experience had been ‘very thought provoking’.

Example 2 (August)

A mum and her ten year old son were taking part in the workshops and the mum was very informed having trained as a teacher and was now studying psychology with an interest in ‘child-centered learning’, especially children on the autistic spectrum.¹⁸

At this time her son was having difficulty at school (resulting in poor attendance) because he could not communicate the things that were making him anxious (at school). She explained that he was much better and liked expressing himself through drawing as he found writing difficult because of the looseness in the joints of his hands which is typical for children with autism. She was struggling with the school because she felt ‘they almost had one way of doing things’ and that the emphasis was on writing. Because he couldn’t express himself verbally he became even more anxious, confused and this led to him feeling ‘overwhelmed and trapped’.
A Rosehill clinician had been discussing various forms of art therapy to help, and had suggested that the art workshops might be useful. The mum felt the art project was very timely and the workshops had resulted in ‘concrete benefits’. Specific methods in the workshops ‘had close links’ and were highly relevant to what she and the clinician were trying to do, especially ‘the idea of articulating your feelings about being in certain places’ and the activities were both accessible and enjoyable. For example the work with colours was very extremely good because choosing and considering colour (spectrums) was ‘quite a meticulous kind of thing’ which suited him fine as it gave him ‘lots of processing time.’ She recognised the artist’s methods as ‘a loosely directed teaching methods’ and knew her son responded well to this approach in contrast to the approach used at his school. She thought that the artist was very focused and had kept them on track if they got a bit lost during a workshop. She respected the artist for genuinely seeking their comments, both the negative and positive, in terms of ideas for the artwork.
Importantly the mum felt some of the experiences in the workshops would be useful as something they could take forward into their everyday lives:
‘I feel that it was just so relevant and I’m quite hopeful that it is something that we can build on, into when he goes back to school next week - you know - that we’re going to still be talking about the same kinds of things and we’ve got lots practical experiences to relate it to.’