Running head PROGRAM AND MISSION ALIGNMENT .docx

1. Running head: PROGRAM AND MISSION ALIGNMENT 1 PROGRAM AND MISSION ALIGNMENT 4 Program and Mission Alignment Student Name Institutional Affiliation Winthrop University aims at offering personalized challenging, graduate, and continuing professional education programs of national caliber. Doing a degree in communication sciences and disorder does not align to the university’s mission since the program is not offered at the university anymore. The program started its closure while I was still in school, which was an indication of its coming to extinction. The program in communication sciences and disorders is also not part of the long-term mission of the university of achieving national stature as a competitive and distinctive, co-educational, public, residential comprehensive, and value-oriented institution. The program has been closed, which is an implication of the failure to meet the required standards to provide competitive skills to its students. Communication sciences and disorders program

2. does not meet the students’ needs of meeting the challenges of the contemporary world by offering them the ability to synthesize knowledge to solve complex challenges. Winthrop University prides itself in offering value-based education, which has shaped the success of the university. Closing the program shows that it does not contribute to the overall mission of the university, which contradicts the provisions of the university, which means that the program does not contribute to the values of the university. Any program that does not contribute towards the achievement of the university’s mission should be scrapped off so that only those programs that have a bearing on the university mission are considered. However, the university needs to evaluate the contribution of the course towards the overall mission of the university. A speech pathologist is concerned with treating speech disorders among people suffering from such problems. The university, on the other hand, is concerned with training people who can treat speech disorders in society. The university, therefore, is a bridge between the prevailing challenge in society and the possible solutions. As such, speech pathologist is an important program that the university should reestablish. References Website: https://www.winthrop.edu/ Journal of Creativity in Mental Health, 7:107, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 1540-1383 print/1540-1391 online DOI: 10.1080/15401383.2012.657597

3. CREATING SPACE FOR CONNECTION: A COLUMN FOR CREATIVE PRACTICE This column is designed to underscore relationally based creative interventions used by counselors and psychotherapists in their practices. Our intention is to provide examples of novel, innovative ways of working with clients in their efforts to deepen self-awareness and their connections with others. Although the interventions within this column will be presented in a linear “how to” manner, an essential premise of this column is that interventions submitted for publication have a contextual and relational basis. Basic to this column is the therapeutic focus of working through latent hurts and impediments to our clients’ health and happiness. Client goals generally involve creating the requisite emotional space needed for genuine relational choice for connection to manifest. If you have created a useful therapy tool, or if you have adapted an existing creative tool that you would like to share with readers, please follow submission guidelines in the author information packet available at http://www.creativecounselor.org/Journal.html. 107

4. Journal of Creativity in Mental Health, 7:108–121, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 1540-1383 print/1540-1391 online ArtBreak: A Creative Group Counseling Program for Children KATHERINE ZIFF, LORI PIERCE, and SUSAN JOHANSON Athens City School District, The Plains, Ohio, USA MARGARET KING Ohio University, Athens, Ohio, USA This article describes the pilot of a school-based creative group-counseling program for children called ArtBreak, a choice-based studio art experience based on the restorative possibilities of art making delineated in the expressive therapies continuum (ETC; Hinz, 2009; Kagin & Lusebrink, 1978). The ETC features a developmental hierarchy in relation to how art is created and the therapeutic properties of associated media. Learning from the pilot suggests the ETC is a valuable framework for supporting groups of children in kinesthetic, affective, and cognitive ways. The article also includes suggestions regarding logistics, community, and future documentation and research. KEYWORDS children, art, group counseling, expressive therapies continuum, creative counseling, creativity Schools offer art making to students in a variety of formats and for mul-

5. tiple purposes. Art educators teach children about techniques, materials, processes, art appreciation, and art history; they also encourage play, creativity, and imagination (Szekely, 2006). Art making can be a support to classroom teaching: The ateliers of Reggio Emilia schools and the curricula of Waldorf schools are art based (Gandini, Hill, Cadwell, & Schwall, 2005; Pelo, 2007). Also, North Carolina and Oklahoma’s system of A+ Schools is a reform model of arts integration (President’s Committee on the Arts and the Humanities, 2011). School counselors use visual art to provide creative counseling in individual or themed group settings (Allan, 1988; Address correspondence to Katherine Ziff, Athens City School District, 25 S. Plains Road, The Plains, OH 45780, USA. E-mail: [email protected] 108 ArtBreak: Creative Group Counseling 109 Gladding, 2011; Somody & Hobbs, 2006/2007). Art therapists sometimes practice in schools, their work supporting student mental health (Essex, Frostig, & Hertz, 1996; Malchiodi, 1996; Pleasant-Metcalf & Rosal, 1997; Rosal, McCulloch-Vislisel, & Neece, 1997). Visual arts in schools is valuable

6. in encouraging school engagement and community, creativity, collaboration, innovative thinking, and attention (Kosik, 2009; President’s Committee on the Arts and the Humanities, 2011). ArtBreak, a program grounded in the therapeutic use of studio art, is a choice-based studio art experience for children based on the restorative possibilities of art making delineated in the expressive therapies continuum (ETC; Kagin & Lusebrink, 1978). The pilot program took place in two elementary schools in rural Southeastern Ohio from 2009 through 2011. ArtBreak was planned and facilitated by an elementary school counselor in consultation with school psychologists and administrators and a university professor. RATIONALE ArtBreak shares boundaries with both art therapy and art education, although it is neither. It incorporates the ETC as a guide for choosing materials for the studio, offering them to children, and thinking about what children are accomplishing as they choose and work with various media. Grounded in the ETC and studio art, ArtBreak is a group-based creative counseling program designed to help students build social skills, develop

7. problem-solving abilities, and relax and express feelings. The ETC is a theoretical framework for engaging the expressive and integrative potential of creativity through the use and properties of visual art. Art therapists Sandra Kagin and Vija Lusebrink introduced the ETC in 1978; it has been elaborated by Lisa Hinz (2009). The ETC features a developmental hierarchy associated with how information is processed in relation to how art is created in a therapeutic context. ETC delineates three general restorative goals of associated media: (a) Fluid media like watercolor, chalk pastels, and finger paint support kinesthetic/sensory goals such as relaxation and expression of feelings; (b) more resistive media like colored pencils, crayons, markers, clay, and tempera paint support perceptual/affective goals such as improving cognition, increasing empathic understanding, identifying emotions, and cause and effect; and (c) resistive media like collage, sculpture with found and recycled materials, and illustrated books support cognitive/symbolic goals such as developing problem- solving skills and identifying and integrating strengths (Hinz, 2009). The third cognitive/symbolic area of the ETC is further differentiated by Project Zero research, which identifies eight habits of mind supported by studio art,

8. including development of craft, ability to engage and persist, envisioning, 110 K. Ziff et al. TABLE 1 The Expressive Therapies Continuum: Therapeutic Goals and Suggested Materials Continuum Level Therapeutic Goals Suggested Materials I. Kinesthetic/Sensory Relax Soft clay Express feelings Finger paint Watercolor Chalk pastels II. Perceptual/Affective Improve cognition Tempera paint Empathic understanding Crayons Identify feelings Oil pastels Improve social skills Drawing materials Improve attention Understand cause and effect III. Cognitive/Symbolic Develop problem-solving abilities Identify and integrate strengths Collage Sculpture with repurposed materials Clay

9. Mask making Markers Art making with two or more steps Illustrated books and narratives Note. Adapted from Hinz (2009). expression, observation, and reflection (Winner, Hetland, Veenema, Sheridan, & Palmer, 2006). Table 1 shows the three levels of the ETC. Studio art has long been associated with psychological healing and regeneration (Adamson & Timlin, 1990; Essex et al., 1996; Moon, 2002). Douglas and Jaquith (2009) associated choice-based art in the classroom with building skills of problem solving, working habits, reflecting, connect- ing, constructing knowledge, and problem finding. Boldt and Brooks (2006) described how art making by groups of students builds community, supports social skills, and fosters belonging, mastery, independence, and generosity. Art making can reduce stress, and for children experiencing cognitive, physical, or emotional stress, a source of relaxation at school can support learning (DeLue, 1999). In studio art therapy, art making is central to the theoretical approach,

10. conceptual understanding of clients and their art making, design and cre- ation of therapeutic work space, and interactions and communications about the process (Moon, 2002). Likewise, an art studio orientation in which students are supported in their ideas, intentions, decisions, and choices is different from the use of art-based protocols for assessment, diagnosis, and treatment. In such an environment where work is facilitated rather than directed, authentic growth and learning can take place (Adamson & Timlin, 1990; McLennan, 2010; Rogers, 1989). ArtBreak offers students an opportunity to pursue independent, choice-based art making according to their own ArtBreak: Creative Group Counseling 111 interests, in a studio furnished with materials and media that reflect and support all three levels of the ETC framework. ASSUMPTIONS ArtBreak is based on the following assumptions: 1. Art making supports children in expressive, affective, and cognitive ways as delineated in the ETC. 2. Art making in a group builds community and develops social

11. skills. 3. Art making in school increases student engagement. 4. Art making supports creativity and divergent thinking. ARTBREAK PILOT OBJECTIVES Our pilot program included five objectives: 1. Learn whether the ETC is applicable to a school-based group studio art format and, if so, how. 2. Provide an opportunity for students to build social skills, develop problem-solving abilities, and relax and express feelings as they choose. 3. Learn whether the logistics of ArtBreak (weekly 30-minute groups) are feasible in a school setting. 4. Create forms and documentation systems for ArtBreak. 5. Identify other learning from the pilot. PILOT PROJECT In its 1st year, the program served 36 children in six groups in one school. The following year, ArtBreak expanded to serve 44 children in two schools in a total of eight groups. Each group, composed of kindergarten through sixth-grade students of diverse ages, genders, and skills, worked together for 30 minutes per week throughout the school year in an open art studio

