Promoting young people's health through drama and dance

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Abstract

Kerry Dalgetty and Julie Redman (Health Promotion Schools Team) and student Christopher Taylor describe a ten-year Tayside programme.

content

Work on young people's health issues, using the medium of drama and dance, has developed over a ten-year period in Tayside through collaboration between Health, Education Departments and Dundee College.

The main developments have been:

• From 1998 an annual Drama tour has been helping S3 pupils explore 'Health Issues and Using Services'.
• From 2003 an annual dance tour for S2 pupils is continuing to help explore feelings and emotions with a dance called 'How We Feel'.
• From April 2007 an annual Forum Theatre tour for S1 pupils is exploring tobacco and smoking issues.
• From October 2007 dance and drama workshops with Primary 7 pupils have been exploring tobacco and smoking issues.

In session 2007/08 around 7,500 pupils across Angus, Dundee and Perth & Kinross participated in these tours. The tours visited 27 secondary schools and 3 offsite schools. The Primary 7 workshops visited 30 primary schools. 

If all goes according to plan, most of the P7 pupils who took part in the dance/drama workshops in 07/08 will carry on exploring health issues through dance and drama each year as they move through secondary school S1 - S3.

How did this work come about?

NHS Tayside's Health Promotion Schools Team and the Educational Development Services in Angus, Dundee and Perth & Kinross Councils have a long history of joint working, which goes back to the late 1980's and work in Tayside before even the three current  local authorities were formed. This joint work includes collaboration around all aspects of Health Promoting Schools.

The 'trigger' to start using drama and dance came as a result of the developments in Angus that had created a network of services for and in partnership with young people. These services came under the auspices of 'Angus <21 Health'. A discussion took place on the Angus <21 Steering group (made up of staff from Health and Education) about how we could better educate young people about health services, their rights and responsibilities, including young people who are under 16 years old.  Young people had said that embarrassment and fear of broken confidentiality were the biggest barriers they faced when seeking health advice and support (Redman et al 1997 and Taylor 2000). 

We thought that it might be useful to utilise a drama, specifically created, with participative workshops. We also thought it might be more effective if the actors were young enough to be credible, i.e. a peer education approach.  It was with this in mind that we approached the Centre for Performing Arts in Dundee College, and the partnership with them was born. 

What happens?

The tours are organised by the Health Promotion Schools Team. The performances and workshops are delivered by students, graduates or lecturers of the Centre for Performing Arts, working hand-in-hand with health staff. 

Prior to the arrival of the drama/dance/forum theatre, pupils do a preparatory lesson in Social Education. There is also a follow-up lesson and this helps embed the work not only in the curriculum but also the life of the school.  Pupils come in groups of up to 60 to the drama/dance/forum theatre. They stay for a double period, in which there is a 30 minute performance (play or dance) followed by participative workshops and, finally, pupils' questions are answered by a panel of health and guidance staff. Pupils meet the staff who provide the local services, work with these staff in the workshops and, as mentioned above, have an opportunity to ask them questions. Pupils also receive a copy of locally-produced information leaflets about young people's services.

S3 Drama tour on Health Issues and Accessing Services

This tour aims to raise some of the main health issues facing young people, e.g. sexual health, alcohol, drugs, tobacco, sexuality, eating disorders and family issues, and give young people an opportunity to explore their fears and anxieties about accessing services. The play is created by the Centre for Performing Arts and portrays the issues in a realistic and engaging manner. Pupils then explore some of the issues and devise a short drama piece in the workshops, which they show to each other. 

A sample of the questions that pupils ask the panel gives us an idea of their concerns:

If you get caught having underage sex, what would happen?

Is the morning after pill free?

If I spoke to a health worker, would it be confidential?

What do you do if your mates go out drinking a lot?

My friends want me to take drugs but I don't want to, If I don't they'll hate me, should I?

It's coming up for a year since someone close to me died and I miss them.

Is there anyone that can help me?

What do I do if my mate is gay?

 A sample of pupil feedback to the question 'What was the most important message for you?' gives an idea of what pupils gained from this tour:

There are always people there to help.

That if you have a problem, to remember that there are people that have gone through it.

Don't be persuaded to do too much too young.

You have to be thoughtful about your decisions.

'How We Feel' S2 Dance Tour

This tour developed when both the Health Promotion Schools Team and Education Departments prioritised more focused work on promoting mental and emotional well-being. Dance seems to be a good medium and the Scottish School of Contemporary Dance (SSCD) were keen for their students to have the learning experience of a schools tour. 'How We Feel' explores young people's feelings and emotions, while also discussing where they can go for support and help. The dance performance deals with a wide range of both positive and negative feelings and many other issues, from feeling good, enjoying school and having friends to bullying, loneliness, alcohol and self-harm. 

