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The Art of Healing: Leilani Miranda, MM* *The Music Garden
Background All children are shaped by their early life experiences. Children growing in safe homes and communities with nurturing, predictable and attentive caregivers view the world as a relatively safe, exciting place to explore and learn. Consistent, nurturing and enriching experiences help children develop in optimal ways, thereby increasing their chances for health, happiness, productivity and creativity. Positive early life experiences not only facilitate the development of the child’s intellect but also stimulate the child’s physical, social, emotional Many children, however, do not have all of the opportunities to help them meet their potential. Millions of children each year are maltreated. These children may be exposed to chaotic, neglectful and terrorizing experiences at an early age. In the absence of repetitive, patterned and enriching experiences, they may develop in disorganized or even dysfunctional ways. These children will have emotional, behavioral, cognitive, social and physical problems. The specific problems of any individual child vary but often include anxiety, impulsivity, sleep and motor coordination problems, hypervigilance and attention problems, verbal and social language problems. Because so many of these children have difficulty focusing on tasks and paying attention, especially to verbal cues, they will frequently be unable to learn at the same rate as other children. Since all learning – motor, emotional, social and cognitive – requires attention, these children begin to fall behind. The mismatch between their chronological age and their developmental "ages" becomes magnified. They may be eight years old, but they think, act and behave as if they are four. The Neurodevelopmental Core of the Healing Arts Project A major objective of the CIVITA S Healing Arts Project is to help individual children erase this mismatch. The clinicians and artists help provide enriching, nurturing experiences matched to the developmental "needs" of the child. The overarching conceptual rationale for the Healing Arts Project comes from, ironically, developmental neurobiology. Indeed, the more we learn about the brain and brain development, the easier it is to understand why many of these "non-traditional" arts modalities are so enriching and, in some sense, "therapeutic." Three main principles of neurodevelopment guide the Healing Arts project: 1. Sequential Development The brain, at birth, is undeveloped. During its development it organizes and grows in a sequential fashion, starting from the lowest, most regulatory regions of the brain a nd proceeding up through the more complex parts of the brain responsible for more complex functions (Figure 1 and Table 1). Healthy development of one region/ capability is dependent upon the healthy development of lower brain regions which takes place earlier in the process (see Figure 1 and Table 1). Therapeutic and enrichment experiences of the child, therefore, must be provided in an appropriate sequence and matched to the child’s level of neurodevelopment. In turn, this matching process is dependent upon adequate assessment of the child’s development in the key areas of physical/ motor, behavioral, emotional, social and cognitive domains. 2. Use-dependent Development The normal organization of any brain area or capability is use-dependent. ; Neurodevelopment is dependent upon the presence, pattern, frequency and timing experiences during development. The more patterned activity (e.g., music, reading, co nversation), the more the brain regions responsible for these task will organize and be functionally healthy. The implications of this are profound. Children exposed to consistent, predictable, nurturing and enriched experiences will develop neurobiological capabilities that will increase the child's chance for health, happiness, productivity and creativity. Conversely this means that the child with ne glect, chaotic, and terrorizing environments will have significant problems in all domains of functioning. The program implications of use -dependent development are that children exposed to maltreatment will be at greatest risk and, from a public health perspective, should be the target of proactive enrichment and therapeutic services (see below). Further implications of the principle of use-depend ent brain development are in service design and delivery. The enrichment or therapeutic services that are provided need to be consistent, predictable, patterned and frequent. This means that the major providers of the experiences in the child’s life – caregivers, teachers, parents – must be involved in learning and delivering elements of the therapeutic and enrichment outside of the specific hours dedicated to this during the week. The Healing Arts Project has targeting high-risk children and uses parent, caregiver, teacher and volunteer activities to complement and enhance the services provided by the professional staff. Table 1. Neurodevelopment and Optimizing Experiences
3. Windows of Opportunity The majority of this sequential and use-dependent development of the brain takes place in early childhood. Proactive is better than reactive. It is easier and more cost-effective to provide enrichment, educational and therapeutic services earlier rather than later. The Healing Arts Project has focused on young children and their families. These services are integrated with the child’s home and community environment in a fashion that facilitates proactive rather than reactive and passive approaches to young children.
The Healing Arts Project The Healing Arts Project provides innovative enrichment and therapeutic services to maltreated children, utilizing artistic modalities, such as music, movement, touch, dance and storytelling. These activities are tailored to match a child’s neurodevelopmental needs and provide optimizing sensory experiences appropriate to the child’s stage of development. For instance, a child who was raised in a neglectful environment without much stimulation would benefit from exposure to a structured, sensory experience like a music and movement class. The introduction of rhythmic and patterned stimuli would facilitate the development not only of motor control, but also of the child’s social and language skills. Enrichment activities such as Music and Movement can help to stimulate and organize a child’s brain through providing enjoyable, sensory experiences in a predictable, non-threatening manner. The Healing Arts Project is a collaborative effort between ChildTrauma clinical staff and Houston’s creative arts community. The Project draws on the expertise of local artists to provide enriching, creative and fun experiences to maltreated children. The artists share their passion for, and understanding of, their art form with the children, their caregivers and the collaborating clinicians. The various Healing Arts modalities provide an opportunity for the children to have diverse sensory experiences in a non-threatening environment. The child benefits not only from exposure to the art form, but from the relationship that develops with the artist. The consistency and nurturance provided by the artist over a period of time can be as significant to the child’s development as exposure to the art form itself.