12. format. Process We followed a simple framework for implementing ArtBreak, available to any practitioner in the field wishing to implement the program. 1. Begin by setting up the art studio; the size and facilities of the space determine the parameters of what can be offered. A room with a sink and 112 K. Ziff et al. shelves can accommodate many options. A very small space can work by having students build sketchbooks to work in and keeping handy a bucket of clean water, damp rags, and a pan for things to be washed later. 2. Using the ETC (see Table 1) as a guide, stock the studio space with at least two kinds of materials from each of the three areas of the ETC, choosing media with which you are familiar. For ideas on acquiring and setting up materials, consultation with a school art educator is helpful. Douglas and Jaquith (2009) also provide advice on how to set up art centers. 3. Introduce teachers, families, and administrators to the

13. ArtBreak program by inviting teachers to visit the studio and offering art materials as door prizes, hosting an open studio for families at fall parent– teacher conferences, and/or announcing the program in the school newsletter. 4. Invite teachers to refer students and obtain written parent/guardian permission for students to participate. We developed a referral form (see Appendix) based upon the ETC. 5. Begin the groups by introducing new materials and processes as students ask or seem ready for them. An ongoing list of “things we need” posted in the studio is a helpful guide for introducing new materials. Daily written reflections by the practitioner are also a good support for deciding about new materials and problem solving. Our ArtBreak groups were organized and facilitated by the school counselor whose role was to model problem solving; demonstrate the use and care of materials; teach skills such as clean-up; introduce new tools; encourage and model supportive behavior, supportive language, and other prosocial skills; keep time; and make decisions about introducing new materials and processes.

14. Students were referred to the groups by their teachers, a school- based intervention team, community mental health professionals, or families. Students were introduced to ArtBreak in a contained format to help them learn the choice-based format. For the first two sessions, the counselor placed an appealing object (e.g., a toy dragon, a clay turtle, an orchid in bloom) on the table and invited students to create an image of it with media of their choice. Students then continued with their own choice of media and projects. More art materials, tools, and processes at all three levels of the ETC were introduced to the ArtBreak groups when students seemed ready or when students asked for them. Some students began making art on cafe- teria trays and chose from a basic set of media from all three sections of the ETC: fluid media such as finger paint, more resistive materials such as oil pastels and colored pencils, and very resistive media such as markers. Other groups began by building sketchbooks from repurposed cardboard, filling them with papers of their choice, and using media from all levels of the ArtBreak: Creative Group Counseling 113 ETC such as finger paint, water color, chalk pastels, tempera

15. paint, crayons, markers, collage, and “pop-up” creations. Documentation of ArtBreak included the counselor’s weekly notes on each child’s work, including choice of media, the child’s description, and group process. Notes were taken by hand during ArtBreak and transcribed on a laptop. At the end of the day, the counselor wrote reflections about materials, questions, problems and challenges, ideas for improvements, communications, and collaborations. The counselor also photographed student work. Some parents requested electronic portfolios of their children’s work, which was accomplished via e-mail. Each ArtBreak session had its own rhythm and challenges. Following are composite vignettes illustrating two very different sessions. The following scenario occurred during the ninth session while children worked independently with different media. Six children, ages 5 through 11 years, rush into the school counselor’s room and dive into the apron box for smocks. It is time for ArtBreak in this rural elementary school. Two students head for the back table where their robots are ready for them; they have been under construction for several weeks now, and today the students would decide to work

16. on the problem of how to create and attach moveable arms. A second grader circles the room a time or two before settling on finger paint, choosing glossy paper and a selection of paints, dampening the paper with a sponge, and carefully squeezing out globs of paint, while exclaim- ing over the bright hues and the satisfyingly squishy feel of the paint. A fourth grader reaches for her cardboard and duct tape construction and continues to grapple with how she will make a sturdy and meaningful object. Another child walks about the room eyeing paints, boxes of collage materials, and the construction corner stacked with cardboard and other repurposed objects. This child selects a 5-gallon plastic jug, mixes tempera paint, and covers the jug with a turquoise and green under-the-seascape. Filling the jug with water makes it hard to handle, so a handful of glass pebbles serves as sea water. A sixth child works carefully on a valentine collage for a sibling. ‘Where’s the music?’ one child shouts. Oops—the counselor forgot to turn it on, and she hits the start button for the jazz CD the group has become accustomed to. The children work steadily for half an hour, talking among themselves and occasionally offering announcements to the group. The

17. counselor moves around the room, supporting problem solving by offering tools, assistance with hole punching, towels when water spills, and a basket of new string and yarn. The counselor occasionally pauses to make notes about what the children are doing and saying. The children try to eke out a few more minutes past the half hour of allotted work time and then help with a whirlwind clean-up. Art is stacked on a rack to dry, and the counselor takes 5 minutes to write down notes about the group’s process and reminders about materials or room rearrangements needed. 114 K. Ziff et al. Morning ArtBreak ends; the counselor gets the room ready for the rest of the day, which will include an afternoon session with a different group. In the next scenario, upper-elementary boys are in their 12th week of ArtBreak. By this time, the group had formed a working community, and all elected to embark on sewing projects. Six boys enter the room and walk around, examining the latest addi- tions to the cardboard sculpture center and plunging their hands

18. into the giant bowl of buttons. The counselor points out a shelf newly stocked with fabric, and there are exclamations—the boys have been anxious to sew for 2 weeks, ever since one of them fashioned large pieces of fleece scraps into a lap blanket for his teacher. All of them decide to work on fabric projects and they rummage through wool remnants, flannel yardage, cotton batting, threads, and needles. They decide to make pillows of varying sizes, and chaos ensues with cries such as: ‘How do you thread the needle?’; ‘How do I knot the thread?; ‘Will you help me straighten out my pillow?’; ’I need help! These scissors won’t cut this material’; ‘I asked first for help!’; and ‘No, I did!’ One boy has an outburst of impatience and retreats to the counselor’s desk to recover, rejoining the sewing table after a few minutes. The counselor gives a brief demon- stration of a running stitch (wishing she had purchased thicker thread that would tangle less easily). Ten minutes of calm descend upon the room, the boys carefully stitching. ‘I thought sewing was girly but it’s not,’ one of them offers to the group. ‘We like this,’ a few boys reply. ‘So shorter stitches make the sewing stronger, don’t they?’ notes another student. ‘You know, this is relaxing,’ declares the student who

19. had the impatient outburst. Then, another rush of calls for assistance occurs as the boys hurry to finish up their projects so they can take them home that day. A bag of polyester batting is passed around, and pillows of cotton flannel, calico, and fake fur ranging in size from 6 to 18 inches long are stuffed, stitched, and tried out. One boy shouts with frustration about finding a way to bring his completed cardboard structure from the previous week safely home on the bus; another student comes to his aid, rummaging in the sculpture center for just the right size box. The boys rush back to their classrooms to get ready to go home for the day. The counselor sits down and thinks about how she might have created a more orderly introduction to sewing. The next day, the school psychologist, after listening to an account of the sewing group, reflected that the session was a model for the boys in moving from chaos to calm productivity. ADAPTATIONS ArtBreak could be offered to children by classroom teachers and in other settings such as libraries and mental health centers. ArtBreak could also be

20. ArtBreak: Creative Group Counseling 115 adapted for middle and high schools. During the pilot, teachers requested an ArtBreak for themselves, which could be offered on a drop- in basis. The counseling center of George Washington University offered to students an ArtBreak program of structured art-based activities to support creativity and mental health (Gladding, 2011). Campus programs could include an ongoing ArtBreak in a studio format based on the atelier model offered by the Medical College of Pennsylvania (Bartley, 1997) to its students in a course entitled Medicine and Art. REQUIREMENTS AND LIMITATIONS ArtBreak is situated in a school-based group-art studio environment facilitated by a school counselor; participating students have been referred for support with goals listed on the referral form (see Appendix) aligned with the ETC. Therefore, ethical considerations addressed included (a) necessity for written parent/guardian permission for students to participate; (b) pri- vacy and confidentiality related to student work; (c) written parent/family permission for use of student work in public presentations; (d) considera-

21. tions for managing requests from education professionals to visit an ArtBreak group; and (e) a working knowledge of the ETC and its associated art- making materials by the ArtBreak facilitator. Space is also a consideration. A space with no running water needs cleaning, a container of water for watercolor paints, and a bucket for used brushes. A small room can accommodate ArtBreak with groups of three to four children and creative use of space. Funds are necessary for many of the art supplies needed, though construction/sculpture and collage materials can be obtained free from a variety of sources. DISCUSSION ETC Learning from the pilot program encompassed three areas: the ETC, community, and logistics. In regard to the ETC, ArtBreak students worked at all three levels of the ETC. Figure 1 shows kinesthetic enjoyment of paint. In Figure 2, a student has used collage and pastels to express a relationship, a function of the perceptual/affective level of the ETC. Figure 3 illustrates use of construction materials and multistep problem-solving processes at the cognitive end of the ETC.

