Expressive therapies enhance the well-being of hospice patients, families and caregivers.
Published August 1, 2017
“A young boy who had endured several surgeries drew his happy safe place,” smiles Abigail Unger, director of Expressive Therapies at Hospice Buffalo, reflecting on the impact of the organization’s addition of art therapy to their Expressive Therapies program. “Another also drew about his fears and worries. In the drawings, he’s faced with conflict; he’s under attack. He draws himself the tools necessary to fight this battle.”
“Some of these children are terrified as they face medical procedures and appointments – maybe it’s the mere mention of ‘the needle’ that causes a child to run away, withdraw, experience anxiety attacks, understandably,” Unger continues. “The therapist works to develop coping skills in anticipation of such appointments. Over time, drawings reflect how they are progressing – children depicting actual medical tools in their artwork, in great detail, demonstrates how they are dealing with their fears in a more direct way. They are finally able to acknowledge the fear.”
Unger, a licensed creative arts therapist and credentialed music therapist, has a natural affinity for caregiving – establishing an expressive therapies team with an organization like Hospice Buffalo was a natural fit.
In 2004, Unger joined the organization as a music therapist. Through her years of practice, she recognized the potential of developing various therapeutic arts programming to align with the mission and vision of Hospice Buffalo to meet the needs of patients and families through their end-of-life experience as well as their post-death experience. In 2010, she proposed and was tasked with the opportunity to establish a dynamic and robust Expressive Therapies team.
There was a missing component Unger envisioned – one of significant impact on an interdisciplinary hospice and palliative care team – the discipline of art therapy. In 2014, she learned of UB SON’s service learning projects through education liaison, Kelley Clem. Unger inquired about the potential advantages of a collaborative effort to create a proposal for a pilot art therapy program.
When Unger arrived at Hospice Buffalo about 13 years ago, there was one other music therapist and one massage therapist.
“Skilled nursing facilities can be really wonderful, but they’re often missing the warmth and familiarity and richness of the home environment,” says Unger. “Music therapy was specifically brought in to enhance it in that way. The program sprawled because leadership saw the demonstrated need and benefits of this therapy for patients and families, and for the interdisciplinary teams working with them.”
Similarly, they recognized the positive impact of massage therapy on patients with pain and anxiety.
One major hurdle facing such programs, though, is funding – with hospice being a Medicare benefit, the core reimbursable service components include physicians, nurses, social workers and chaplains.
“We had to find a way to pay for expressive therapies,” Unger explains. “Luckily Erie County is such a supportive community – they are so connected and invested – and we have a wonderful foundation.”
A donation line was established for the Expressive Therapies team, which tripled in size within five years, extending their reach to every care program at Hospice.
“When we got to the point where we could develop this team, I recognized that in order to have a really robust expressive therapies team, I needed to add some other components like art therapy,” says Unger.
Again, resource limitations forced Unger to place her vision on the back burner. It was the potential of the project goals – coupled with six UB SON students’ desire to partner with Hospice Buffalo – that led Unger to a collaboration that would give life to the art component.
Over the course of the Fall 2014 semester, Unger worked alongside students from Clinical Associate Professor Joann Sands’ Public Health Nursing for Population Health course – Jane Ginther, Kaitlin Organisciak, Sara Alexanderson, Kara Godzala, Erica Babulski and Samantha Kulu – to develop a pilot proposal for an art therapy program.
“The [project] entailed researching the history of art therapy and studies supporting its therapeutic benefits,” explains Ginther. “We also identified reputable programs throughout the nation, compiled a list of potential donors and grants, and developed a model program specific to the Essential Care for Children program.”
“The focus was on Essential Care for Children because that is the optimal target for this kind of work,” Unger adds. “And, we can support our donors by making sure our efforts are also meaningful to them by providing them feedback and outcomes.”
Their goal? Obtain per diem status for the art therapy program.
“The overarching theme of our research was that it’s not just medicine, but rather many of the other aspects of care, like art therapy, that make the patient experience valuable,” Organisciak says.
“[When we learned that we would be presenting our research] to the hospice management team and to one of their top donors … we knew we had to continue to work hard and create a heartfelt presentation,” says Godzala.
The hard work and collaboration paid off.
“Upon our successful acquisition of endorsement to initiate this pilot program, the art therapy discipline was established at Hospice Buffalo,” Unger reports.
With funding in place, she was able to hire art therapist Kris Crosson as part of the Expressive Therapies team.
“We are presently heading into year two of full offering for our Essential Care for Children’s team, with 31 families presently receiving art therapy support,” Unger smiles. “Additionally, we have integrated intermittent art therapy sessions for two of our ongoing yearly community grief support groups. Upon enhanced development and growth throughout this time, art therapy is now considered a core component of our Expressive Therapies offerings.”
“Being able to combine research and nursing in a real-world manner … showed me that it is possible to make a difference in other ways and that nursing research is important,” says Organisciak.
“This project underscores the importance of collaborating with the community to identify key health issues and to improve the health status of community populations,” Ginther adds. “The community really plays an integral role in improving health.”