Impact case study database
Applied Theatre for Children in Hospital
1. Summary of the impact
Professor Sextou’s widely-funded research has pioneered the conceptualisation and development of a ground-breaking bedside theatre model of direct benefit to hospitalised children’s wellbeing. Her research has outreached over 4,000 children in 1:1 bedside performances at Birmingham Children’s Hospital and Heartlands Paediatrics NHS Trusts. The number of beneficiaries exceeded the target audience by 30% maximising the benefits for hospitalised children. The analyses of the unique longitudinal datasets she generated have influenced parliamentary debates and recommendations supporting improvements on the Arts for Health (WHO Review 2019; The Y Connect Project Report Australia 2019; APPG Report Creative Health 2017).
2. Underpinning research
Children experience a sequence of clinical stressors during hospitalisation that affect their quality of life. The motivation for this research arose from the lack of adequate research practice used for theatre in child healthcare to improve their wellbeing. In 2010, Sextou undertook the first ever mixed-methodology study combining bedside performance, quantitative and qualitative methods with children (4 to 12 years old) and their parent/carers on NHS hospital sites. The study reported perceived benefits by the participants such as distraction from illness, improved collaboration with nurses in procedures and coping with pre-operative anxiety (Sextou and Monk 2013). Key insights from this publication were further developed by Sextou with outputs published internationally that reflected this research in the wider area of arts in healthcare [R1-R6]. CADLab’s bedside theatre model for children in hospitals is based on this conceptual design.
Conceptual development of bedside theatre in hospital: Professor Sextou secured a HEfCE and UnLtd. Entrepreneurship award to establish the Community and Applied Drama Laboratory (CADLab), a research hub at Newman University in 2010 https://www.newman.ac.uk/knowledge-base/cadlab/. She has identified innovative, publicly-engaged, participatory theatre research projects that had direct impact on the wellbeing of short- and long-stay children in hospital and led to developments that include:
Adapting participatory storytelling to reduce sick children’s levels of clinical anxiety and improve their wellbeing.
Using puppetry to improve children’s communications with unfamiliar adults, teachers and nurses.
Training the artist to be emotionally aware in healthcare settings.
Methodological development: The CADLab model has been rolled out further at Birmingham Children’s Hospital (paediatrics, cardiac, oncology, haemoglobin-dialysis, intensive and complex care), Heartlands Hospital Paediatrics and Acorn’s hospice via publicly-funded projects by BBC Children in Need, The Lottery Community Fund and other Organisations. Total external funding support since 2010 exceeds £100,000, with the vast majority awarded since 2016. Methodological developments include:
(a)mixed-methodologies were used to capture the effect of theatre on the child’s wellbeing (i.e. performance-based research combined with scientific methods such as pre-and post-performance interviews and questionnaire), and
(b)multi-disciplinary approaches were used to research ethics (i.e. artistic, medical, and scientific views) to improve the efficiency of ethical procedures for arts-based research in clinical settings.
| Grant/event | Year | Amount | Project |
|---|---|---|---|
| 1.BBC Children in Need grant | 2019-2021 | £27,844 | RocketArts |
| 2.The Lottery Community Fund | 2019 | £10,000 | RocketArts |
| 3. Broken Puppet 3 Symposium | 2019 | £ 4,206 | Symposium income |
| 4.The Grimmitt Trust | 2013-18, | £ 3,000 | Bedside theatre |
| 5. Newman University Research Fund | 2019 | £850 | The artist in healthcare |
| 6.W.A.Cadbury Trust | 2012-18 | £ 2, 750 | Bedside theatre |
| 7.BBC Children in Need grant | 2016 | £49,349 | Bird Island |
| 8.Heart of England Foundation NHS Trust | 2013 | £ 2,000 | Breathing with Love |
| 9.HEfCE & UnLimited | 2010 | £ 3,800 | CADlab |
| Total | £103,799 |
3. References to the research
Outputs R1, R2, R3, R4, R5 and R6 demonstrate my research expertise in applied theatre practice in child healthcare in relation to the wellbeing of the children as audiences and the complexities of what it is to be an actor-in-healthcare. Outputs R7, R8 and R9 demonstrate the fusion of theatre knowledge and mental health/illness for the wider applied theatre field in the community sector.
R1 Sextou, P., Karypidou, Anatoli and Kourtidou-Sextou, E. (2020) ‘Applied Theatre, Puppetry and Emotional skills in Healthcare: a cross-disciplinary pedagogical framework’, Applied Theatre Research, 8(1): 89-105, doi: https://doi.org/10.1386/atr_00028_1
R2 Sextou, P. & Rolston, W. (2020) ‘ Exploring methods of training the actor/puppeteer in healthcare: a Socratic dialogue, Journal of Applied Arts and Health, double special issue, 11 (1-2). pp. 171-176. https://doi.org/10.1386/jaah_00030_7
R3 Astles, C., Fisher, E., Purcell-Gates, L. & Sextou, P. (2020) Broken Puppet Symposia. Journal of Applied Arts and Health, 11 (1 & 2). pp. 200-207. ISSN 2040-2457
R4 Sextou, P. & Karypidou, A. (2018), ‘What does the actor need to perform in health care? Emotional demands, skills and competences’, Applied Theatre Research, 6(2): 107-19. doi: 10.1386/art.6.2.107_1
R5 Sextou, P. (2016) Theatre for Children in Hospital. The Gift of Compassion. Intellect.
