Potential Partners in Enhancing the Health and Well-Being of Today's Youth

Australian Occupational Therapy Journal (2008) 55, 287–290 doi: 10.1111/j.1440-1630.2007.00713.x

InBlackwell Publishing AsiaPractice

Occupational therapy and circus: Potential partners in enhancing the health and well-being of today’s youth Jill Maglio and Carol McKinstry Faculty of Health Sciences, School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia

KEY WORDS community circus, education, life skills, Research conducted by the Victorian Curriculum and occupational therapy, young people. Assessment Authority (VCAA) led to the establishment of a framework, the ‘Victorian Essential Learning Stand- Introduction ards’ (VELS) that aims to promote holistic education for young people (VCAA, 2005). The success of this educa- This paper describes and discusses the benefits of a tional reform requires a collaboration of disciplines to project involving a community circus program developed meet the complex needs of young people. Occupational for Victorian schools to assist in addressing students’ therapists’ knowledge of program development, service needs for life skills acquisition. A program logic model delivery and evaluation can enable them to work in col- framework (CAOT, 1999), together with an occupational laboration with community organisations, providing perspective, was used to develop an evaluation tool for varied and innovative input into educational programs. Westside Circus’ ‘Circus in Schools’ program. The project was unique in that it introduced an occupational Background perspective to the evaluation of this innovative educational program. Although the project’s focus was primarily Westside Circus is a not-for-profit community circus on program evaluation, it also demonstrated a connection organisation that works in partnership with the commu- between the core beliefs of community circus, education, nity to provide a variety of programs, workshops, and occupational therapy, and health promotion. performance opportunities for young people throughout The occupational therapy profession can play a key Victoria. ‘Community Circus’, also known as ‘Recreational role in education reform, which includes working in Circus’, ‘Social Circus’, or ‘New Circus’ (Bolton, 1999), partnership with community organisations to develop focuses on teaching, empowering, and communicating innovative programs that meet the needs of young people. using circus as a medium, featuring physical activities Educational and allied health professionals agree that and no animals. Community circus provides an environ- effective teaching strategies which seek to promote over- ment of personal artistic expression and group solidarity, all health and well-being need to be implemented in creating opportunities for young people to forge new ties schools to provide students with skills that will enable with society. them to be healthy and positive contributors to society Westside Circus recently implemented the ‘Circus in (Struthers, 2005). With an understanding of the dynamic Schools’ program across a range of Victorian primary interdependence of the person, occupation, and environment and secondary schools. The program included a variety (CAOT, 1999), occupational therapists are equipped with of games and circus disciplines with physical and coordi- skills that enable them to advise on educational program nation components that were pursued individually, in development, implementation and evaluation. pairs, and within larger groups. The two-hour weekly program occurred during a school term at either the school or the Westside Circus training space. The program aimed to use circus as a constructive model to build Jill Maglio BA Psych, MOTherapyPrac; Occupational resilience, develop life-long learning, and encourage Therapist. Carol McKinstry BAppSc(OT), MHlthSc; excellence in students incorporating the VELS. Lecturer. National and international research completed by the Correspondence: Jill Maglio, 124 Gore Street, Fitzroy, Vic. VCAA (2005) led to the development of the VELS, pro- 3065, Australia. Email: [email protected] moting life-long learning through curriculum design. Accepted for publication 25 May 2007. The new approach closely links traditional subject areas © 2008 The Authors to life skills such as the development of physical, personal Journal compilation © 2008 Australian Association of and social skills, and the ability to apply knowledge in Occupational Therapists workplace situations and future learning (VCAA). Life 288 J. MAGLIO AND C. MCKINSTRY skills contribute to the successful independent function- expected to modify practices to work with students ing of an individual and are needed for the transition holistically, as well as develop community partnerships into adulthood. A review of the literature by Cronin to meet the VELS requirements. Occupational therapists (1996) reported that many students do not learn life skills can assist in program development, enabling essential by themselves and require increased life skills content learning for students and