An important aspect of the Healing Arts Project’s success is its collaborative nature. Though the artist plays a crucial role in providing enriching experiences to the children, he or she does not work alone. The ChildTrauma clinicians provide training, assessment and recommendations for appropriate enrichment activities. They provide general information and training to the artists on how to work effectively with maltreated children. They also make recommendations regarding which enrichment activities are appropriate for a child, based on their The collaborative nature of the Healing Arts Project is not limited to the artists and clinicians involved. The project itself is a component in a larger system of therapeutic intervention available to maltreated ch ildren. The enrichment activities provided by the Healing Arts Project are often used in conjunction with other interventions, such as play therapy, psychoeducation or pharmacotherapy. Caregivers and siblings of a child in treatment are often encouraged to p articipate in the enrichment activity and are given materials and guidance to help them incorporate the activity into their daily lives. Children, regardless of their early life experiences, benefit from exposure to Healing Arts Project activities by developing social skills, demonstrating mastery of the activities (thereby increasing their self-esteem), and discovering creative outlets for self-expression. Maltreated children benefit, in addition, from the profound effect these activities can have on their brain development, and as a result, on their overall functioning.
Core Enrichment Modalities
A. Music and Movement groups provide a rhythmic and patterned set of experiences that allow a child to develop motor, language and social skills with adults and peers. The children are exposed to singing, movement, chanting, storytelling and simple instruments. The semi-structured nature of the group prepares the child to cope and excel in a classroom setting. Children who come from verbally and socially impoverished environments are typically placed with in this specific track. B. Hatha Yoga carefully integrates physical postures, movement and focused breathing. Children who practice Hatha Yoga consistently learn to control their body, regulate breathing, increase their strength and enhance their body awareness. Children who have been sexually/ physically abused often feel physically powerless, and their mind/ body connection may be weakened or disrupted. Utilizing "animal postures", actually Hatha yoga, the child is suddenly a powerful lion, or an angry cat. This boost in personal power may also help to increase the child’s self esteem. C. Developmental Movement uses props (scarves, balls, hoops), movement and music to encourage a child’s self-expression. These purposeful movement experiences allow the child to learn by thinking and doing. Children also increase their self, body, and spatial awareness.
II. Written and Behavior al Expression Modality
A. Expressive Writing and Dramatic Play uses storytelling, writing exercises and movement to create a
III. Touch Modalities
A. Massage Therapy uses a safe gentle touch to increase the body’s natural healing process. Massage has been shown to reduce stress hormones, alleviate depressive symptoms and enhance body image. Children who have difficulty regulating themselves and their behaviors (impulsivity, sleep, eating) may benefit from the calming effect of massage. B. Reiki Touch is a 2,500-year-old system of healing. It is a non-verbal, gentle, patterned touch that is safe and comforting. This offers children positive replacement experiences, encourages healthy emotional and physical development. This approach has great promise for children experiencing severe neglect early in life. Reiki and other touch modalities appear to have a direct impact on important neuroendocrine systems responsible for regulating healthy physical and emotional growth.
Summary The Healing Arts Project benefits maltreated children on many different levels. It provides patterned, repetitive and organizing sensory stimulation, encourages healthy social, behavioral and emotional development and provides children with enjoyable, non-threatening experiences. The collaborative nature of the Healing Arts Project enables the expertise of artists and mental health clinicians to be effectively used to assist maltreated children. It is our hope that collaborations of this kind will continue to develop in other communities as we all work to protect, understand, enrich and heal our maltreated children. About the Authors LEILANI MIRANDA, MM is a certified Early Childhood Music and Movement specialist with a private early childhood studio in Houston. She has conducted numerous Music and Movement classes for the ALISON ARTHUR is the former director of the Healing Arts Project, a component of the TRACY MILAN, LMSW is a licensed social worker/ clinician who provided assessment and intervention for young, maltreated children at the ChildTrauma Programs. She has participated in a number of ORE MAHONEY, MSW is the inaugural ChildTrauma Scholar in Social Work. In this capacity, he has used his clinical skills as a social worker to provides assessment and intervention for young, maltreated children within the ChildTrauma Programs. Mr. Mahoney conducted Music and Movement classes and acted as a primary clinical liaison for the Healing Arts Project. BRUCE D. PERRY, M.D., Ph.D. is Chief of Psychiatry at Texas Children's Hospital in Houston, Texas. He also serves as the Thomas S . Trammell Research Professor of Child Psychiatry in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. |
