Art, Music and Games... in a Hospital

What does healing look like beyond the medical chart? 

In this episode, two practitioners at Children's Hospital Los Angeles share how art, music, and virtual reality are playing meaningful roles in pediatric care, not as extras, but as essential parts of the patient experience.

Nicole Albers, art therapist and Team Lead for the Mark Taper – Johnny Mercer Artists Program at CHLA, explains how art and music therapy meet children where they are, giving hospitalized kids a sense of power and control in an environment where almost everything else is decided for them. From lullabies customized to a parent's Spotify playlist to narrative art therapy that lets a child explore fear through a story about a tiny mouse, the work is as varied as the patients it serves.

Dr. Joseph Miller, Interventional Radiologist at CHLA, shares how virtual reality is changing the procedural experience for pediatric patients, reducing the need for full anesthesia in certain procedures, easing anxiety, and allowing his team to serve patients they previously would have had to turn away.

Together, they offer a picture of a hospital that treats the whole child, not just the diagnosis.

Connect with Nicole Albers:

Nicole Albers LinkedIn

Mark Taper – Johnny Mercer Artists Program

Connect with Dr. Joseph Miller:

Dr. Joseph Miller CHLA

Connect with us:

KidsX Website

KidsX LinkedIn

Children's Hospital L.A. Website

Children's Hospital L.A. Instagram

Children's Hospital L.A. LinkedIn

Transcript

SPEAKER_00 0:01

Welcome to the Dose of Optimism, where I talk to the optimists in healthcare. My name is Omkar Kulkarni, and I work at one of the world's best children's hospitals where I lead innovation. I started Kids X, which is a premier international startup accelerator for pediatric innovation. And over the years I've met thousands of startups, investors, and innovators. Every one of them has a story, and every one of them is optimistic about the problems they're solving. On this podcast, you'll meet amazing people who will share their stories and what makes them optimistic about the future of healthcare. A little note before we get into this episode. We are not offering medical advice and we're not endorsing any products. Please talk to your own physician about your health or the health of your children. Alright, let's get started. Today's episode is a fun one. We talk about how art and music and games on virtual reality can be really helpful to kids in the hospital. We talked to Nicole Albers. She's a licensed marriage and family therapist and she's a board-certified art therapist at Children's Hospital Los Angeles. She serves as the program lead for the arts program here, where she integrates art and music therapy into pediatric care to support emotional expression, coping, healing for kids who are hospitalized and their families. Nicole, thanks for joining us.

SPEAKER_02 1:35

Thanks for having me. I'm so excited to be here.

SPEAKER_00 1:37

Tell me about what you do. So you're an art therapist, right?

SPEAKER_02 1:40

Yeah, I'm an art therapist here at Children's Hospital. I've been here for 14 years. It's been really cool. So I get to meet families and kids, see what their needs are, and provide art therapy as a way of coping, as a way of dealing with the hospital and a way of self-expression.

SPEAKER_00 1:57

Why is it important for them to have the opportunity to engage in art?

SPEAKER_02 2:02

We focus so much on the medical part of the kid, but they're a whole child. They're a whole person. And so we really want to acknowledge their kidness, who they are within their family. And there's a lot of things out of their control here in the hospital. Like they don't get to decide when they get their medication or what treatment they're doing, or even when doctors are coming in and out of their room or nurses checking their IVs. But in art therapy, they have total power and control and they get to make all the decisions. It can be something as small as deciding if you want white paper or a color of paper, or it could be, do you want to use markers or colored pencils today? So every little micro decision adds up to them being more empowered in their healthcare journey.

SPEAKER_00 2:48

So walk us through different types of art therapy that patients will do when they're at our hospital.

