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The Moon Balloon Project
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Evaluating the Effectiveness of an Intervention
That Uses Images and Symbols to
Help Children Express Their Feelings

Healthcare experts agree that hospitalization and illness are stressful for everyone, but can be especially so for the developing child. Often the feelings children experience are confusing, difficult, and perhaps too frightening to put into words. Representing these experiences through the use of symbols and images result in the invisible becoming visible through association. The Moon Balloon®, a 40-page colorfully illustrated interactive journal, provides an opportunity for children to create their own stories of hope and discovery, enticed by the wonder and magic of hot air balloons and other colorful and playful artistic symbols.

This study sought to determine if a one-time intervention using The Moon Balloon® at the bedside could have a positive influence on helping children cope with hospitalization and illness. Participants included 50 English-speaking children, ages 5-19 years, 14 boys and 36 girls, receiving care on the general pediatric inpatient units of an urban children’s hospital within a general hospital in the Northeastern United States. A pre- and post-test approach incorporated quantitative and qualitative methods using three instruments: child and parent versions of the PedsQL Present Functioning Visual Analogue Scale©1998 J.W. Varni; an investigator designed Parent Survey; and recorded observations in field notes.

Results indicate a statistically significant (p=.001) reduction in child and parent perceptions of the child’s fear, sadness, anger, worry, fatigue, and pain or discomfort following the Moon Balloon® intervention. Ninety-eight percent of parents rated the Moon Balloon® session as effective in helping their child express feelings about hospitalization, fears, or frustrations; 84% reported discussing these feelings with their child after the session; 93% said they had learned something new about their child as a result of the session; and all of the parents who were present during the sessions described the Moon Balloon® intervention as having a positive effect on them (e.g., relaxation, enjoyment). Content analysis of the sessions revealed four themes: (1) When images speak the unspoken; (2) When images speak of beauty; (3) When images speak of stress; and (4) When images transform. Unsolicited comments from pediatric staff disclosed the value of the drawn symbols and images in helping medical personnel understand what children are feeling and thus improving quality of care.

Findings suggest that a one-time Moon Balloon® intervention can be used to help children cope with the stresses of hospitalization and illness. Future studies that track continued use of the book could provide evidence of long-term effects of the intervention. Research also is needed with other populations of children dealing with difficult feelings, such as those resulting from a family member’s illness, grief and loss, bullying, divorce, disaster, abuse, or other trauma.

"Arousing Curiosity: When Hospital Art Transcends,"

Healthcare Environments and Design (HERD) Journal, May 2011 www.herdjournal.com

"Exploring the Ability of a Drawing by Proxy Intervention to Improve Quality of Life for Hospitalized Children"

Art and Health Magazine, accepted for publicaiton in March 2012


"The Little Magician"

Grief and the Healing Arts , Sandra Bertman PhD www.sandrabertman.com

© 2010 Judy Rollins, Joan Drescher, & Mary Lou Kelleher
Photos ©Denise Michel Photography LLC, unless otherwise indicated