also in evaluating these pro- throughout their school careers. ‘Personal and Social gram components and student acquisition of life skills. Skills’ and ‘Interdisciplinary Skills’ are new focus areas Although there is a lack of literature relating to circus that schools are encouraged to include in their curricu- programs, particularly in Australia, Bolton (1999) high- lum to address students’ need for life skills acquisition. lighted the use of recreational circus by humanitarian Under this framework schools are given the autonomy to and peace-making groups as well as by schools and the determine the most appropriate way for students to increasing number of new circus companies emerging acquire knowledge and skills in these areas (VCAA). The throughout the world. In addition, many organisations ‘Circus in Schools’ program has strategies that provide are providing circus training for various populations of multiple ways in which schools can meet the VEL stand- people in need of social justice and support. For exam- ards and promotes the learning of life skills. ple, Cirque du Soleil has formed a program dedicated to To assist schools implementing the VELS and increas- allying with youth at risk (Cirque du Soleil, 2007). The ing health promotion, an opportunity exists for occupa- Women’s Circus in Victoria prioritises working with sur- tional therapists to adopt a consultancy approach, vivors of physical and sexual abuse as well as women marketing their services to schools rather than working aged over 50 years (Andrea Ousley, personal communi- only with individual students. Occupational therapists cation, 22 February 2007). The Westside Circus outreach can assist in Victoria’s educational transition to a more program also provides circus training experiences to holistic view of students and the skills they require. people with emotional and mental health issues, intellec- Occupational therapy skills and strategies can promote tual and physical disability, as well as to mainstream school and student success in accordance with the society. Further research and published literature are Ottawa Charter’s strategies for health promotion (World needed to promote the effectiveness of circus programs Health Organization, 1986) and VELS; occupational to the overall health and well-being of individuals (Bolton). therapists can assist schools in the following ways: With continued development and evaluation of com- 1. Collaborating as part of a multidisciplinary team at munity circus programs, it is proposed that evidence of all levels of the education system from policy-makers the effectiveness of circus as a suitable occupational to specific program delivery and evaluation (World therapy intervention will aid the profession to develop Health Organization, 1986). future partnerships with schools, and community circus 2. Understanding the importance of occupational bal- organisations. Given that this project’s evaluation was ance to overall well-being, and specifically related to completed from an occupational perspective, the occupa- learning as the main productive role of youth. tional elements are also clearly evident. 3. Assessing personal components involved in occupational performance within social, cultural, institu- Project methods tional, and physical environments (CAOT, 2002). 4. Involvement in school management and governing The overall aim of the project was to conduct a process bodies, working in partnership with community evaluation using a program logic model framework organisations, parents, and as advocates (Struthers, (CAOT, 1999), in addition to developing an evaluation 2005). tool that could assess outcomes of future programs 5. Assisting school systems in the transition process of against VELS criteria. implementing programs like the ‘Circus in Schools’ program, that meet the VELS. Phase 1 6. Assessing learning environments, assisting teachers in identifying essential program components for the Information gathering population, and suggesting programs to address To identify the connections between the circus program local and social issues present that will fit with and VELS standards relating to the development of individual or group needs. students’ life skills throughout their education, VELS Traditionally, occupational therapists have intervened documents were analysed and circus trainers were inter- to assist individuals to meet their needs within the viewed. Program sessions were also observed and school school context (Case-Smith, 2005). Although there is still action plans were reviewed to identify program aims, a place for the profession to intervene directly with indi- objectives, components, strategies and proposed outcomes. viduals, an opportunity now exists for occupational This was also necessary to identify the connections therapists to intervene within school systems and the between the circus program aims and what the VCAA wider community (Struthers, 2005) to address the VELS. believe are important life skills for youth to obtain Presently, teachers and school administrators are throughout their education.