S2 pupils watch a performance and then go into workshops. Led by the students and supported by local health and project workers, the pupils choose three feelings, for example excited, sad and bored, and have to show these non-verbally. Groups, in turn, perform their three feelings to other pupils, who have to guess the feelings shown. 

The dance and workshops aim to foster understanding of self; empathy for others; appreciating differences; being able to deal with adversities; learning to talk about feelings and emotions; and accessing health services. 'The most important message for you…?' Sample of pupil feedback:

Talk to someone.

That you can talk with your body.

Expressing feelings.

Not to keep your emotions bottled up.

Don't bully.

Be happy.

"How We Feel" Diaries

As part of the pre-dance lesson pupils complete an anonymous diary saying how they feel on that day. These diaries are opened in Health Promotion and are sorted according to whether the feelings expressed were positive, mixed/neutral or negative. 

Table 1.  Positive and negative feelings (Angus and Dundee, N = 1,844)

These diaries give a valuable snapshot into young people's feelings. Pupils who expressed positive feelings wrote about: feeling good or OK because they had good friends; a sense of achievement; were doing well at school; felt loved by family or boy/girl friend; had something to look forward to; enjoyed sport. Many of these pupils also seem to have an absence of trouble in their lives e.g. that they hadn't fallen out with friends or family.

Pupils who expressed mixed or neutral feelings wrote about: feeling good about things in one area of their lives but not another; feeling mixed up or confused; having difficulties but knowing they will be resolved; accepting the ups and downs of life; talking about what they are doing rather than their feelings.

Pupils who expressed negative feelings wrote about: feeling tired, bored, angry, unloved or down; problems at school e.g. being called names, being bullied; struggling with school work; worrying about tests; feeling unhappy about how they looked or because they felt different; falling out with friends and family; problems at home e.g. arguments; illness; separation of parents; the burden of keeping secrets for friends or family; feeling responsible for things that were not their fault; coping with their own, or a friend's, problem e.g. self-harming, not eating; being sad about the death of a loved one.  Some young people expressed negative feelings because they were having a "bad" day but for others there were long term issues involved.

We give pupils feedback about their diaries via a Newssheet and to staff, on request, via the Guidance staff team meetings.  The diaries also inform and influence the following year's production so that it focuses on issues and concerns pertinent to young people of this age.

S1 Forum Theatre Tour

Given that the S2 dance and S3 drama tours were firmly embedded in the secondary schools, it made sense to focus on a younger age group. We know from research that pupils between P7 and S2 are the most likely age group to try smoking and we therefore decided to create a tour for S1 pupils, using a forum theatre approach to address smoking and health. 

The play is specifically devised to focus on the methods employed by cigarette companies to sell their products, as well as the impact smoking has on health. Pupils then take part in workshops, led by the actors, and discuss the issues raised before devising their own end to the play. Supported by their actor, each group then shares their acting contribution with their peers in an improvised performance using the stage and scenery. Afterwards, the pupils are encouraged to ask questions and raise any issues they have about smoking and health.  When asked what they liked, pupils said they felt that the play had been written for them and not for adults, they were not being 'preached' to about smoking, and everything they were told was true. The pupils also liked the fact that the actors were young and they could relate to the actors' own personal stories.

A sample of pupils' comments includes:

It told us what the tobacco companies thought about us.

The fact they didn't tell you not to smoke, they gave you the facts to help you make your decision.

Funny but serious at the same time.

It is very good because it means I am going to tell my mum and dad to stop smoking. 

P7 Dance/Drama workshops

Following the introduction of the forum theatre tour for S1 pupils, the next logical step seemed to be to develop work around smoking and health in primary schools. 

One-day dance and drama workshops organised and led by the Centre for Performing Arts have been offered to all Dundee primary schools, as well as a selection of schools in Perth & Kinross. The morning session focuses on the body, the way it can move, the effects of smoking and feelings, and choices and influences on decision making. The afternoon session uses scenarios for groups to create short performances, which are shown to fellow pupils and parents. The day closes with a question and answer session.

Feedback from both staff and pupils has been very encouraging.  Pupils' responses include:

I really enjoyed working on the play; I really like listening to other people's ideas and plans.

I think that acting out scenes will help people understand more about the effects.

I really enjoyed it.  I'm more strong about saying no to a cigarette.  Thank you.

Education and health staff's responses include:

Excellent delivery, children thoroughly enjoyed learning about smoking through dance and drama – enjoyed the active learning.

