Clinical Social Work and the Medical Model : Use of Art and Play Therapy Interventions

Smith ScholarWorks Theses, Dissertations, and Projects 2009 Clinical social work and the medical model : use of art and play therapy interventions Corye Elizebeth Goodman Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Goodman, Corye Elizebeth, "Clinical social work and the medical model : use of art and play therapy interventions" (2009). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1202 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. Corye Goodman Clinical Social Work and the Medical Model: The Use of Art and Play Therapy Interventions ABSTRACT This study aims to determine the self-identified role of clinicians working within the medical model. Secondly, the study intends to determine if art and play therapy interventions were regularly implemented by clinical social workers practicing with hospitalized children within a pediatric medical facility. The study hopes to gauge both the clinicians’ understanding of possible barriers to these interventions within the medical model, and also the clinicians’ beliefs about the importance of play within pediatric hospital settings as a determining factor to patients’ psychological needs during their illnesses. A mixed-methods online survey was sent to over 300 medical social workers within the United States. All 137 participating clinicians held at least an MSW and worked within a pediatric medical facility. Clinicians were asked to self-identify their primary time commitments within their current setting, their primary theoretical orientation, and their beliefs on the benefits of play, any barriers they felt existed within their current medical setting, and any examples of play techniques they utilize within the medical model. The conclusion of the study indicates that art and play therapy interventions are not commonly utilized within pediatric medical settings due to structural barriers such as time constraints, a lack of space or appropriate materials, and the lack of exiting policies that refer patients to child life specialists or volunteers for such interventions. Further, this study’s results indicate that most medical social workers find that their primary role is to conduct psychosocial assessments, conduct patient and family counseling and psycho-education around illness and hospitalization, plan patient discharge, and serve as a case manager, which includes resource referrals for patients and families. CLINICAL SOCIAL WORK AND THE MEDICAL MODEL: THE USE OF ART AND PLAY THERAPY INTERVENTIONS A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the degree of Master of Social Work. Corye Goodman Smith College School for Social Work Northampton, Massachusetts 01063 2009 ACKNOWLEDGEMENTS Thank You Brookie, Bizzy, Mrs. Laura, Big C, John, Beth and Margo Goodman! Your support encouraged me throughout and you’re my favorite people. I would also like to acknowledge the children living on the bone marrow transplant unit at Children’s Hospital Los Angeles. Thank you for inspiring me with your strength and smiles. I would like to extend my gratitude to Colette Duciaume-Wright MSW, LCSW for her endless encouragement and invaluable contributions throughout this process. Additionally, I would like to thank Marjorie Postal for her support with the statistical analysis portion of this research and Liane Hartman for her support with the formatting portion of this study. Thank to the entire Smith Social Work community for their constant support and guidance throughout. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS .......................................................................................... ii TABLE OF CONTENTS .............................................................................................. iii LIST OF TABLES ........................................................................................................ iv CHAPTER I INTRODUCTION ................................................................................................ 1 II LITERATURE REVIEW ..................................................................................... 9 III METHODOLOGY ............................................................................................... 29 IV FINDINGS ........................................................................................................... 37 V DISCUSSION ....................................................................................................... 55 REFERENCES ............................................................................................................. 65 APPENDICES Appendix A: Anonymous Survey.. .............................................................................. 68 Appendix B: HSR Approval Letter.............................................................................. 72 Appendix C: Informed Consent .................................................................................. 73 Appendix D: Do Not Consent “Skip Logic” Page ....................................................... 75 iii LIST OF TABLES Table 1. Demographics of Sample: Gender, Most Advanced Degree, Licensure Status ... 39 2. Current Work Setting ........................................................................................... 40 3. Years in Pediatric Medical Social Work and Training in Art/Play Therapy ........ 42 4. Time Commitment and Social Work Roles .......................................................... 44 5. Utilization of Play and Art Therapy Interventions ............................................... 48 6. Frequency Play Interventions and Effectiveness of Play Interventions ............... 49 7. Recommendations of Play and Art Therapy ........................................................ 50 8. Barriers for Use of Play within Medical Setting .................................................. 51 iv CHAPTER I INTRODUCTION This study examines the role of the clinical social worker within a pediatric hospital setting. The study emphasizes the importance of art and play therapy psychological interventions with children who are living within a medical care facility. The study explores the intervention methods most commonly used by hospital social workers, with special analysis given to the clinical social worker’s ability to practice play and/or art therapy intervention techniques within the medical model. The research touches on the empirical data surrounding the emotional needs and psychosocial symptoms of physically ill children within a hospital setting. Common feelings and fears for these children can include a sadness surrounding their illnesses, the fear of death and of being alone, and the struggle to conceptualize the physical symptoms and outcomes of their illnesses. Psychosocial needs include the need for play and creative expression, the desire for caretaker closeness, the need for participation in care and treatment, the importance and need for good relationships with the medical team, the need for physical and emotional mastery, and the need to socialize and communicate with others, especially primary caretakers, regarding their illnesses (Bjork, Hallstrom, & Nordstrom, 2006). Prior to data analysis this study predicted that due to the limitations within the current medical model and additional demands of the medical social worker, play and art therapy interventions would not be commonly utilized with ill children living in the 1 hospital. The study identifies the ideologies and realities of the current medical model that prevent the common teaching and practicing of art and play therapy. It also determines the changes that are necessary in order to incorporate more effective psychological interventions into the existing medical model. According to Nora Mindell, there is a pressing concern and need in pediatric medical units around the world to improve the quality of psychological care for children suffering from life threatening illnesses (Mindell, 1998). In the United States, it was estimated by the National Cancer Institute (2001) that cancer would be detected in 8600 children under the age of fifteen. In 2000, the number of children with cancer in the United States was calculated at 67 million, making the incident of cancer 156 cases out of every 100,000 children (Fochtman, 2006). These figures are continuing to grow. While the incident rate of childhood cancer is increasing, as well as the incident rates of pediatric genetic blood disorders and pediatric brain tumors, so is the survival rate of childhood cancers and other pediatric illnesses. With the advancement of available medical treatments, more children are surviving their illnesses and recovering to lead healthy lives with normal life expectancies. In 2000, the average survival rate for all types of childhood cancers was 78 percent. Today, the survival rate for Acute Lymphocytic Leukemia in children fifteen years old or younger is 85 percent, unlike twenty years ago when the survival rate was only 56 percent (Fochtman, 2006). Although survival rates have increased, little changes have been made in psychological interventions within the hospital setting by pediatric oncology social workers (Jones, 2006). 2 Traditionally, the hospital social worker takes on numerous

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