22. Some children spent months using the same medium. Others began at one end of the continuum and moved to the other end (e.g., from chalk pastels to multistep sculptures or from markers and construction to finger paint). Teachers referred students to ArtBreak for reasons at all three levels 116 K. Ziff et al. FIGURE 1 Fluid media can encourage tactile expressiveness. The Garden of Rain, watercolor spattered on paper. Printed with permission. FIGURE 2 Media with some resistiveness can encourage exploration of relationships and cause and effect. Earth With Ocean, Fish, and Moon, collage with paper and chalk pastels. Printed with permission. of the ETC. Referral reasons for the 44 students in the 2010– 2011 program were: kinesthetic/sensory reasons, such as relaxation, for 14 students; perceptual/affective reasons, such as improving attention and social skills, for 25 students; and cognitive/symbolic support, such as integrating personal strengths or improving problem-solving skills, for 5 students. Of the 44 students, 31 were boys and 13 were girls. ArtBreak supported some students in making progress on referral goals. Some, referred to ArtBreak

23. for a needed break from the academic or social demands of the classroom, found the group a relaxing experience. Several children with social skills goals became more comfortable with new processes and new people, and they later ArtBreak: Creative Group Counseling 117 FIGURE 3 Resistive media can encourage creative problem solving. School of the Future With Roof That Opens, cardboard, tempera paint, yarn. Printed with permission. demonstrated the ability to engage in meaningful social interactions in the group and in the classroom. In several cases, students made great improvements in prosocial behaviors in both the group and classroom settings. A child with behavior goals became positively engaged in ArtBreak— completing work and offering to help others—as well as in the classroom. A child who was referred to develop skills of concentration worked with steady focus in ArtBreak, carefully making cardboard constructions meaningful to him. His teacher later noted increased focus in the classroom. Community

24. In regard to community, the ArtBreak groups became supportive commu- nities where students felt safe to explore pursuits of their own choosing. Students helped each other solve problems, practiced and developed positive social skills in the groups, learned how to be flexible and tolerate frustration, and made friends. We found that mixing ages in the groups offered advantages by freeing students from preexisting classroom-based expectations and friendships. The ArtBreak pilot flourished with the support of a community of adults inside and outside the school district. Teachers, the school intervention team, community mental health specialists, and families referred students for 118 K. Ziff et al. participation. Students also referred themselves, and ArtBreak participants referred their friends. School art educators helped identify resources for supplies, and students brought to ArtBreak the skills they learned in their art classes. Principals and school district administrators provided funds for key supplies and materials. School psychologists collaborated during all steps of the ArtBreak pilot. A university faculty member provided

25. consultation and served as a writing and research collaborator. School staff as well as local business establishments donated materials for students to use for art making. Logistics With regard to logistics, we learned that although the half-hour format fits well within the context of a busy school day, it is a bare minimum amount of time for students to decide upon and begin a project. Some students embarked on complex projects requiring multiple sessions, but no matter what the project, a half hour seems to be a minimum for students to have a satisfying experience. Though students are taught clean-up skills, there is usually little time for thorough clean up in a 30-minute period. Therefore, the counselor needs additional time after each group to complete the cleaning process. Some students, though, seemed to find cleaning up meaningful, especially when it involved running water. Finding time in the counselor’s day to offer enough ArtBreak sessions to meet demand was a challenge. Finally, acquisition of materials, especially keeping the sculpture center well stocked with cardboard boxes and other repurposed items, is a continuing process requiring time and ingenuity.

26. CONCLUSION The ETC is a valuable framework for selecting and providing media in our ArtBreak studio. It is also a useful guide for reflecting upon art made by students and deciding about materials that should be introduced. The ETC provides a practical structure for referring students for participation in ArtBreak. ArtBreak also seems to support sensory, affective, and cognitive development of its participants. Our documentation of the ArtBreak pilot generated a considerable quantity of materials: photographs, hand-written reflections, and notes on conversations with teachers and administrators, children, and families. This process of reflection and documentation helped guide the work through the school year. Counselors or others setting up a similar program should plan for daily time to reflect and document their work. It would be helpful also to set up a structure for assessing each student’s progress on referral goals. ArtBreak: Creative Group Counseling 119 REFERENCES

27. Adamson, E., & Timlin, J. (1990). Art as healing. Boston, MA: Coventure. Allan, J. (1988). Inscapes of the child’s world. Dallas, TX: Spring Publications. Bartley, M. (1997). Creativity and medicine: An atelier in medical school. International Journal of Arts Medicine, 5(2), 36–39. Boldt, R., & Brooks, C. (2006). Creative arts: Strengthening academics and building community with students at risk. Reclaiming Children and Youth, 14, 223–227. DeLue, C. H. (1999). Physiological effects of creating mandalas. In C. Malchiodi, (Ed.), Medical art therapy with children (pp. 33–49). London, UK: Jessica Kingsley. Douglas, K., & Jaquith, D. (2009). Engaging learners through art making: Choice- based art education in the classroom. New York, NY: Teachers College Press. Essex, M., Frostig, K., & Hertz, J. (1996). In the service of children: Art and expressive therapies in public schools. Art Therapy: Journal of the American Art Therapy Association, 14(1), 181–190. Gandini, L., Hill, L., Cadwell, L., & Schwall, C. (2005). In the spirit of the studio: Learning from the atelier of Reggio Emilia. New York, NY: Teachers College

28. Press. Gladding, S. T. (2011). Counseling as an art: The creative arts in counseling (3rd ed.). Alexandria, VA: American Counseling Association. Hinz, L. (2009). Expressive therapies continuum: A framework for using art in therapy. New York, NY: Routledge. Kagin, S. A., & Lusebrink, V. B. (1978). The expressive therapies continuum. Art Psychotherapy, 5, 171–180. Kosik, K. S. (2009, May). Creativity, the arts, literature and learning. In M. M. Hardiman & K. S. Kosik (Chairst), Creative brain: Using brain research on creativity & the arts to improve learning. Symposium conducted at the meeting of Learning and the Brain, Washington, DC. Malchiodi, C. A. (1996). Art therapy in schools. Art Therapy: Journal of the American Art Therapy Association, 13(2), 2–4. McLennan, D. (2010). Process or product: The argument for aesthetic exploration in the early years. Early Childhood Education Journal, 38, 81–85. doi:10.1007/s10643-010-0411-3 Moon, C. (2002). Studio art therapy: Cultivating the artist identity in the art therapist. London, UK: Jessica Kingsley Publishers.

29. Pelo, A. (2007). The language of art: Inquiry-based studio practices in early childhood settings. St. Paul, MN: Redleaf Press. Pleasant-Metcalf, A., & Rosal, M. (1997). The use of art therapy to improve academic performance. Art Therapy: Journal of the American Art Therapy Association, 14(1), 23–29. President’s Committee on the Arts and the Humanities. (2011). Reinvesting in arts education: Winning America’s future through creative schools. Washington, DC. Retrieved from http://www.pcah.gov/publications. Rogers, C. R. (1989). Personal thoughts on teaching and learning. In H. Kirschenbaum & V. Henderson (Eds.), The Carl Rogers reader (pp. 301–304). Boston, MA: Houghton Mifflin. 120 K. Ziff et al. Rosal, M., McCulloch-Vislisel, S., & Neece, S. (1997). Keeping students in school: An art therapy program to benefit ninth-grade students. Art Therapy: Journal of the American Art Therapy Association, 14(1), 30–36. Somody, C., & Hobbs, M. (2006/2007). Paper bag books: A creative intervention with elementary school children experiencing high-conflict parental divorce.

30. Journal of Creativity in Mental Health, 2(3), 73–87. doi:10.1300/J456v02n03_07 Szekely, G. (2006). How children make art: Lessons in creativity from home to school. New York, NY: Teachers College Press. Winner, E., Hetland, L., Veenema, S., Sheridan, K., & Palmer, P. (2006). Studio thinking: How visual arts teaching can promote disciplined habits of mind. In P. Locher, C. Martindale, L. Dorfman, & D. Leontiev (Eds.), New directions in aesthetics, creativity, and the arts (pp. 189–205). Amityville, NY: Baywood. Katherine Ziff is a School Counselor at Athens City School District, The Plains, Ohio. Lori Pierce and Sue Johanson are School Psychologists at Athens City School District, The Plains, Ohio. Margaret King is Professor Emerita in the Patton College of Education and Human Services at Ohio University, Athens, Ohio. ArtBreak: Creative Group Counseling 121 APPENDIX ArtBreak Referral Form

31. Student’s Name: ________________ Classroom Teacher: _______________ Primary Reason for Referral Other Reasons (check one) (check as many as apply) Kinesthetic/sensory reasons for referral Express feelings: is sad...................... ..................................................( ) ( )........................................................ Express feelings: is angry................. ..................................................( ) ( )........................................................ Express feelings: is upset................. ..................................................( ) ( )........................................................ Needs a chance to relax.................... ..................................................( ) ( )........................................................ Needs a break from academic demands...................................( ) ( )........................................................ Needs a break from social demands...................................( ) ( )........................................................ Perceptual/affective reasons for referral

32. Develop empathic understanding for self or others.......................( ) ( )........................................................ Identify feelings in self and others........................................( ) ( )........................................................ Understand cause and effect............. ..................................................( ) ( )........................................................ Support social skills........................... ..................................................( ) ( )........................................................ Support attention and focus.............. ..................................................( ) ( )........................................................ Cognitive/symbolic reasons for referral Support problem-solving skills..........................................( ) ( )........................................................ Identify and integrate personal strengths...................................( ) ( )........................................................ Details or other reason for referral: Note. Referral form developed by Katherine Ziff based upon the ETC framework as presented in Hinz (2009).

