Formal elements are the various aspects of an artwork that you can use to analyze and come to an understanding of a piece of art.
efficacy of arts-based interventions in medical education
Infant was in father’s care for 2 weeks. Father brought son back to meet mother at a family wedding. Mother undressed son to change his diaper in front of Father and saw this on infant’s left lateral thigh. Father could not explain the injury.
This is a case seen by the Pediatrics Department here at McMaster University. Can you explain what you see here, using the principles discussed earlier?
Description: Infant’s leg, suggested by the chubby thigh and the size of the thigh in proportion to the adult hand holding it in place. My eyes are drawn to the centrally located raw pink colour that stands out in contrast to the skin tone. This pink area contains well-demarcated margins with a patterned appearance. Some parts are blackened compared to the skin, giving a burnt appearance. There are multiples discoloured areas, localized to this anterolateral leg area. The blackened appearance along with the exposed pink area gives me the impression that the top layer of skin has been peeled away, possibly due to a burn, suggested by the blackened areas. Whatever caused this seems to have been localized. There do not appear to be any other injuries inconsistent with a burn.
Of course in a case like this, have to consider child abuse. Child Protective Services was involved in the case. It was suspicious that the parents did not provide a mechanism for the burn injury. However, it was important to look at the case as a whole, and consider all of the options. The fact that the burn was concentrated to one part of the body, and that there were no other injuries on the infant suggested that this was not a chronic issue, but an acute one. It was important to think about the history the parents had given – in this case, prolonged travel on a hot sunny day – and think about the things that could have caused this injury, which is what led the clinicians to realize that the exposed plastic of the car seat led to this burn, and it was an accidental injury. However, it is important as a clinician to suspect child abuse when elements of a story are inconsistent.
Wekerle CIHR Team - CAPHC Picturing Wellness
Christine Wekerle, Ph.D., Pediatrics
Editor-in-Chief, Child Abuse & Neglect
Co-Curator, Picturing Wellness Art Exhibit @McMaster
Museum of Art
Picturing Wellness: From Adversity to Resilience
• March 3, 4, 5 2016 Conference via
McMaster Continuing Health Sciences Education (CHSE)
• Providing #art=#resilience activities:
o Picturing Wellness Exhibit @ McMaster Museum of Art
o Talk by Sheldon Kennedy: Swift Current Documentary
o Presentation from Toronto Police
Victim Services’ Youth Advocates
Teens Ending Abusive Relationships
(TEAR) TwitterChat #TEARtalk
o One-man play on mental health
and resilience journey
o Yoga & Mindfulness Practice
How do you picture
• Picturing Wellness by Craig Kung, McMaster Medical
Student entered in Art with Impact 2015
Child Abuse & Neglect – Trauma, Resilience
• “…in the lexicon of strengths, it is as wrong to deny the possible
as it is to deny the problem” (Saleeby, p.297)
• Child abuse/neglect deaths > male children > male offenders
• Cases w/ child abuse/neglect-related deaths differ in the use of
all types of child welfare services
(case management, mental health
services, education/training, court
• Identified triggers: Crying child, toile training/feeding issues,
intimate partner violence
• 1 in 6 children had prior disability/chronic illness (1 in 3
prior abuse/neglect, from autopsy evidence)
• US National Child Death Review Case Reporting System
The Resilience Journey
Navigating & Negotiating
Transitioning from Adversity
① Acknowledging Adversity
② Crafting Daily Resilience Practice
③ Shifting Perspectives & Mindsets
④ Reaching Out For Help
⑤ Transforming Burden Into Beauty
⑥ Managing Stress Storms
⑦ Emerging & Extending Your Grace
TEDxHamilton 2015 Talk – C. Wekerle
• Review (Domhardt et al., 2015)
(3) solutions-focused coping style
• Flett, Flett, & Wekerle (in press; www.in-car.ca)
(4) self-reinforcing (acknowledge achievements)
(5) self-compassionate (capacity and motivation to perceive self
accurately and empathically)
(6) direct coaching (anticipatory social guidance; “mattering”)
• “…unique signature is the transformation of adversity into personal,
relational, and collective growth through strengthening existing social
engagements, and developing new relationships, with creative
(Cacioppo et al., 2011, p. 44).
