In an activity room at the Child and Adolescent Psychiatry Day Hospital, a group of young patients gazes at a large poster. Fantastical artwork by Kevin Peterson depicts a little girl with red hair and a blue dress strolling purposefully down a graffiti-filled urban street. Improbably, she is accompanied by a raccoon and a black bear.
The young people share their observations about the artwork over the course of a guided discussion — which utilizes Visual Thinking Strategies (VTS) — led by pediatric psychiatrist Leslie Miller and adolescent psychiatry fellow Cami Burruss:
“With all that graffiti and the boarded-up buildings, I wonder if they’re safe.”
“Maybe they are headed to the forest.”
“I think they are looking out for each other.”
Miller and Burruss were aware that Johns Hopkins psychiatrist Meg Chisolm had found success using VTS with medical school learners to strengthen skills like observation, critical thinking and communication, vital for providing humanistic health care. The two adolescent psychiatrists believed VTS could also hold big benefits for children and adolescents coping with significant mental health issues.
So they applied for an impact grant (formerly microgrant) from CIM’s Center for Humanizing Medicine (CHM) and used the $1,500 they received to pursue training in VTS and to make laminated posters of different pieces of art and photography.
The duo’s idea was just one of 25 projects funded by the IHM in 2024 — and already many are bearing fruit, says Martha Abshire Saylor, Mary Ousley CIM Scholar.
“We were floored by the response when we announced the program last year. We received close to 100 applications from across The Johns Hopkins Hospital, Bayview Medical Center and Suburban Hospital!” says Abshire Saylor. “We are thrilled with the implementation of this first batch of grants. The point of this program is to make a small but mighty impact in improving patient care — and that’s just what is happening.”
She mentions a monthly “Spa Day” in the Medical Intensive Care Unit, for example, in which a nursing team wheels around a cart loaded with scented lotions and other care products used to lift the spirits of very sick patients through a little pampering. Or the tote bags stocked with sidewalk chalk, bubbles, a Frisbee and a jump rope, which are distributed to adolescents with HIV to encourage them to have fun and stay active. Or “buzzy bees” — small devices that convey a vibration on the skin aimed at distracting pediatric patients who are getting injections. “The pediatric nurses are very excited to use them,” says Abshire Saylor, who is CIM’s first nurse scholar.
For their part, Burruss and Miller have been heartened to see how the VTS art education groups they lead have helped young patients, including those suffering from social anxiety, to engage.
“These discussions help them with their ‘tolerance for ambiguity,’ since there is no right or wrong answer, and on identifying affect through nonverbal expression and perspective-taking as they identify with different characters and viewpoints,” says Miller. “These are all skills that are critical in mental health treatment.”
Adds Burruss, “There have been a number of times that we’ve shared with staff how a particular patient did a great job of participating and they are so surprised, saying, ‘Really? This person has never spoken up in a single group session!’”
The duo, who started with weekly sessions last September at the outpatient day hospital have since expanded to the Bayview campus, where they now lead VTS group discussions through the adolescent Intensive Outpatient Program. Psychiatric staff members at both clinics, buoyed by the participation they’ve seen in young patients, are now eager to get trained in VTS themselves so that they can lead discussions and expand the reach of the effort.
That’s exactly the kind of outcome that Abshire Saylor and other leaders of the CHM are hoping for with the impact grants.
“The goal is to make these creative efforts to improve patient care sustainable, so that the work can live on and even grow once the grant ends.” – Martha Abshire Saylor
“The goal is to make these creative efforts to improve patient care sustainable, so that the work can live on and even grow once the grant ends,” she says.
To further amplify the reach, Abshire Saylor is working on a research paper with Scott Wright, co-director of the CHM and the Anne G. and G. Thomas Miller Professor of Medicine. Through analyzing applications, they aim to describe and group together common “dehumanizing” problems patients experience that can be addressed through big ideas and small amounts of funding.
Seed funding through the CHM will continue. “We’ll be sending out a new request for proposals later this spring, with a plan to award funding to a new batch of projects in July,” says Abshire Saylor.
“Humanizing medicine is a dream,” she says, “but it can become reality as frontline clinicians notice the dehumanizing problems around them and get support to make an impact on patient care.”