33. Copyright of Journal of Creativity in Mental Health is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Journal of Creativity in Mental Health, 8:395–415, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 1540-1383 print/1540-1391 online DOI: 10.1080/15401383.2013.844660 CREATING SPACE FOR CONNECTION: A COLUMN FOR CREATIVE PRACTICE Counseling Groups: A Creative Strategy Increasing Children of Incarcerated Parents’ Sociorelational Interactions ANGELICA LOPEZ The Village South/WestCare, Miami, Florida, USA ISAAC BURT Florida International University, Miami, Florida, USA Children of incarcerated parents are at a greater risk for developing social and relational issues due to negative socialization.

34. By using a creative integration of imagery, bibliotherapy, and traditional group counseling, this intervention addresses children’s relational and social competencies. The purpose of this article is to provide mental health counselors with a creative, pragmatic approach to use with youth struggling with relational issues. The brief, 6-week intervention outlined in this article may benefit children both socially and behaviorally. Improvement in social and relational competencies helps youth form healthy relationships in the future. KEYWORDS parental incarceration, children, counseling group, social and relational abilities, group intervention, creativity in counseling During the last decade, incarceration has risen considerably due to a number of risk factors such as poverty, low parental education, and absence of parental figures (Harper & McLanahan, 2004). The dramatic growth in Address correspondence to Angelica Lopez, The Village South/WestCare, 169 East Flagler Street, Suite 1300, Miami, FL 33131, USA. E-mail: [email protected] 395 396 A. Lopez and I. Burt the number of parents being held in state and federal prisons is

35. of particular concern. For example, Glaze and Maruschak (2008) reported a 79% increase in the number of parents being held in state and federal prisons from 1991 to 2007, while custodial populations grew by 92%. Furthermore, in midyear 2007, 52% of state and 63% of federal inmates reported having at least one child younger than the age of 18 (Glaze & Maruschak, 2008). Unfortunately, children who witness their parent’s arrest and con- viction are the ones left with the complications of putting their life back together. Usually referred to as the hidden or invisible victims, these children are understudied and underserved, making them an extremely vulnerable population (Miller, 2006). Initially confused by their parent’s absence, most children experience a wide range of emotions and behaviors (Geller, Garfinkel, Cooper, & Mincy, 2009). For example, some boys may display rebellious, angry, or undisci- plined behaviors such as acting out and getting into fights to solicit attention (Burt & Butler, 2011). Other boys may exhibit shyness, anxiety, para- noia, and reticence, particularly around adults (Davies, Brazzell, La Vigne, & Shollenberger, 2008). Additionally, two of the most common emotions that plague children of incarcerated parents are embarrassment

36. and shame (Miller, 2006). Increased embarrassment and shame affect children’s social and relational development with peers and adults. Consequently, Miller (2006) reported that some youth go as far as shutting down to avoid talking about their parent’s incarceration. It is also common for many children to lie to protect themselves from emotional pain and social isolation. Lying then becomes a secondary habit that may enter into adulthood and cause further social and relational problems (Johnston, 1995). Succinctly stated, a number of harmful issues negatively amalgamate to affect children’s social and relational abilities due to parental incarceration (Miller, 2006). A direct consequence resulting from the preceding factors is that children of incarcerated parents are often apprehensive to create social bonds, as they fear others may become aware of their family status. The result is that these children oftentimes find themselves feeling alone with few, if any, people with whom they can relate or talk to (Nesmith & Ruhland, 2008; Phillips & Gates, 2011). Further, Phillips and Gates (2011) identified the fear children experience as a type of stigmatization. According to Phillips and Gates, stigmatization is the process of having negative characteristics applied

37. to a person. Consequently, these negative attributes result in devaluation, stereotyping, and discriminatory treatment. Isolation begins to develop, and detachment from others inhibits children from forming social ties and bonds (Miller, 2006). For example, previous researchers found that children worry about how others view them after learning about their situation (Phillips & Gates, 2011). Worry and anxiety combine, leading to social fear and loss of social and relational competencies. Children of Incarcerated Parents 397 LOSS OF SOCIAL AND RELATIONAL COMPETENCIES The impact of parental separation and loss of social and relational competencies can differ, depending on whether the incarcerated parent is the mother or father. Davies et al. (2008) specifically identified a mother’s incarceration as more detrimental to a child’s capacity for forming relationships compared with incarceration of a father. Among many reasons, the pivotal role that mothers often play as primary caretaker in the child’s life explains this outcome (Davies et al., 2008). Additionally, a father’s absence due to incarceration oftentimes leaves the sole caretaking to the mother (Glaze &

38. Maruschak, 2008). If the mother then commits a crime that leads to incarceration, it causes a major disruption and parental absence in the child’s life. The loss of both parents results in a grandparent or other relative providing care for the child, or leads to placement in the child welfare or foster care system. Feelings of abandonment, anger, and anxiety may increase and might impede the child’s ability to establish and maintain relationships with others (Phillips & Gates, 2011). Furthermore, Glaze and Maruschak (2008) concluded that regardless of the sex of the parent, incarceration influences children’s social and relational abilities and interactions tremendously. The Influence of Attachment According to Bandura (2008), the level of parental attachment and role- modeling directly affects a child’s behavior. For example, if the attachment level is high and the parent models inappropriate behavior, the child is likely to mimic the actions of the adult (Bandura, 2008). Youth’s imitative behavior may serve as an undesirable “coming of age” or “badge of honor” with the parent and in the juvenile system. However, even if parental attachment is not high, but the child perceives it to be, it also directly influences social and

39. relational abilities (Burt & Butler, 2011). An example of the influence of the perception of attachment is an incarcerated parent who is not present in a child’s life. However, the child may believe mimicking behaviors similar to the incarcerated parent will create a bond between them, therefore compensating for the physical absence. Thus, the rationale of the child is as follows: Imitating behaviors will build a stronger relationship and increase attachment between parent and child (Phillips & Gates, 2011). Although this dubious logic may not be accurate, it provides the child with feelings of hope (Burt & Butler, 2011). As a result, a potentially distorted perception of the attachment between parent and child begins to develop (Lopez & Bhat, 2007). Clearly, the perception of attachment (real or imagined) is critical for this population. Lastly, recent studies indicate the sex of the incarcerated parent greatly affects attachment as well (Phillips & Gates, 2011). 398 A. Lopez and I. Burt NEGATIVE PARENTAL ATTACHMENT AND THE INCARCERATED MOTHER Traditionally, society views mothers (women) as more nurturing

40. than fathers, or men, and less likely to have a negative parental attachment (Burt, 2013). Operationally defined, negative parental attachment is when a parent develops an attachment that promotes anxiety, sadness, anger, or fear in the child (Phillips & Gates, 2011). As a result, researchers believe negative parental attachment is worse when it is the mother who is incarcerated (Phillips & Gates, 2011). Although current researchers have asserted this view is not entirely accurate, the idea continues to persist in society (Cross & Campbell, 2011). Consequently, an incarcerated mother violates the societal norm of the nurturing maternal figure (Johnson & Easterling, 2012). Violation of this social standard further stigmatizes youth, as society looks down on jailed individuals (Shlafer, Poehlmann, & Donelan- McCall, 2012). Further, according to societal norms, the mother should be the one lov- ing and nurturing the child (Kjellstrand, Cearley, Eddy, Foney, & Martinez, 2012). Although sex does not necessarily determine the ability to provide attachment and nurturing, having a mother (or woman) act in ways that contradict societal norms and functioning may be mentally detrimental for children (Cross & Campbell, 2011). Hence, the child receives the following implicit message from society: The person who should provide

41. care and love for you is absent and negligent (Shlafer et al., 2012). The impact of this message is critical in that it affects children’s ability to socialize and build relationships with others (Kjellstrand et al., 2012). To further illustrate the impact of female parental incarceration on children’s social and relational skills, Glaze and Maruschak (2008) conducted a study evaluating children of incarcerated mothers in state prisons. Glaze and Maruschak indicated grandmothers (42%) and other relatives (23%) were primary caretakers. Furthermore, while in the custody of others, youth would imitate behaviors similar to the incarcerated mother. Although the mother was absent, some youth perceived a bond or link with her through their actions. Additionally, a large percentage of fathers (88%) reported that at least one of their children was residing in the care of the child’s mother or another person. Obviously, this population has distinct behavioral and relational problems that mental health and school counselors should address. AN UNDERSERVED POPULATION Phillips and Gates (2011) indicated counselors should address the impact of parental incarceration on a child’s social and relational ability, as it is

42. extremely important. Although awareness of the influence of parental incarceration on children’s social capabilities continues to rise, information on effective services remains limited. An explanation by Miller (2006) discussed this discrepancy. He suggested that while literature provides practitioners Children of Incarcerated Parents 399 with awareness of the multitude of problems, there is an absence of specific interventions addressing this distinct population. Lopez and Bhat (2007) additionally stated, “Despite alarming statistics, research on school- based support services remains limited” (p. 140). Moreover, Nesmith and Ruhland (2008) put forth the idea that interventions not only need to address relational behaviors, but also need to draw upon the population’s unique strengths. Researchers indicate this population has distinct characteristics such as resiliency and dedication (Phillips & Gates, 2011). As such, mental health counselors need to be creative in developing interventions when reaching out to this population. Creative, strength-based interventions are critical with populations that may not respond well to traditional therapeutic modalities (Burt, 2013).