R6 Sextou, P. & Hall, S. (2015) ‘Theatre & Community: Bedside theatre promoting child wellbeing in cardiac and cancer units’, Applied Theatre Research, 3(1): 67-84.
R7 Patterson, P. & Sextou, P. (2017) ‘Trapped in the Labyrinth’ – the use of symbolism, time and aesthetic distance in exploring the impact of mental illness through theatre’. Medical Humanities, 43(2): 86-91, doi: 10.1136/medhum-2016-011094
R8 Sextou, P. & Patterson, P. (2014) ‘Theatre, Stigma and Society: Mental illness on stage’. The International Journal of Social, Political and Community Agendas in the Arts, 9(1): 1-10.
R9 Sextou, C. and Smith, C. (2017) ‘Drama is for Life! Recreational drama activities for the elderly in the UK’. Text matters A Journal of Literature, Theory and Culture, 7(7): 273-290, doi: https://doi.org/10.1515/texmat-2017-0015.
Outputs R1, R2 and R3 were developed by research that Sextou conducted during the Broken Puppet 3 International Symposium that she organised at Newman University (2019). These papers are included in special issues of the Journal of Applied Arts and Health double special issue (2020), co-edited by Sextou, and the Applied Theatre Journal (2020). Outputs R1, R4 and R6 were published by Applied Theatre Research (ATR impact factor 0.10, H index 1). Output R5 is a research-evidenced monograph that presents pioneering research. The author was invited to make key-notes by the Universities of Cork (Ireland), Gdansk (Poland) and Griffith (Australia). She was also interviewed widely about this monograph by Medical Humanities, Arts Professional, Goldlink, Steps, Interjuli Magazine/Germany, Gdansk TV Poland, and ABC Radio, Australia. Interviews are published online. Outcomes R7, R8 and R9 were published in international peer-reviewed journals. R7 was first presented at a conference at the University of Birmingham (2016) and then, it was published in the MHJ special issue in 2017 (MHJ impact factor 0.69, H index 24). Outcome R9 was published in a peer-reviewed annual volume by the University of Lodz that was launched in an Erasmus event in Poland (2017) attracting the interest of academics and the wider community.
4. Details of the impact
Impact on policy and guidance
Professor Sextou’s research has contributed to a wider acceptance of the role of the arts in healthcare and influenced debates about the Arts for Health & Wellbeing of children and young people in the UK and internationally. More specifically,
Sextou’s monograph [R5] is mentioned in the All-Party parliamentary Group Report “Creative Health” (2017:98) and influenced the recommendation ‘schools and universities to play their part in raising awareness of the opportunities for artists in health and social care’ (APPG 2017:156). APPG 2017 informed the policy and delivery of arts in healthcare. This led to help policy makers to develop the case that the arts in healthcare ‘should be a main stream intervention’ (Kings Cultural Community 2017).
Sextou’s research [R6] is referenced in the World Health Organisation European Review (2019:34) on evidence supporting the role of theatre in child healthcare. There is a clear link between the APPG Report, the WHO Review and the contribution of Sextou’s research which is acknowledged in by the authors.
Sextou’s mixed-methodology [R6 and R9] provided pioneering facts about the impact of participatory theatre on wellbeing. These outcomes are discussed in The Y Connect Project Report (2019:172) influencing debates in the Australian education sector and proposing the capitalisation on the possibilities that relationship with qualified artists provide in child healthcare.
Further Sextou has worked as member of the Arts Steering Group of Birmingham Women's and Children's NHS Foundation Trust towards writing a strategy for the Arts in the Trust. Her research influenced the introduction of participatory arts on hospital wards, improving the experience of over 270,000 children in-patients, visitors and staff (ASG minutes 26/2/2020).
Sextou was awarded the ‘high commended recognition’ at the W. Midlands Arts, Health and Wellbeing competition (2014) for her model of applied theatre research practice. ‘'All of the judges were impressed by your work and thought that your project had made a significant impact.'
Her research also demonstrated significant results about the demand for training the artist and puppeteer-in-healthcare on interpersonal competences to support them emotionally when working with vulnerable children [R1, R2, R3 and R4].
Cross-disciplinary research between Drama and Psychology raised awareness in the public about Bipolar Disorder, prevention and wellbeing through devised theatre. [R7, R8 and R9].