Childhood Traumatic Events:
Abuse & Neglect
Abuse by a family member or
someone connected with the family
is in itself a barrier to victims
accessing help (UK Child
Commissioner’s Report, 2015,)
• Earlier disclosure predictive
of better health outcomes
• Having 3+ persons to talk
with buffers childhood
• 7.6% of adults reporting
child abuse were child
• 3 types of abuse (physical,
sexual, and witnessing IPV
increase likelihood of child
• What does it take for
abused/neglected children to
Ontario Incidence Study of
Reported Child Abuse & Neglect
CIS study – www.cwrp.ca
48% child previously investigated
58% multiple substantiated incidents within maltreatment type
18% multiple substantiated types of maltreatment
10% reported by health care professionals – under-reporting?
CanMEDS Roles: Context for
Child Abuse/Neglect Learning
Health Advocate- Child injury
prevention; child well-being
Collaborator – Team,
Child welfare, police,
Public health etc.
The Child Abuse/Neglect
“Child protection is a difficult area of
practice that can involve making
decisions that are emotionally
challenging, complicated by
and sometimes go against the wishes
-General Medical Council, 2012
o Nature of the injury
o Developmental capabilities of the child
o Social history (risk factors) and history of injury
o Research [e.g., 51% closed cases (substantiated) and 38%
(suspected) re-referred within 5 years to child welfare, Dakil
et al., 2011]
o Most suspected cases in hospital go home with parents
(75.6%, Friedman et al., 2012) – Follow-up assessment
• Common to see risk to siblings, re-victimizations, and multiple
forms of maltreatment
Child Abuse/Neglect Screening in ER
(Netherlands; Louwers et al., 2012
• (1) Is the history consistent?
• (2) Was there unnecessary delay in help-seeking?
• (3) Does the onset of injury fit with the developmental level of
the child? (<1% babies who are not mobile present with
bruising, Gilbert et al., 2009)
• (4) Is caregiver behaviour and caregiver-child interaction
• (5) Are findings of the top-to-toe exam consistent with history?
• (6)Are there any signals for concern that the child or other
family members are safe?
The Art-based System of Looking
How to Look:
• Colour: hue, intensity, temperature
• Texture: how surface looks or feels
• Shape/Form: outline of object
• Line: length, direction
• Space: area around, within, or between objects
• Emphasis: importance given to one part in the art
• Movement/Rhythm: how the artist uses elements to direct the
eye around the art work
• Pattern/Repetition: repeated use of similar elements (such as
colour or line)
Support for improvement in:
o Descriptive ability
o Observational accuracy
o Manage complex patterns
o Awareness of multiple perspectives
o Appreciation of subtle cues
o Skepticism about initial impressions
Other proposed benefits (yet unsupported by quality data)
o Improved teamwork and collaboration
Basic Questions to Guide
• What’s going on in this picture?
• What do you see that makes you say that? (evidence)
• What more can we find?
• START with:
• 1. Where does your eye first go to?
• 2. Describe details of what you see?
• 3. Go around the picture? What else do you see?
Analyzing Visuals – 11-mo.
Case – Shape?
Moharir, Niec & Wekerle (2012). Burn injury in an 11
month old infant. Pediatrics & Child Health, 17(9), 495-497.
• Child with father for 2 weeks
• To return, there was a 5 hour car ride in 35°C weather
• Infant in car seat, exposed to sun through windows
• Mother noticed burn upon arrival
• Went to emergency room following day
• Infant appeared healthy and engaging
• Burn pattern on infant exactly matched exposed plastic part of car-
• Verified by placing infant into car-seat
• Appropriate call to CAS – no story for injury
• In-Depth CAAP Evaluation: Accidental burn injury due to skin
exposed to heated plastic of car-seat
Museums contribute to...
pursuit of health [via] relaxation,
an immediate intervention of beneficial change in physiology,
emotions or both.
They also encourage introspection,
a process of understanding one’s feelings and thoughts
that is essential to mental health.
Museums foster health education that equips
individuals…[to] address social conditions…
by public health advocacy and
by enhancing healthcare environments.
Silverman, L. (2010). The Social Work of Museums. NY:
The art & science of seeing
CAN Clinical Pearl:
reside in what is
missing, what is not
there but which is
expected to be
there, or distortions
in what is there.
• International Journal of Child and Adolescent Resilience
• TEDxHamilton Talk (C. Wekerle, September, 2015)
• TED Ed Lessons: 1) Risk and Resilience in Youth
Suicidality:http://ed.ted.com/on/6nReRcN0 (2) Adverse
Childhood Events (ACEs) & Childhood Maltreatment
• Prezi Presentations: Child Sexual Abuse: A Hidden Problem
• Follow on Twitter @DrWekerle #picturingwellness