43. By creating interventions that focus on strengths, rather than deficits, traditionally underserved populations may demonstrate increased commitment and respond more positively (Gladding, 2012). Furthermore, due to mone- tary limitations in schools and community settings, mental health and school counselors have to be creative in developing economical interventions. In essence, counselors need to draw upon the strengths of this population, avoid social isolation of children, and at the same time, utilize resources to their economic maximum (Burt & Butler, 2011). Clearly, children of incarcerated parents are an underserved population with distinct attributes and characteristics not seen in other populations (Miller, 2006). Thus, coupled with these distinct traits and the burden of economic limitations, a dilemma arises for mental health and school counselors: How do counselors develop creative and inexpensive interventions while simultaneously reaching out to as many individuals as possible? Economic Limitations and the Need for Creative Interventions As mentioned previously, economic resources are less readily available in schools and community centers (Burt & Butler, 2011). For children of incarcerated parents, the impact of inadequate economic resources

44. may be even more detrimental than for the average child. For example, family income and home stability are areas in which children with incarcerated parents suffer dramatically. Geller et al. (2009) explained reasons for economic disparity and loss of familial stability, including a discussion of how these factors combine to affect children negatively. First, following a parent’s incarceration, there are fewer financial resources available to the family (i.e., loss of income). Furthermore, the possibility of needing legal representation exists as well, as not all families’ socioeconomic status qualifies for a public defender. Second, loss of income directly affects children through lack of resources to provide adequate nutritional diets. Thus, some children do not receive the necessary vitamins and nutrients required for developing youth. Due to loss of income, many children receive little to no health care and may experience other losses such as lack of clothing, school supplies, and 400 A. Lopez and I. Burt availability of technology. Furthermore, if the primary caretaker is incarcerated and there are limited capacities for support and supervision, relationship

45. breakdowns and negative socialization effects are likely to occur (Murray & Farrington, 2005). These negative socialization and relationship problems are exacerbated if children also attend academically ineffective schools (Burt & Butler, 2011). POTENTIAL RESOURCES AS POSITIVE ROLE MODELS While researchers demonstrate the challenges children face due to incarcerated parents (Phillips & Gates, 2011), questions remain about what resolutions exist that offset these problematic issues. One identified solution to decrease the risk for economic hardship and relational instability is to develop creative family service interventions that ameliorate material hardship and ensure social stability (Geller et al., 2009). Examples of family service interventions are free workshops conducted by counselors, certified public accounts, and other professionals at local community centers. Burt and Butler (2011) supported the idea of professionals providing free services at community centers. They further stated that professionals providing services could do so voluntarily, or on a pro-bono basis. Provision of free services not only assists the family unit, but it also offers a potential additional benefit to the child.

46. As stated by Bandura (2008), adults provide implicit direction and learning to children through modeling. The professional who is offering the free service is a potential role model for the child, and they may emulate the positive behavior observed (Burt & Butler, 2011). By offering free services, the professional’s altruistic behavior can serve as a buffer against negative parental models. Succinctly stated, children need an appropriate person with which to identify, as modeling is critical for the development of children (Bandura, 2008). For instance, Murray and Farrington (2005) asserted that an alarming rate of incarcerated parents have children who desperately lack positive role models. Consequently, an emerging need exists for mental health and school counselors to use effective, creative interventions to alleviate the hardship these children endure. DEVELOPMENTAL CHALLENGES Nesmith and Ruhland (2008) stated that without creative and novel interventions, children’s responses to incarceration or other social trauma could manifest later on in negative developmental behaviors. In the past, research has indicated that behavioral techniques are best suited to deal effectively with these antisocial and delinquent behaviors and responses. However,

47. current literature suggests otherwise. Roysircar (2009), for example, stated that due to an increased awareness of multiculturalism, many traditional talk therapies are no longer appropriate. She further asserted that instead Children of Incarcerated Parents 401 of strict behavioral strategies, counselors should use creative culturally sensitive treatments. Burt and Butler (2011), as well as Gladding (2012), agree with and support Roysircar’s assertions. Burt and Butler stated that traditional talk therapies may not be as effective with the current generation of clients exhibiting potentially destructive behaviors. Examples of such behaviors are hypervigilance, sexualized behavior, and excessive verbal and physical aggression. Boys, in particular, may benefit from creative interventions as they may display delinquent and antisocial behavior due to parental incarceration (Davies et al., 2008). Murray and Farrington (2005) found that 71% of men who experienced parental incarceration during childhood had more antisocial and delinquent behavioral outcomes at 32 years of age. GROUP BENEFITS

48. Although risks for children of incarcerated parents are evident, key factors such as social support systems and increased self-efficacy are imperative for growth and development (Bandura, 2008). Nontraditional group counseling focusing on empowerment, self-efficacy, and creativity has shown success with underserved populations (Burt, 2013). Groups provide a social sphere that promotes exploration of commonalities in a nonjudgmental atmosphere. Furthermore, nonjudgmental groups encompass creative strategies such as rope courses, martial arts, and bibliotherapy (Burt, 2013). Groups can play a primary role in assisting children of incarcerated parents with needed resources that may break the cyclical pattern of intergenerational criminal- ity. Murray and Farrington (2005) stated that when parental incarceration occurs, there should be an extensive range of creative support services that counselors offer. Burt and Butler (2011) suggested group counseling that focuses on empowerment and self-efficacy may be a creative alternative counselors can use with this distinct, underserved population. The conceptual group described in this article may serve as a useful intervention that provides mental health and school counselors with a creative method to work with children of incarcerated parents. Thus, the

49. intent of this article is twofold: (a) to improve children’s social and relational competencies, and (b) to provide counselors with a creative, pragmatic resource that reaches out to children of incarcerated parents, an underserved population. GROUP PROCESSES Main Objectives of the Group The primary purpose of this conceptual counseling group is to increase children’s social and relational competencies. To accomplish this goal, members must attain several objectives during the group’s lifespan: 402 A. Lopez and I. Burt 1. Decrease the effect of social stigma and isolation by allowing members to voice freely their thoughts and feelings regarding parental incarceration. 2. Improve self-esteem by increasing children’s sense of belonging through providing a warm, caring environment where they can see others have issues similar to theirs (Bandura, 2008). An additional benefit children receive from having a warm, supportive environment is that it may help alleviate confusion and stigma that have arisen due to negative

50. social experiences (e.g., parent’s incarceration; Bandura, 2008). 3. Increase empowerment through use of collaborative exercises, pair sharing, and bibliotherapy. 4. Use role-plays and collaborative exercises to help members begin to make appropriate choices, as well as improve academic, social, relational, and behavioral decision-making. 5. Use positive interactions, role-modeling, pair sharing, and bibliotherapy to guide members to begin forming healthy relationships in and outside group sessions. Miller (2006) stated, “When children have access to resources that help them cope with developmental challenges, they successfully achieve developmental tasks” (p. 478). Through attaining these objectives, members benefit and learn to build established, trustful relationships. Furthermore, members begin to understand their feelings and the feelings of those around them, as they relate better to others. Ultimately, this understanding assists in developing healthy coping skills that support children’s social and relational skills into adolescence and adulthood (Burt & Butler, 2011). Facilitator Style and Theoretical Considerations

51. According to Gladding (2012), facilitation style is a crucial factor contributing to the successfulness of a group. When groups provide therapeutic services for children, appropriate facilitation style may be even more critical for positive outcomes (Burt & Butler, 2011). For groups serving underserved and underage populations (e.g., children and adolescents), several specific facilitator and group characteristics must exist (Burt, 2013). For example, specific factors may include creativity, empathy, and appropriate disclosure (Corey, 2011). However, for underserved populations such as children of incarcerated parents, an additional number of factors need addressing. For example, facilitation with children of incarcerated parents must include structure, appropriate social limits, and consistency to serve as a buffer against the instability in their lives (Lopez & Bhat, 2007). Democratic facilitation, a leadership style that trusts members to develop their own potential as well as that of others in the group, assists in providing clear explanations of group format, leadership roles, and group expectations, while contributing to successful outcomes (Gladding, 2012; Price & Limberg, 2013). Due to

52. Children of Incarcerated Parents 403 the distrust that is typical among children with incarcerated parents (Bender, 2003), direction from the facilitator will occur at the start and end of each group meeting. Facilitators will primarily focus on the here- and-now and will help group members to apply gained insights into making changes in their lives (Burt & Butler, 2011). This conceptual group’s theoretical orientation relies heavily on Carl Rogers’s person-centered therapy, which emphasizes empathy and uncon- ditional positive regard. Although there is a focus on Rogerian concepts, many features of the group are eclectic in nature. This group also uses techniques from other theories in an organized manner. These techniques include bibliotherapy, art therapy, and cognitive-behavioral therapy. Labeled techni- cal eclecticism, this style allows the facilitator to use a strong theoretical base and draw from other conceptual techniques systematically (Young, 2013). Springer, Lynch, and Rubin (2000) advocate the importance of highlighting children’s strengths to help youth understand that their parent’s inappropriate actions do not make the child a bad person, nor do their actions mean that the child is at fault. Focus on the here-and-now occurs during session