Phase 2 strating the programs ability to address and meet the VELS. Process evaluation In addition to the development of this tool, observations The information gathered in phase 1 was plotted into a made by the project manager, school representatives, program logic model in order to make evident the and journal entries from the participants resulted in sub- relationship between overall program objectives and jective data which also supported the ‘Circus in Schools’ specific program practices, demonstrating the ‘Circus program’s overall aim of satisfying VELS criteria. in Schools’ program’s ability to implement relevant strategies as intended. In this phase, the following components of the circus program strategies were identified Project findings in each session: The project found that the ‘Circus in Schools’ program Warm-up games — opportunities for team work, collabo- objectives and values are congruent with principles that ration, verbal and non-verbal communication, underpin VELS education reform initiatives and occupa- increased challenges, and a mix of attainable and tional therapy practice. The implementation of the program challenging tasks. strategies was also shown to be consistent with VELS Acrobatics — core, upper and lower limb strength and criteria. Observations made by the project manager, in flexibility, body awareness, trust, positive risk-taking, addition to qualitative perspectives of the students and giving and receiving physical support. school representatives, highlighted the positive benefits Acrobalance — team work, body awareness, problem- of the ‘Circus in Schools’ program in the following solving, trust, safe and positive physical interaction, program objectives: gender stereotypes around strength challenged, and 1. Provides a fun, motivating and intrinsically reinforc- a mix of achievable and challenging tasks promoting ing experience. self-efficacy. 2. Increases positive risk taking both physically and Manipulation (juggling, hula hooping) — grading of tasks emotionally, in a safe and supported environment. to increase challenge. Opportunities to improve coor- 3. Promotes physical health and body awareness dination, gross, and fine motor skills. Promotion of through activity. rapid thinking, reaction, persistence and practice. 4. Enables participants to acquire a broadened skill base Opportunities for peer education, creativity, and relating to circus as well as more generic ‘life skills’. improvisation of combining skills learned. 5. Increases self-confidence and self-efficacy. Balance-based activities — promotes reduced fear of 6. Improves social connectedness, teamwork, and lead- heights and physical limits. Peer-to-peer support and ership skills within the group. trust of self and others. Taking responsibility for 7. Provides opportunities for calming rhythmic activities, safety of self and others is integrated. Awareness of increased sensory feedback, a focus on balance, and self in relation to others and the physical environment coordination. is continually addressed. 8. Creates a space in which participants feel a sense of Performance — promotes creativity, collaboration, break- belonging. ing down of inhibitions, exploration of theatrical themes, giving and receiving social support, experi- Implications for occupational therapy, ence of taking on different roles, development of different characters, brainstorming, problem-solving, education, and circus in future and various forms of communication. practice These activities assist individual students and The experience of working with Westside Circus high- groups to improve occupational capabilities in a range of lighted many parallels between the ‘Circus in Schools’ physical, cognitive and affective areas. The variety of programs and occupational therapy practice. The pro- activities enables the intervention to be more effective in gram was innately client-centred and structured to meet meeting the diverse needs within the population. participants’ individual needs while capturing the essence Phase 3 of the programs’ main objectives and VELS criteria. Occupational therapists are well placed to take a broader- Outcome evaluation based advisory role, working at a policy or program The completed program logic model enabled a data development level in education, in addition to working collection tool to be developed that assessed the pro- with individual children to meet their specific needs. In gram from the perspective of the trainers, participants, order for a successful partnership among community and school representatives. The evaluation tool con- circus facilitators and occupational therapists to emerge, sists of a before and after design with the intervention a number of key things are required. Open dialogue being two circus activities that incorporate a wide range among both disciplines is needed to enable understanding of the program’s strategies. Each program strategy is of each others role and how they can work together to linked to a different VELS component; therefore, demon- ensure that the programs meet the needs of each individual