Societal Impact on child healthcare
Professor Sextou’s arts-based research projects have outreached over 4,000 hospitalised children in 1:1 performances and over 1,000 siblings in small-scale group performances since 2014. The capacity of BCH to treat inpatients is 300 beds. Sextou’s projects were offered to short- and long-term patients in oncology (25-bedded ward), dialysis (10-bedded ward), complex care (6-8 bedded ward), cardiac, neurosurgery, paediatrics and PICU in a rota. Her research offered a constant provision of artistic interventions (weekly basis) and a series of benefits for ill children. It also introduced new methodological approaches to theatre in mental ill/health contexts.
Testimonials
‘The research project has had a very positive impact on well over 2,000 medically ill and injured children's social wellbeing during bedside and group performances. The children’s experience of hospital was enhanced and enriched by your deployment of sensitive storytelling interactions with actors, puppets and artists. Your caring and sensitive approach to our pupils in hospital has developed children’s communications with teachers and increased their engagement with learning.’ (The Centre Leader of an LEA provider in healthcare, email, 2019).
‘CADlab projects have played a valuable role in ensuring that we deliver such high quality activities at Birmingham Children’s Hospital. CADLab has improved the overall experience of the child and family in hospital’ (Lead Nurse of patient satisfaction and participation, interview, 2016).
‘The CADLab project has been received extremely well at Heartlands Hospital by all concerned. The benefits of the performance are the breathing techniques help the children to relax, which leads to less stressful time in hospital for patients, parents and staff. Children have benefited hugely’ (Heartlands hospital NHS interview, In Sextou 2016:103).
‘We would like to tell you of the excellent session that took place on Wednesday afternoon. Children didn't want to leave the playroom. The lasting effect was that the children were still talking about it the next day in a positive way.’ (Nursery Nurses, Paediatric Unit Heartlands, email, 2018).
‘Performances stimulated the children, provided entertainment and created a lovely happy atmosphere. We thank Persephone for coming to Acorns hospice’ (Nurse, email, 2016).
‘It was brilliant, lovely and really nice. It had emotions and the breathing helped me when I was a little bit nervous’ (Quote from a child in ‘Arts and Music’ Monthly Report, Heart of England NHS Foundation Trust, 2014).
‘Erm cos it was like my own imagination, I was in my own little world. Erm, because it makes you feel relaxed and ready for bed’ (Child aged 9, interview In Sextou 2016:85).
‘Cos it made (the child) smile and we haven’t seen a smile on his face for two days. It helped him relax and for him to relax I was de-stressed’ (Parent, interview In Sextou 2016:87).
International impact
In 2018, Professor Sextou became Adjunct Research Fellow with Griffith University Australia and Co-Chief Investigator of ‘Future Stories’ (FT) pilot study, a pioneering arts with technology-based research study for children in palliative care in partnership with Griffith University, Sydney NSW University and Queensland Children’s hospital in Brisbane, Australia. Sextou’s book Theatre for Children in Hospital: The Gift of Compassion (Intellect) was instrumental in establishing Persephone’s reputation internationally.
Testimonials
‘The impact of Persephone’s work on the research team has led to us adopting new practice-based approaches in the project, and has informed the ways in which the design of a new and innovative approach to creative care in hospitals has evolved. This had a significant impact on both the ethical and philosophical processes we use in the research, leading to high level impact on long term stay children in hospitals, and the ways in which aesthetic work leads to strong cultural and social outcomes’ (Lead Investigator, Australia, email 5/9/2019).
‘Dr Persephone Sextou’s research on theatre for children in hospital has influenced the Future Stories’ research team thinking and practice at Queensland Children’s Hospital in Australia. Her contribution to research methodology and ethics has made a positive impact on the wellbeing of young people in palliative care during the Future Stories pilot study in 2019-2020 in preparation of the main study starting in 2021’ (Director - Paediatric Palliative Care Service, Australia, email 8/8/20).
Impact on training provision
Professor Sextou’s research has been applied through (1) practical E-Resources and (2) training for actors, puppeteers, nurses and creative therapists in healthcare. Sextou organised the Arts for Health & Wellbeing Conference for the Cathedrals Group of Universities in September 2018 offering a Forum for debates and planning towards an Arts for Health strand of training provision in CG: https://www.newman.ac.uk/wp-content/uploads/sites/10/2018/01/Cathedrals-Group-Conference-Report.pdf She organised the Broken Puppet International Symposium 3 (BP3) on theatre/puppetry, disability, health & wellbeing at Newman University in April 2019. Her research influenced the conference agenda and composed a Manifesto on professional training of applied puppeteers in healthcare: https://www.newman.ac.uk/wp-content/uploads/sites/10/2018/01/BROKEN-PUPPET-3-REPORT.docx Sextou’s impact on the training provision further led to two special journal issues on applied theatre, puppetry, training and health/disability [R1, R2, and R3]
5. Sources to corroborate the impact
Impact on Policy
All-Party parliamentary Group Report “Creative Health” (2017:98)
World Health Organisation European Review (2019:34)
Y Connect Project Report (2019:172)
Impact on Society
- Testimonials from health professionals and patients