SPEAKER_02 2:55

The really cool thing is it's really customized to each kid and their needs. So we're trained art therapists and we're also marriage and family therapists. So we go in and we're assessing what the need is for that kid, that day, that moment. So sometimes it is coping skills. So what that might look like is we make a mini book of coping skills, how to handle the hospital. Or I've done it where kids will make brochures about their diagnosis so they can share with their family and friends. I have cancer. This is what I'm going through. This is how you can help me. This is what to expect. I remember one kid says, yeah, I'm going to lose my hair, but don't make a big deal about it. So it was a way for her to communicate her needs in the hospital out to her family outside the hospital. And I love narrative approaches. Narrative therapy is one of my favorites. It just marries so beautifully with art therapy. So with our littles, it's about creating that story, creating that narrative. So they might not be able to tell me that they're afraid of being here, that things are really scary, but they can tell me a story about a tiny mouse who's afraid of being squoshed and what they're feeling. And we get to go into that. I go, oh my goodness, how do they deal with this? Like, how can they be brave or what can we do to help equip them? So jumping into that metaphor in that story with especially our littles helps them explore the hospital experience without it being so overt, but it is still resolving those questions and those feelings that are coming up from being here. With our teens, it is a whole different thing. They are on people. We have to respect that they are young adults. And so it is really in their control. I will say, what do you think about making a cloche today? What sort of vibe are you feeling? What sort of vibe are you looking for? Lately, I've been doing an art group for our eating disorder kiddos, along with our psych social worker, Ileana Bialreal. And it's been so cool with these kids. Sometimes we do a meditation about a tree, about your rooting and your strength and your grounding and reaching higher and looking for those potential good things. And other times it is what's a quote to live by. Let's figure out what your guiding quote or your affirmation can be through this hospital experience. So the art just can wiggle into all these really cool places to meet the mental health needs, but like I talked about, the whole child needs.

SPEAKER_00 5:30

I feel like I need to do some art myself.

SPEAKER_02 5:31

Do you ever find yourself drawing or painting or I'll tell you that I was a really sensitive kid. I was still a sensitive adult. It was before people knew about highly sensitive people. And I know that I would come home from school feeling really bogged down or affected by my day. And my mom would put out paper and give me markers and she would say, draw until you feel better. And so from a kid, art became a natural language for me for feeling identification and expression. So going through school, through college, and realizing, wow, if I sat at this kickwheel and made pottery for an hour, I could calm my body and I could study. I could be prepared for my next class. I could write that paper. So it is also reminding myself like it worked for you in your childhood and all through your 20s. It still works now. So sometimes I'll have a tough session and I'll go to the healing garden and I'll sit out there and just do a little watercolor or draw a little doodle or do a little writing as a way of help grounding myself and recentering. And I feel like art therapists forget that they're also artists and that it's important to fuel that part of us as well.

SPEAKER_00 6:47

I've wondered why, as kids and as young adults, we incorporate art into curriculum for school and then we hit the workforce and art's gone from our lives. And I imagine there's benefit to adults having art in their lives. And I imagine the mental health benefits and perhaps even physical stress benefits.

SPEAKER_02 7:09

Yeah, I think about how the adult coloring book movement has really taken on.

SPEAKER_00 7:14

I love adult coloring books.

SPEAKER_02 7:15

I think it can be grounding. Your focus can be where that color pencil is hitting the paper instead of your whole day. You can just focus in on that one color, that one line, that one shape.

SPEAKER_00 7:27

Your point earlier about kids in hospitals not having control over everything that they're doing.

SPEAKER_02 7:32

I'm so lucky to be able to lead up the program for art therapy and music therapy. And I am humbled by the work of my staff. They're so cool. They do magic in the room. Our music therapists can work with our teeniest, tiniest of babies in the NICU. They have a special training to work in the NICU to be able to understand signs of overstimulation in the babies and know how to apply music in a way that can help them calm and get to a restful sleep state, which we know when babies are sleeping, that's when their bodies are restoring and healing. And so it's really important with all the beeps and sounds and loudness in the hospital to get these babies to a good calm state where they can rest. Sarah is our music therapist in the NICU. And I love to say that she can lullabify any song. So she talks to the parents and sees, what were you listening to when you're pregnant? Who, what's on your playlist? Show me your playlist. And the some of the parents are a little shy because they're like, I don't think this is children's hospital appropriate. But she's like, no, I want to hear, I want to see. And she'll create a custom lullaby for that baby based on their parents' music choice. She will find a way. She's done Drake, she's done The Weekend, she's done Guns and Roses, like Sweet Child of Mine. You will never hear it the same again after you've really listened to those lyrics. Her music therapist can just tuck into some really interesting places that other people in the hospital space can't. So the overlap is power and control, that one-on-one relationship, that attunement, but they can also help with neurologic development. They can go into our rehab unit and help those kiddos along with their PTs and OTs, walking and talking again, utilizing the music as a catalyst for that.