Good variety – sit down talk / activity.

Children were having a great time.

(This section about the P7 workshops is based on an article by Laura Scott, Dance Lecturer, Centre for Performing Arts, Dundee College that appeared in 1^st Class, Issue no33 -- a health promotion newsletter for schools in Angus, Dundee and Perth & Kinross)

Evaluation - Is it effective?

Evaluation of the tours comes through feedback questionnaires from pupils and staff. These show consistently that the vast majority of pupils like and engage with the experience of the tours. The wide range of issues commented on by pupils indicates that there is most often 'something for everyone'.

Both the S3 drama and S2 dance tours promote local health services and there is plenty of anecdotal evidence that services are better used following the tours. Cool2talk is a local website where young people can post health questions and receive an answer within 24hours. This service always shows a marked increase in use during and following the tours.

The peer education element is an important factor. Many of the pupils comment positively on the age of the cast and how they identify with both them and their portrayal of the issues. We have found that the college students and graduate actors always show very high commitment to the tour and the positive benefits, as they also perceive it, for the pupils. Some college students who went to school locally remember the tours coming to their school and its positive impact.

Teachers are enthusiastic and supportive of the tours and in many schools the PSE programme is structured so that they cover the health issues raised in the tour at the same time. The pre and post lessons have been built into the curriculum. Teachers often comment favourably on how pupils engage with the tours and that sometimes the most unlikely pupils participate enthusiastically in the workshops.

The range of issues covered. These issues are exactly the ones that our pupils will be dealing with. Drama performance was excellent and questions and answers at the end very worthwhile. Everyone was encouraged to participate. (S3 tour)

At first, although I believe dance is a good medium for exploring feeling and emotions, I did wonder if pupils would participate. In fact they did and have continued to do so.  The way in which the dance students engaged the pupils was amazing. (S2 tour)

It seemed to be pitched at exactly the right level as it kept the whole year's attention. (S1 tour)

Involving young people

Young people are directly involved in creating the dance and drama pieces. This is not an optional extra but integral and essential to all the work. The original S3 drama came from extensive work, through Angus<21 Health, where young people contributed to service developments taking place at that time in Angus. They were directly involved through seminars, discussions, consultations and visiting services and advised on all aspects of how to set up and run services.

The involvement of young people has continued. For example, we ran the S2 'How We Feel' dance in the first year as a pilot project in one secondary school in Angus. Using a questionnaire we explored young people's feelings; what makes them feel good and bad; who they could talk to and what could help. Following this, pupils and student dancers took part in workshops and pupils gave their ideas of what they wanted included in the dance (Specialist Health Promotion Service, 2004). 

We explored young people's views on lesbian and gay issues through focused group discussions (Tayside Health Promotion Centre, 2001). This highlighted the importance of discussing these issues from an early age and the need for positive messages to counteract the prevailing homophobic climate of fear. As a result of this work we have ensured that these issues are included in the S2 and S3 tours.

The NQ Theatre Arts students devise a new play for the S3 drama each year as part of their college course. They speak with young people and research all the issues as well as drawing on their own experience, as many of them have not long left school. In this way they ensure that the play they create is relevant and portrays 'real-life scenarios'.

A group of S3 pupils in a secondary school worked with the health promotion graghic designer and a member of the schools team to design the leaflet on young people's services that is given out on the S2 and S3 tours.

Dundee Educational Development Service held a city-wide pupil conference when Tobacco prevention monies first came available. Pupils discussed all the issues around tobacco, smoking and what would help, i.e. education, diversionary activities and smoking cessation. Their ideas were fed into to the creation of the S1 Forum theatre.

Conclusion

We have found drama and dance a positive and effective way of promoting the mental, emotional and physical health of young people. Each new piece of work has its own unique features, but all of them share a positive and participative approach that engages young people and contributes to and complements the classroom-taught health education programmes.

References

Redman, J., Goudie, H. and Taylor K. (1997) Angus young people's health project: making health services more appropriate and accessible. Health Education, 2, 65-71.

Specialist Health Promotion Service, Tayside (2004) How we feel:  A pilot project with S2 pupils, parents and staff from Arbroath Academy, Angus and dancers from the Scottish School of Contemporary Dance. Unpublished report.

Taylor, K. (2000) Using drama as a tool for educating young people about accessing health services: A comparison of two approaches. Health Education, 4 (vol. 100), 168-173.

Tayside Health Promotion Centre (2001) Exploring health inequalities, the views of young people on young gay and lesbian issues: Report of a needs assessment. Unpublished report.