53. activities whereby children begin to receive feedback about their behavior, are able to practice new social skills, and learn how peers perceive them (Lopez & Bhat, 2007). Logistics and Prescreening Groups consist of 6–10 children, approximately 6–11 years of age and in grades second through fifth. The facilitator needs to work collaboratively with administrators, teachers, and school counselors for the group to be successful (Lopez & Bhat, 2007). Teachers and counselors alike monitor the children around them for appropriate group fit and serve as a prescreening tool to identify children in need of this service. Selection of potential members is from a list that teachers provide to counselors that notes excessive behavioral problems within the 6-week academic semester. Potential members must have at least four documented instances of severe behavioral problems in the 6-week period, in addition to having confirmation of an incarcerated parent. There must be evidence of (a) fighting, (b) verbal attacks on peers and teachers, (c) four or more unexcused absences, and (d) in-school or out-of-school suspensions (Burt & Butler, 2011). After identification of potential participants, each one will meet

54. indi- vidually with the group facilitator (i.e., mental health or school counselor). The facilitator explains the group’s purpose and discusses the opportunity to interact with others in similar situations and to engage in activities that promote self-esteem and social skills (Lopez & Bhat, 2007). The facilitator also converses with each potential participant about any personal goals they may have at this time. Prior to any group meetings, the facilitator has each member sign a child assent form, and a parent or guardian signs an informed consent. 404 A. Lopez and I. Burt DESCRIPTION OF SESSION PLANS First and Second Sessions Basic rules for the group consist of respect for people’s thoughts, beliefs, and values (Gladding, 2012). These rules are similar to school protocols where members will not physically assault others, will refrain from cursing, and will allow others to talk (Burt, 2013). The facilitator discusses confidentiality in the pregroup meeting and reinforces it as a topic of importance. At the end of each session (Table 1), the facilitator will allocate 10

55. minutes for reflection and summarization. FIRST SESSION The first session, an introduction meeting, focuses on relieving anxiety. Members break the ice, introduce themselves, and discuss basic ground rules and expectations. To ensure that members know they are there for a common purpose, the facilitator restates the purpose of the group. Next, the facilitator uses nonthreatening collaborative exercises so members get to know each other better while reducing apprehension and anxiety (Springer et al., 2000). During this activity, members spread out from each other and throw around a soft rubber or cloth ball. When a member catches the ball, he or she tells the group something about him or herself. In this activity, all members engage in a socially interactive activity and feel less pressure in front of the group to disclose things about themselves. The facilitator demonstrates how to do the activity by performing the activity before the rest of the group. Burt, Patel, and Lewis (2012) discuss an activity in which members find commonalties between one another, which can increase cohesion and

56. reduce anxiety. In this activity, members go through a process of identifying adult role models. Each member specifies and discusses a person, as well as what makes the person special. According to Burt et al. (2012), cohesion increases as members see that others choose similar people (e.g., a family member or celebrity). Anxiety also decreases as connections between members begin to develop (e.g., role models chosen based on similar likes and characteristics). Thus, the objective of the first session is to allow members to begin to form bonds and group cohesion as they develop a sense of relation to one another. SECOND SESSION The second session focuses on further disclosure, development of group cohesion, and establishing trust. Here, members continue to get to know each other and feel more comfortable with the relationships forming in this process. Activities in this session allow members to express how T A B L

57. E 1 G ro u p Se ss io n Su m m ar y Se ss io n N u m b e r

58. G ro u p G o al / T h e m at ic C at e g o ry G ro u p A ct

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60. n o rm s, e x p e ct at io n s, an d in tr o d u ct io n s (1 ) G

61. ro u p m e m b e rs b e g in in tr o d u ci n g th e m se lv e

62. s, o u tl in e b as ic g ro u n d ru le s, an d d is cu ss th e ir

63. p e rs o n al g o al s as a m e m b e r o f th e g ro u p .

64. (2 ) G ro u p m e m b e rs w il l ca tc h a ru b b e r/ cl o

65. th b al l an d d is cl o se so m e th in g ab o u t th e m se lv

66. e s to o th e r m e m b e rs . 2 D is cl o su re , g ro u p

67. co h e si o n , an d e st ab li sh in g tr u st (1 ) F e ar s in

68. a h at — g ro u p m e m b e rs w ri te th e ir fe ar s in a h at

69. an d th e n ra n d o m ly re ad th e m to an o th e r m e m

70. b e r w h o o ff e rs e m p at h y an d su p p o rt . (2 ) R

71. at tl e sn ak e : St an d in g g ro u p m e m b e rs fo rm a la

72. rg e ci rc le an d ta k e tu rn s b li n d fo ld e d . W h e n b

73. li n d fo ld e d , in st ru ct io n s ar e to lo ca te a h id d e n

74. ra tt le an d to u ch th e m e m b e r w h o is h o ld in g it

75. . B o th m e m b e rs g o in to th e ci rc le , w h il e o n

76. e av o id s b e in g to u ch e d b y th e o th e r. In a co

77. ll ab o ra ti v e e ff o rt , m e m b e rs fo rm in g th e ci rc

78. le h e lp th e b li n d fo ld e d m e m b e r fi n d th e ra tt le

79. . 3 Id e n ti fy in g so ci al su p p o rt an d co p in g st ra te

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81. il y O R co m m u n it y g e n o g ra m to id e n ti fy an d d is

82. cu ss tr u st in g th e ir re la ti o n sh ip s. (2 ) B ib li o th

83. e ra p y : g ro u p re ad in g o f M y D a d d y is in Ja

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85. in g st ra te g ie s, id e n ti fi ca ti o n , an d d is cu ss io n

86. o f b o o k ch ar ac te r an d n e g at in g d is to rt e d th in

87. k in g . (3 ) F e e li n g m o n st e rs : G ro u p m e m b

88. e rs w il l p o u n d , sq u e e ze , o r p o k e m o ld in g cl

89. ay , in an e ff o rt to h e lp re le as e th e ir u n e x p re ss e d

90. fe e li n g s. G ro u p m e m b e rs w il l sh ar e th e ir m o

91. n st e rs an d e x p la in th e ch o se n fe e li n g , fo ll o w

92. e d b y th e ir re as o n in g . (C o n ti n u ed ) 405

93. T A B L E 1 (C o n ti n u e d ) Se ss io n N u m b e r G ro

94. u p G o al / T h e m at ic C at e g o ry G ro u p A ct iv it

95. y 4 Se lf -e st e e m an d st re n g th b u il d in g (1 ) D ra

96. w (c re at e ) a tr e e o f p e rs o n al st re n g th an d g ro

97. w th , w h ic h is re p re se n te d as th e ir se lf -p o rt ra

98. it , an d e m p h as iz e p o si ti v e ch ar ac te ri st ic s. T

99. h e ro o ts o f th e tr e e sy m b o li ze p e rs o n al st re n

100. g th s, w h il e th e le av e s ar e d if fi cu lt ie s th at m

101. e m b e rs ar e cu rr e n tl y st ru g g li n g w it h o v e rc

102. o m in g . O n th e o p p o si te si d e o f th e p ap e r, e

103. ac h g ro u p m e m b e r w il l id e n ti fy p o si ti v e ch

104. ar ac te ri st ic s th e y h av e w it n e ss e d fr o m th e

105. m e m b e r, in st il li n g an d im p ro v in g se lf -e st e e m

106. . E ac h m e m b e r w il l h av e th e o p p o rt u n it y to

107. sh ar e an d p ro ce ss w it h th e re st o f th e g ro u p m

108. e m b e rs . 5 E st ab li sh in g tr u st in g re la ti o n sh ip

109. s an d d e v e lo p in g so ci al sk il ls , e m p h as iz in g

110. so ci al an d re la ti o n al su p p o rt . (1 ) D is cu ss io n o

111. f w h at co n st it u te s, a g o o d fr ie n d , fo ll o w e d

112. b y a fi ct io n al ad v e rt is e m e n t se e k in g a fr ie

113. n d w it h d e sc ri b e d q u al it ie s (2 ) R o le -p la y in

114. g e x e rc is e e x e m p li fy in g . p o si ti v e q u al it ie

115. s o f th e ir id e al fr ie n d . (3 ) G ro u p m e m b e rs

116. cr e at e a v is io n b o ar d u si n g m ag az in e s an d

117. d is cu ss th e ra ti o n al e b e h in d th e ir se le ct io n s.

118. 6 P o si ti v e o u tl o o k fo r th e fu tu re an d a re v ie

119. w o f sa li e n t p o in ts fr o m p re v io u s se ss io n s (1

120. ) P iz za an d ic e -c re am p ar ty fo r al l m e m b e rs

121. . (2 ) Id e n ti fi ca ti o n o f co m m u n it y , sc h o o l, an

122. d fa m il y su p p o rt . D is cu ss io n w il l su rr o u n d ap

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124. m in is te ri n g ce rt ifi ca te s o f co m p le ti o n , e n h an ci

125. n g fe e li n g s o f ac co m p li sh m e n t. 406 Children of Incarcerated Parents 407 they view themselves. Additionally, exercises in this session emphasize the identification of individual strengths and fears while helping members

126. recognize that they are not alone (Lopez & Bhat, 2007). One creative activity the facilitator uses to achieve this objective is to have members write a fear on a small piece of paper, fold it up, and drop it into a hat. Members then take a turn reaching into the hat and reading the fear they pick. Members test their social and relational abilities by sharing whether they have felt similarly to other group members. Proceeding in this manner allows members to engage in a way that reduces fear. This activity is especially helpful for children, as they sometimes feel as though they cannot relate to others, or they believe no one understands their feelings. Nesmith and Ruhland (2008) state that children who suffer from social stigma and isolation are often unable to connect to others or find people they can trust. As a result, these children feel socially marginalized or ostracized. Blanton, Christensen, and Shakir (2006) suggest using collaborative activities to increase trust and cohesion in a group. An example is the collaborative activity that Blanton et al. label Rattlesnake. In this activity, group members attempt to devise strategies to help blindfolded members locate a hidden rattle. The group forms a standing circle as the facilitator gives a rattle

127. to a member. The facilitator blindfolds another member and tells the person to locate the rattle by touching the individual holding the rattle. Both group members enter the circle as the individual with the rattle attempts to avoid being touched. Members forming the circle collaborate and brainstorm ideas to help the blindfolded person accomplish the goal of locating the hidden rattle. Through this collaboration activity, all members win. One person attains a goal as others take pride in assisting a member’s accomplishment. According to Blanton et al. (2006), these types of collaborative activities serve to increase cohesion as members begin to build trust through working together. Third and Fourth Sessions The third and fourth sessions focus on identifying additional social support, improving trust in relationships, reducing feelings of isolation, building self- esteem, and identifying personal strengths. THIRD SESSION As the group progresses into the third session, it is important to identify additional social support available to members once the group terminates.