SPEAKER_00 9:32

For some of the older kids, do we find ways for them to be able to play music or sing or something along those lines?

SPEAKER_02 9:38

Yeah, we know that music is important. It can benefit our mental health. It can help us be motivated. It can help us when we're sad. Our older teens really are more into playlist making. And so it's a concept of one of my interns taught me this mood vectoring, which is start in the mood where you are. And then what songs would it take to get you to the mood you want to be in? So creating that playlist, if you're sad and you're down in the dumps, but you want to get to neutral or you want to get to happy, okay. What's the seven songs that are going to get you from one place up into the next place? The other thing I love about music therapy is they look at the monitor and they can see the heart rate change and the oxygen levels change as a result of the music intervention. So you can see that it's working.

SPEAKER_00 10:32

So you play the music, you sing a song, and you can see the biometrics of the patient improving based on that. It's so powerful. It's really cool. What excites you about the work that you do? Music, art, you work with kids, you make their lives better. What's your most exciting part about all of it?

SPEAKER_02 10:51

I love being in the rooms with the kids and families. I love that you knock on the door and you're not quite sure what you're gonna walk into. It's a different family system. It could be a different diagnosis, age, abilities, mobility. All of these things can be so different. And you just get to be on your toes and you walk in and you're like, how can I be of service to this family in this moment? And kids are funny. They crack me up. So I love to see what their imaginations can make, what their drawings look like, and the stories that they'll come up with. So I like storing those like little moments for tougher days to reflect back on these bright spots, this funny story a kid told me this amazing artwork that a kid really tuned into, or a parent who felt respite and relief to be talking to a therapist for a while.

SPEAKER_00 11:45

There's nothing better than seeing a kid give you a piece of artwork that they're so proud that they made, or listening to a song that they're singing that they're just so proud of. There's something about the creation of art, whether it's music or other forms of art, that for kids that it's so powerful. You can see it in their eyes. You can see the pride that they have in it. I imagine, particularly for kids with who are going through medical treatments, it's even more powerful. My last question for you the unique thing about children's hospitals is there are not only kids in the room, but there's also parents in the room or grandparents in the room or other family members. Does music ever help them? Is there ever art therapy in which the parents are doing art alongside the kids? How expansive is music and art therapy or yeah, we're part of family-centered care.

SPEAKER_02 12:33

Whoever the kid considers family is family and we treat them like family. So sometimes that kid and the parents are just so disconnected. Like the medical treatment can really wear on you as a parent to see your child in pain or suffering. It can just have that emotional toll on you. So it is about reconnecting them. So if we see that parent who is like just scrolling, like doom scrolling, I'll say, Hey, why don't you come to the bedside and join us? And I get them to draw. I get them to draw with their kid on the same piece of paper or in different papers and tell me everything you love about your kid. What are the top five things that make your kid special? So engaging that parent along with the kid. And I always say, When was the last time you did art together? And oftentimes the answer is never. And I say, Whoa, we created a new family tradition today. So how are we going to keep this family tradition going when I leave? Same with the music with our babies, helping the parents reconnect to them. Our music therapists do what they call a family band. And so the patient is the leader of the band. They choose what instruments the whole family will play, who gets to play when, they'll point to one and they want the tambourine louder and they didn't want their dad to be quieter on the drums. So this kid becomes the band leader. And it's just just showing. They have this network of support. They have all of their people in the room who are listening and attuning to their exact needs. And they get to have fun too. Added bonus. They get to have fun. The parents get to see their kids as their kids again. I get that comment a lot of, oh wow, this is how they are at home. We're getting to see a glimpse of them at home again.

SPEAKER_00 14:22

That's really special. Nicole, thank you for sharing everything that you're doing.

SPEAKER_02 14:26

Of course. Thanks for having me. It was great to talk to you and just be able to brag about how amazing our therapy and music therapy is here.