© 2008 The Authors Journal compilation © 2008 Australian Association of Occupational Therapists 290 J. MAGLIO AND C. MCKINSTRY participant. Occupational therapists and circus facilitators Conclusion also need to create opportunities to attend each others’ forums, events, and workshops. This would enable a Utilising a partnership between occupational therapy richer understanding of the community circus and occu- and community circus, this project demonstrated the pational therapy culture and how they can contribute to ability of an intersectorial health-care approach to meet creating optimal health for specific populations of people the diverse needs of the primary and secondary school who utilise the service. students. The introduction of the VELS within the Victo- Although this project focussed on life skill acquisition rian education system provides occupational therapists for youth, occupational therapists can continue to work with the opportunities to develop implement and evalu- in partnership with circus organisations and schools ate programs that will assist schools to meet the VELS to address the needs of individuals in relation to sensory requirements, enhancing the health and well-being of processing, coordination and tone, and physical, emo- students. This is the beginning of a new partnership tional, and mental health. In assessing the capacities of between education, circus, and occupational therapy dis- individuals and planning programs to improve function ciplines, with much room for expansion. This innovative and occupational performance, circus trainers and project combining occupational therapy with an alterna- occupational therapists have complementary skills. tive education program is an example of how occupa- Occupational therapists and circus trainers can work tional therapists can utilise a health promotion approach. together under a health promotion focus to meet the A collaborative intervention focussed on a community overall health needs of the youth population. Some provides a more effective and sustainable way of build- specific examples of how the two disciplines can work ing healthier communities. as partners to empower individuals and communities include: Acknowledgments 1. Professional development — Occupational therapists can educate circus facilitators about the particular We would like to acknowledge the assistance provided issues facing specific populations. For example, when by Stephanie Urruty, project sponsor and general man- dealing with groups of people who have autism, ager of Westside Circus, Andrea Ousley, the Westside occupational therapists can share information about Circus trainers, the Yarra Youth Rotary Project, and all individuals needs for proprioceptive feedback. Ther- the schools and participants within the programs apists can help the facilitators have a better under- observed. This project was completed in partial fulfil- standing of the limitations and strengths commonly ment of the graduate entry Master of Occupational Ther- faced by people with autism. This input by the occu- apy Program, at La Trobe University. pational therapy profession can enable circus trainers to fully address the needs of the specialist groups References they are working with. 2. Co-facilitating — Circus trainers and occupational Bolton, R. (1999). Circus as education. Australian Drama Studies, 35. therapists facilitating programs together within the Canadian Association of Occupational Therapists (CAOT) circus training space can enable each profession to (1999). A program evaluation workbook for occupational thera- support each other by sharing their expertise (Ous- pists: An evidence based practice tool. Ottawa, ON: CAOT ley, 2007). The occupational therapist provides focus Publications ACE. on the strengths and limitations of the individuals Case-Smith, J. (2005). Occupational therapy for children (5th within the group, determining appropriate grading ed.). St. Louis, MO: Elsevier Inc. of tasks to promote success of the participants and Cirque du Soleil (2007). Retrieved 18 March 2007, from offering assistance where needed. The circus trainer http://www.cirquedusoleil.com. Cronin, M. E. (1996). Life skills curricula for students with is able to direct the session focussing on the various learning disabilities: A review of the literature. Journal of elements within the activity that integrate the holistic Learning Disabilities, 29, 53–68. focus of community circus philosophy. Struthers, P. (2005). Inclusive and health promoting schools- Community circus and occupational therapy both implications and challenges for therapists. South African appear to have a tradition of working with people with Journal of Physiotherapy, 61, 28–32. physical and mental health needs, survivors of sexual Victorian Curriculum and Assessment Authority (2005). Vic- abuse and torture, marginalised young people, and those torian Essential Learning Standards. Retrieved 14 July, 2006 experiencing occupational alienation within their social from http://vels.vcaa.vic.edu.au/. and physical environments. By opening dialogue and World Health Organization (1986). Ottawa Charter for Health joining forces, each discipline can become more effective Promotion. First International Conference on Health Promotion in their overall goal of creating global well-being within (Ottawa, Canada). Retrieved 14 July 2006, from http:// all communities for all individuals. www.ldb.org/iuhpe/ottawa.htm.