128. One way the facilitator begins this process is through a family or community genogram. Here, members identify people in their lives that they trust and 408 A. Lopez and I. Burt with whom they may be able to disclose their feelings. As evidenced by Nesmith and Ruhland (2008), children of incarcerated parents often struggle with finding anyone to trust in their lives. However, members may begin to see improved relationships with others as group sessions transform their social and relational abilities with those around them. According to Phillips and Gates (2011), improved relationships assist in reducing the isolation that children may feel. The facilitator also utilizes bibliotherapy by reading the book My Daddy is in Jail (Bender, 2003). Discussion after the reading explores how members were able to identify with the character (Lopez & Bhat, 2007). This activity allows members to discuss fears and identify coping strategies that help to normalize their situation. Furthermore, the facilitator engages members in a dialogue involving how coping strategies can negate harmful emotions or thoughts (e.g., sadness, thoughts of social inadequacy)

129. experienced during the period of parental incarceration. After leading a discussion on appropriate and inappropriate ways to express angry feelings, members participate in an activity labeled Feeling Monsters. In this activity, the facilitator provides members with a slab of molding clay that they mold into a figure of their choosing, symbolizing angry or other unresolved emotions. Members then share their “monsters” and explain the feeling they chose and their reasoning. This activity helps to facilitate discussion, and perhaps resolution, of feelings members may be otherwise unable to disclose, as well as sort out any displaced anger or unresolved emotions in a positive manner (Bender, 2003). Discussion of helpful coping techniques, such as talking to someone, drawing, writing a letter, and journaling during times of stress may prove useful during these stages (Nesmith & Ruhland, 2008). It is through these creative, alternate coping strategies that members begin to identify and form relationships with peers (Miller, 2006). Through positive social bonding, youth begin to develop strong relationship skills that can possibly prevent future unproductive and destructive behavior (Bandura, 2008). FOURTH SESSION

130. Johnston (1995) identified low self-esteem as one of the most common characteristics of children with incarcerated parents. Low self- esteem, in turn, adversely affects children’s ability to respond to future traumatic events. Therefore, the fourth session focuses on building self-esteem as well as identifying strengths. To accomplish these tasks, the facilitator has members draw a self-portrait and encourages them to name positive personal characteristics (Lopez & Bhat, 2007). This activity encourages members to build a positive self-image, confidence, and personal strength. Geller et al. (2009) emphasized the need for facilitators to encourage personal creativity for children of incarcerated parents. To fulfill this creative requirement, members in Children of Incarcerated Parents 409 this group participate in an experiential activity where they create (i.e., draw) their own tree of personal strength and growth, a symbolic representation of their self-portrait (Bender, 2003). As suggested by Bender (2003), the facilitator provides group members with materials such as construction paper, markers, crayons, or pencils. After

131. receiving materials, each member draws a tree with roots and leaves large enough to fill the paper. Additionally, members place their name on their drawing, thus owning the work and making it theirs (Gladding, 2012). The roots symbolize personal strengths, and the facilitator instructs each member to write positive changes they have mastered or noticed in themselves. The leaves symbolize members’ current difficulties, including behaviors they are continuously working to improve. Once members finish decorating their tree, the facilitator instructs them to pass it around the room until it makes a full circle and reaches back to the original member. Through this process, members get to see the trees of their peers. As the drawings are passed around the circle, the facilitator tells members to write on the back of the paper one positive attribute of that member to whom the tree belongs. Each member has the opportunity to share their drawing, descriptors, and what others wrote about them to the rest of the group. In an effort to process unresolved feelings resulting from this activity, the facilitator needs to pay close attention to each member’s reaction and behaviors. This experiential activity not only permits each member to be introspective, but also provides for a potential increase in overall self-efficacy

132. (Bandura, 2008). According to Adalist-Estrin (2006), improvements in self- efficacy can occur in children of incarcerated parents when they become more aware of personal perceptions and feelings. Therefore, increasing individual insight is paramount as improved awareness leads to personal growth and better interpersonal relationships (Miller, 2006). Fifth and Sixth Sessions Sessions 5 and 6 focus on building trusting relationships, developing social skills and self-awareness, and building outside social support to lean on after the termination of the group. FIFTH SESSION The focus of Session 5 is trust issues in relationships and development of appropriate social skills. In anticipation of termination, the facilitator also emphasizes the need for social and relational support in participants’ personal lives. An appropriate exercise the facilitator uses is an activity labeled A Good Friend (Lopez & Bhat, 2007). In this activity, members discuss and define what makes a good friend. Moreover, members create a fictional advertisement seeking a friend that meets their described qualities. The

133. 410 A. Lopez and I. Burt activity ends with members role-playing and exemplifying the importance of the qualities their ideal friend has. Emphasizing positive qualities in others is imperative with this population, as many seek maladaptive groups, such as gangs, to fulfill their relational needs (Burt & Butler, 2011). It is with this increased sense of self-awareness and knowledge about what qualities individuals look for in others that social and relational skills grow. Encouraging a positive outlook for the future and instilling confidence in group members is essential, as worry and hopelessness often plague children of incarcerated parents (Adalist-Estrin, 2006). To circumvent hopelessness, the facilitator must be sure to deal with termination in a caring and sensitive manner (Corey, 2011). In this group, the facilitator has members create a vision board that assists in the termination process by providing inspira- tion and hope for the future (Springer et al., 2000). Construction paper and magazines aid the vision board activity. The facilitator instructs members to look through appropriate, provided magazines. As members cut out pictures, words, people, places, or things, they begin to envision their future. Here,

134. members have the opportunity to create their vision boards any way they choose. This could be a future with or without their parent and may include the actions needed to prepare them for either scenario. Having members systemically consider how their actions directly affect their future is similar to Bandura’s (2008) notion of intentionality. Using intentionality, people predict the likelihood that their behavior will have either a positive or a negative impact on accomplishing their goals in the future. When members share their vision boards with one another, cohesion increases and the process of termination may be easier for members to accept (Gladding, 2012). SIXTH SESSION In the sixth and final session, the group terminates. The facilitator gives a pizza and ice-cream party for all members. This celebration symbolizes a culmination of the dedication the members have put forth and marks a new beginning. As recommended by Burt et al. (2012), the final session focuses on reviewing previous material, as well as identifying strengths and skills that have developed throughout time in the group. Additionally, using cognitive forethought (i.e., predicting how behavior can influence future decisions) is a major component during the final session. Maintaining a key

135. focus on cognitive processes instead of emotional content, as Gladding (2012) mentioned, is vital when working with this population during termination. Therefore, asking members to identify available support within the community, family, and school is useful, as it helps with the transition of termination. The facilitator guides members in discussion of how they will approach people in their lives for support, including how they will phrase their request (Lopez & Bhat, 2007). Corey (2011) and Gladding (2012) both suggested that for termination to be impactful and significant, the final session should Children of Incarcerated Parents 411 include something creative that is inexpensive and tangible. For example, the facilitator has members create a drawing that symbolizes the progression made during the group. The drawing is a concrete item the members can take with them to keep once the group ends. Similarly, Burt et al. (2012) suggested using positive mementos to assist in goal-keeping once the group ends. Evaluations of this conceptual group entail members’ personal

136. evaluations of their experience. Evaluations may determine how helpful they found the group and how well it assisted in the development of social and relational skills. Evaluations administered preintervention, midintervention, and postin- tervention are useful to determine efficacy of the group (McCarthy, 2012). Furthermore, the use of evaluations aids in determining where improvements can be made in group design and structure, as well as in group facilitation (Burt et al., 2012). With evaluation, the ability to pinpoint populations most in need of interventions can assist counselors in ensuring underserved populations receive necessary services (Burt, 2013). Finally, an option for follow-up is an annual assessment of each member determining if they may benefit from additional services. DISCUSSION Due to a lack of literature and interventions for children of incarcerated parents, it is imperative to not underestimate the social and emotional instability these children endure. Springer et al. (2000) determined that although there is “support in general for group work with children who have experienced parental incarceration, there is no available outcome literature on the effectiveness of group intervention with this population” (p.