SPEAKER_00 14:36

And then we talked to Dr. Joey Miller. He's a pediatric interventional radiologist, also at Children's Hospital Los Angeles. He serves as the director of interventional radiology and he's the co-director of the Vascular Anomalies Center. For this conversation, the relevant piece is that he's got a lot of interest and focus around the use of virtual reality in helping kids before and during procedures. And he does this in a way to help distract them and to get them feeling less anxious and more comfortable about the health care they're receiving while at the children's hospital. Dr. Miller, thank you for joining us.

SPEAKER_01 15:20

Thank you for having me.

SPEAKER_00 15:21

The work you're doing around virtual reality in CHLA is unique because you're reaching a set of use cases and a set of patient populations that perhaps other hospitals don't think about. How did you get started with this work?

SPEAKER_01 15:35

It started with recognizing that we had a need to provide our procedural services just more widely than we're able to. CHLA is a wonderful institution that does everything we can for every patient we can, but as a result, we kind of bite off more than we can choose sometimes, and we're a little bit resource-strapped. Interventional radiology, which is what I do, is a minimally invasive procedural specialty where we use ultrasound and x-ray and CT scans to place needles in patients' bodies and to do procedures that traditionally would have been done by a surgeon instead. And particularly for adult patients, those procedures are either done completely awake or they're done with a small amount of sedation that we would provide ourselves. But in a pediatric population, that's untenable. That doesn't really work. And so pediatric interventional radiologists require really strong relationships with our anesthesia colleagues. And cases that would normally be done differently require a full anesthesia provider and anesthesia team here. And so as a result, procedures that would take five minutes or 10 minutes of my time now become 60 or 90 minutes of procedural resource consumption with multiple providers involved and a lot of other people there. And so we were realizing that there was a lot of good that we were hoping to be able to do in a given day that we just weren't able to do because there were so many constraints. And so we started asking ourselves: are there ways that for particular patients that we could get them through these quick procedures, help with their anxiety, help with their pain, give them the kind of experience that we would want for our kids?

SPEAKER_00 17:20

And so when you realize you've got a patient who's got this specific procedure coming up, do you prep them in advance?

SPEAKER_01 17:26

When we first started doing this, you know, the sky's the limit. You could potentially do this for anything or for any patient, but we knew that was probably not going to work out really well. That we didn't want to be offering an inferior procedural experience to people just because we had this thing available. Dr. Jeffrey Gold, who's been here for many years, has published very widely on the potential uses of VR and some of the limitations and taking a lot of the work that he had done and people like him had done to mind. We decided that there would probably be a limited number of procedures that we would start off with that we would think would be good use cases for the technology. And then we'd identify patients in advance and we we'd give the option and say, instead of having to go to sleep and go through recovery and go through all the risk of that and not eat for 12 hours beforehand, we have this alternative for your thyroid biopsy, for instance, right? A thyroid biopsy uses a 25-gauge needle. It's really tiny and it's uncomfortable, but it should not typically be a painful thing. Most of the times when we're doing this, these are teenagers or these are kids who are in their tweens at the youngest, typically. And we decided that those types of cases would probably be the best place to start. And so we started there, and then we started doing lumbar punctures and other similar procedures like that. And as time has gone on, we've just been expanding the indications to where now I have a handful of patients who are in their early 20s where they're actually they've aged out of my ability to give them sedation with an anesthesiologist because of how the hospital works. And I can continue to provide care for them that I would not have been able to do in the past. I would have had to transition them to an adult facility, but I can still treat them for injection sclerotherapies for their vascular anomalies because I can do that procedure awake with VR to help with the anxiety and the discomfort. And I'm sure we'll find additional indications as time goes on. That's what we've been doing recently.

SPEAKER_00 19:19

Dr. Miller, thank you for all the work you're doing and appreciate you coming on the show. All right. Thank you for joining us for your dose of optimism. Make sure to check out our show notes to get more information about our guests and the work they're doing. Visit our podcast page on the Kids X website to join our podcast community and to learn more about pediatric innovation. Thank you to our sponsors and to our presenting partner, Kids X. Please subscribe wherever you get your podcasts. And remember, it takes a village to make sure our kids grow into healthy adults. So volunteer at your local library, help out at the community center, and if you're so inspired, donate to your local children's hospital. Alright, see you next time. The content, views, opinions, and information presented on this podcast do not reflect the views of Children's Hospital Los Angeles or of the sponsors of the podcast.