In the midst of an international health crisis, one group of actors from the Phoenix Theatre Company has found its work in greater demand.
Partners That Heal has been taking actors specializing in improvisation into hospitals since 2011, performing mostly for children who are in intensive care units or undergoing life-threatening treatments.
They’ve performed in 27 different hospitals and organizations using more than 250 improvisation interventions. While most of their work is done with children and teens from age 3, they’ve even sung to infants in neonatal units. Sometimes, when a staff member is having a tough go of it, they ask for an intervention and the team responds.
Then COVID-19 lockdowns hit and the actors could no longer enter the hospital rooms to perform for their patients. However, the need for their services is still great with children facing increased isolation and stress.
So, they moved to a new model, one that was digital only, according to Carlos Castaneda, the development director who started with the Phoenix Theatre this past February, just four weeks before everything shut down.
“Instead of three actors in a room performing entertainment interventions with kiddos, now we’re doing it with Zoom and an iPad,” Castaneda says. “They’re more safe, and that’s kind of how the program has grown to what it is today.”
Surprisingly, the number of patients they see has increased. Each shift is four hours, and they used to spend 30 minutes per patient, taking time to say hello to the adults or care specialists, and then travel from room to room. Now they are seeing patients for 14 to 20 minutes, which has expanded their daily visits.
As a result of the additional demand, they hired another partner at a time when most theaters were laying people off.
“By and large, we’re seeing more patients today with Zoom than we were before,” Castaneda says. “Some of that is technical. It is much easier for us. Each intervention is taken very seriously. Three partners join the Zoom call and a moderator, sometimes me or Pasha (Yamotahari, the associate director in charge of the program), you don’t see us. We switch people over and lock the room so we don’t have any random drop-bys.”
What takes place during those 15 to 20 minutes varies depending on the patients’ needs. The partners prepare improvisational exercises—which they call “interventions”—and the patient chooses one.
Sometimes they might sing a song, play a game, do a puzzle, tell a story with the patient as the hero, or even just listen when a patient wants to talk.
“It’s been more challenging lately, especially for a lot of older patients who have a lot of loneliness,” Castaneda says. “Their family and friends can’t visit as often as before COVID. They just want to vent and have someone to talk to who isn’t a family member or a nurse, so they talk to the partners.”
Sometimes the patients perform for the partners, such as one young man who rapped for them about his journey with health care in and out of the hospital. The partners provided him with an audience.
The goal of the interventions is to empower patients to communicate with their medical providers by breaking down communication barriers, building trust and helping contribute to better health outcomes.
Castaneda explains that once patients build trust with the partners, they shift that trust to their medical providers.
“Many patients assume, providers assume, that everyone knows what is going on, but that’s rarely the case,” Castaneda says.
“Sometimes patients don’t understand what is going on and they don’t know the right questions. Providers assume patients understand and if they aren’t asking questions it is because they know. They assume that communication is being fruitful. What we find is that patients don’t ask questions because they are intimidated or feel deference, especially vulnerable populations or those who lack education.”
Castaneda says the Phoenix Theatre Company has labored to adopt the hard science around performances and learn how each intervention can be effective with patients to have better outcomes.
Yamotahari develops the curriculum and trains the partners on each intervention so that they are ready to perform any of them at a moment’s notice.
As an example, Castaneda says they like to do a choose-your-own adventure intervention for patients who have very little control over their situations. For example, they might not be allowed to eat and be connected to many tubes. The partners let that patient be in charge of their own story—a story partners create on the fly based on things they learned about the patient.
“They’ll take what that patient has said to them—say their favorite animal is ‘this.’ We get to know them, and the partners create a wonderful story about them,” Castaneda says.
“At one point we say to the patient, you can go with Liz’s (one partner’s) story and she will give a little synopsis of where that story will lead. Or you can go with Mike, and he’ll explain where that story will go. We let them choose what adventure they go on. We tell stories and involve their creativity. It can go on for 15 to 20 minutes and the patient is the hero of the story. We try to make it as happy as possible.”
Meanwhile, the moderator captures the story, recording it and jotting down notes. It is then passed to another person, who within a day creates an electronic flip book with the story and images and sends it to the patients and their families.
“If they need positive memory recall, if they are feeling a lot of anxiety and need some cheering up, then we’ll always tell them to go back to that story and feel empowered with that story,” Castaneda says.
He says at first it was pretty challenging to go from performing with three actors in a room to doing it over Zoom.
“We did a 180 in one week. We’re very proud to say that,” Castaneda says. “When we realized there would be a quarantine, Pasha, myself and the partners got together on a Zoom call and it turned into a rehearsal figuring out what activities can we still do and which ones can we not do because it doesn’t translate to virtual.”
As they worked on the transition, they used Castaneda and others as test subjects. They would be a pretend patient and the partners would practice or “rehearse” the interventions over Zoom. While they couldn’t do their entire set of more than 250 interventions, they did play games and puzzles and told stories.
“There was a slight lag here and there at first, but now they’ve got it down to a well-oiled machine,” Castaneda says. “They can still do a lot of interventions, and patients are still responding to the interventions. The ones we perform are still impactful.”
Castaneda says the partners absolutely prefer performing live because they can exchange energy with the patients, but they are glad that they haven’t had to completely stop the program.
“They can still see the patient’s face and their emotions and emulate that,” Castaneda says. “I feel like the partners are seeing that this is just a stop-gap measure. If it is this or nothing, they’d rather do this, and if this is the best we can do, then by golly, we’re going to do it and make it work.”
This period has also seen the program grow beyond Phoenix.
They are talking to organizations that want to adopt their model and are seeing it grow beyond the United States borders.
Unfortunately, during the COVID-19 pandemic, funding from corporations, philanthropists and foundations has decreased. He says they have been invited to work in new hospitals, but right now they can’t because they are at capacity, even with the new partner. They lack the money to support he partners who do the work.
“We would love to bring in more patients, not only in the Valley but across the state, but funding is all being redirected to COVID,” Castaneda says. “It’s been hard for us to find money to support the program. But for as long as we can do it, we will.”
He has high praise for the Phoenix Theatre Company and its leadership, which employs the six partners, Yamotahari and himself. He says they have remained committed to making it happen.
“They created the program and spearheaded the project,” Castaneda says. “We appreciate all of their support.”