137. 433). Thus, the purpose of this article is to bring attention to this population’s needs and concerns. It is the authors’ contention that researchers need to focus on developing and analyzing interventions for children of incarcerated parents. Practitioners, however, need to focus on using appropriate or effective interventions. Children spend many hours in school, and the environment itself provides a developmental context for behavioral, academic, and socioemotional functioning. Therefore, Shillingford and Edwards (2008) suggested strategies that include the school and home as important frameworks to enhance the functioning of children of incarcerated parents. Additionally, collaborative planning between school and home has an added benefit of ensuring the promotion of effective resources to address social problems. Research indicates that children of incarcerated parents are an increasingly vulnerable population that is growing dramatically (Springer et al., 2000). Thus, counselors need to position themselves for early intervention and design appropriate support strategies for this underserved population. 412 A. Lopez and I. Burt

138. Limitations Working with a group of children struggling with personal and familial hard- ships is a difficult task (Phillips & Gates, 2011). There are many additional challenges when implementing a 6-week group intervention. First, the limited timeframe may hinder the array of possibilities for the group itself to evolve. Due to the extensive time children need to build trust, past studies emphasized the importance of extending group sessions for longer periods (e.g., 12 weeks). However, Lopez and Bhat (2007) believed this might be challenging because obtaining support for a long-term group from administrators and teachers is difficult. An additional limitation is the selection of potential members coming from a list provided by school staff. First, having a list provided by school staff may not produce enough applicants to fill the group. Second, the criteria to be included on a list provided by school staff could potentially miss students who may be internalizing, as opposed to externalizing, their problems. Nevertheless, there are few interventions designed specifically for this population (Lopez & Bhat, 2007). As such, even with limitations, counseling groups may provide a creative intervention similar to what Roysircar (2009) indicated underserved

139. populations need. FUTURE IMPLICATIONS Children share the devastation of a parent’s incarceration. Their reactions, however, may differ in various ways. Miller (2006) explained, due to research primarily emphasizing male participants, that there is still an unclear picture of gender differences. Males generally misbehave to acquire attention, while females can be withdrawn, shy, or have problems with communication if the father is the incarcerated parent (Davies et al., 2008). However, if the mother is the incarcerated parent, girls may display excessive anger and aggression. Since recent studies do not distinguish between male and female participants, further research may be warranted in addressing each sex’s specific reactions to incarceration. Specific attention to the implications of negative social bonds, such as gangs, can address what Miller (2006) identified as a desire for a sense of belonging. With such variation within children of incarcerated parents, it is imperative that more researchers explore this population’s needs and concerns (Murray & Farrington, 2005). Therefore, future studies may examine if impact is dependent on sex of parent, type of crime committed, and

140. length of parental sentence. While the focus of this article was aimed at underserved populations (i.e., low socioeconomic status), parental incarceration affects all economic backgrounds. Understanding the effect of parental incarceration on a variety of economic backgrounds is an area that future researchers need to address. Another concern for future researchers is the Children of Incarcerated Parents 413 selection process. As mentioned previously, some children internalize rather than externalize their issues. Developing a recruitment, screening, and selection model that identifies the most appropriate population is imperative for groups (Gladding, 2012). Additionally, further studies may wish to examine the impact of parental incarceration based upon the child’s age, amount of contact maintained between child and parent, and expectations children receive from others regarding their parent’s absence. Lastly, longitudinal studies in the lives of children with incarcerated parents may help to clarify both short-term and long-term impacts on children. Through future interventions, counselors can develop and structure activities that positively influence children’s lives.

141. REFERENCES Adalist-Estrin, A. (2006). Providing support to adolescent children with incarcerated parents. The Prevention Researcher, 13(2), 7–10. Bandura, A. (2008). Toward an agentic theory of the self. In H. Marsh, R. G. Craven, & D. M. McInerney (Eds.), Advances in self research: Vol. 3. Self-processes, learning, and enabling human potential (pp. 15–49). Charlotte, NC: Information Age. Bender, J. M. (2003). My daddy is in jail. Chapin, SC: Youthlight. Blanton, E., Christensen, C., & Shakir, J. (2006). Empowering the angry child for positive leadership. Louisville, KY: Peace Education Program. Burt, I. (2013). Identifying male and female anger: A pilot study with an adolescent population. Manuscript submitted for publication. Burt, I., & Butler, S. K. (2011). Capoeira as a clinical intervention: Addressing adolescent aggression with Brazilian martial arts. Journal of Multicultural Counseling and Development, 39, 48–57. doi:10.1002/j.2161- 1912.2011.tb00139.x Burt, I., Patel, S. H., & Lewis, S. V. (2012). Anger management leadership groups: A creative intervention for increasing social and relational

142. competencies with aggressive youth. Journal of Creativity in Mental Health, 7 , 249–261. doi:10.1080/15401383.2012.710168 Corey, G. (2011). Theory and practice of group counseling (8th ed.). Pacific Grove, CA: Brooks/Cole. Cross, C., & Campbell, A. (2011). Women’s aggression. Aggression and Violent Behavior, 16 , 390–398. doi:10.1016/j.avb.2011.02.012 Davies, E., Brazzell, D., La Vigne, N. G., & Shollenberger, T. (2008). Understanding the experiences and needs of children of incarcerated parents: Views from mentors. Baltimore, MD: The Urban Institute Justice Policy Center. Geller, A., Garfinkel, I., Cooper, C., & Mincy, R. (2009). Parental incarceration and child well-being: Implications for urban families. Social Science Quarterly, 90, 1186–1202. doi:10.1111/j.1540-6237.2009.00653.x Gladding, S. T. (2012). Groups: A counseling specialty (6th ed.). Upper Saddle River, NJ: Pearson Education. Glaze, L. E., & Maruschak, L. M. (2008). Parents in prison and their minor children (NCJ 222984). Washington, DC: Bureau of Justice Statistics.

143. 414 A. Lopez and I. Burt Harper, C. C., & McLanahan, S. S. (2004). Father absence and youth incarceration. Journal of Research on Adolescence, 14, 369–397. doi:10.1111/j.1532- 7795.2004.00079.x Johnson, E. I., & Easterling, B. (2012). Understanding unique effects of parental incarceration on children: Challenges, progress, and recommendations. Journal of Marriage and Family, 74, 342–356. doi:10.1111/j.1741- 3737.2012.00957.x Johnston, D. (1995). The effects of parental incarceration. In K. Gabel & D. Johnston (Eds.), Children of incarcerated parents (pp. 59–88). New York, NY: Lexington. Kjellstrand, J., Cearley, J., Eddy, J. M., Foney, D., & Martinez, C. R. (2012). Characteristics of incarcerated fathers and mothers: Implications for preven- tive interventions targeting children and families. Children and Youth Services Review, 34, 2409–2415. Lopez, C., & Bhat, C. (2007). Supporting students with incarcerated parents in schools: A group intervention. The Journal for Specialists in Group Work, 32, 139–153. doi:10.1080/01933920701227125 McCarthy, C. J. (2012). Developing best practices for researching group work.

144. The Journal for Specialists in Group Work, 37 , 93–94. doi:10.1080/01933 922.2012.666445 Miller, K. M. (2006). The impact of parental incarceration on children: An emerging need for effective interventions. Child and Adolescent Social Work Journal, 23, 472–486. doi:10.1007/s10560-006-0065-6 Murray, J., & Farrington, D. P. (2005). Parental imprisonment: Effects on boys’ antisocial behaviour and delinquency through the life-course. Journal of Child Psychology and Psychiatry, 46 , 1269–1278. doi:10.111/j.1469- 7610.2005.01433.x Nesmith, A., & Ruhland, E. (2008). Children of incarcerated parents: Challenges and resiliency, in their own words. Children and Youth Services Review, 30, 1119–1130. doi:10.1016/j.childyouth.2008.02.006 Phillips, S. D., & Gates, T. (2011). A conceptual framework for understanding the stigmatization of children of incarcerated parents. Journal of Child and Family Studies, 20, 286–294. doi:10.1007/s10826-010-9391-6 Price, E., & Limberg, D. (2013). Addressing the mental health needs of gay military veterans: A group counseling approach. Journal of Military and Government Counseling, 1, 26–39. Rogers, C. (1983). Freedom to learn for the 80’s. Columbus,

145. OH: Charles E. Merrill Publishing Company. Roysircar, G. (2009). Evidence-based practice and its implications for culturally sensitive treatment. Journal of Multicultural Counseling and Development, 37 , 66–82. doi:10.1002/j.2161-1912.2009.tb00092.x Shillingford, A. M., & Edwards, O. W. (2008). Professional school counselors using choice theory to meet the needs of children of prisoners. Professional School Counseling, 12, 62–65. doi:10.5330/PSC.n.2010-12.62 Shlafer, R. J., Poehlmann, J., & Donelan-McCall, N. (2012). Maternal jail time, con- viction, and arrest as predictors of children’s 15-year antisocial outcomes in the context of a nurse home visiting program. Journal of Clinical Child & Adolescent Psychology, 41, 38–52. doi:10.1080/15374416.2012.632345 Springer, D. W., Lynch, C., & Rubin, A. (2000). Effects of a solution-focused mutual aid group for Hispanic children of incarcerated parents. Child and Adolescent Social Work Journal, 17 , 431–442. doi:10.1023/A:1026479727159 Children of Incarcerated Parents 415 Young, M. E. (2013). Learning the art of helping (5th ed.). Upper Saddle River, NJ:

146. Pearson. Angelica Lopez is an In-Home On-Site Therapist at The Village South/WestCare, Miami, Florida. Isaac Burt is an Assistant Professor in the Department of Counselor Education, Leadership, and Professional Studies at Florida International University, Miami, Florida. Copyright of Journal of Creativity in Mental Health is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

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