In Conversation with Mairéad Kinlough, Clinical Nurse SpecialistSupporting teenagers in a Transition Clinic through the arts

What was the incentive behind setting up a ‘Transition Clinic’ in the Renal Unit in Temple Street?

Traditionally we always had a joint ‘Transition Clinic’ with Beaumont Hospital and one of Beaumont’s Consultant Nephrologists came to Temple Street. He would meet with the young person here and their family and explain what would happen once they transitioned to Beaumont and how he would look after them for the first year in their ‘Young Person Clinic’.

We felt that there was a need to set up another ‘Transition Clinic’ to involve our multidisciplinary team – which includes our psychologist, our social worker, our Consultant Paediatric Nephrologist and myself – so that we could meet with the young person and their family and using some of the information from the Stepping Up programme [https://www.steppingup.ie/], educate them and prepare them for transition. They would come to see us at these clinics twice, so that before they would meet the Consultant from Beaumont at the joint clinic, they would be a lot more prepared and a lot more educated for transition to adult services.

When they come for their regular appointment to Temple Street, we also use that as an opportunity to avail of education or to see the young person on their own, so that they get used to speaking for themselves at appointments. We start the transition process and the education around it at 14 years of age even though the teens don’t actually transition until they are aged 16. So it’s two years and more, if you like, of preparation.

The ‘Transition Clinic’ that you invited me to come along to was the second one that you’ve tried out here but there have been other ‘Transition Clinics’. Did you get to see how other clinics worked or had you undergone training?

I had read information on transition and the recommendation is that you begin it when they’re at least 14 years if not younger, so that’s why we targeted that age group. There are a lot of publications that suggest getting the MDT [Multidisciplinary Team] on board. I’d spoken to colleagues in other hospitals in the UK to learn how they do it and we also depended on the expertise of our Consultant Paediatric Nephrologist, Dr Dolan, who had experience from other hospitals that she’s been involved with.

The Stepping Up programme gave us a starting point for asking questions, to assess how much the young people already knew. So that was also helpful.

Have you come across anything else that you found helpful in this process?

Working with you as Fireflies Artist-in-Residence was helpful as well. Having an artist on board brought a difference dimension to the preparation for transition. The feedback we got back from the young people in terms of speaking to a non-medical person was that they found it helpful not to be bombarded with questions. It was giving them an opportunity to talk about what they wanted to and to express themselves. So they did find it helpful working with an artist. And it did allow for a more relaxed feel towards the end of the clinic.

I know that I got in touch with Lisa Edwards (Nephrology Service Coordinator at Temple Street) but what prompted you to invite an artist onboard in the session?

Lisa had heard of the work Helium did and she thought it would be a good idea and suggested it to me. And then I met with you and I heard your ideas and I spoke to our Consultant Paediatric Nephrologist, Dr Dolan. We were interested to see how receptive the young people would be to it and how it could be developed in the future.

When I was telling you my ideas, the ideas were still forming, because it depends on trying them out with young people. I think that from your perspective it must have been a little bit of a leap of faith.  

When you are introducing something you like to have more of a clearly defined idea of what it’s like. But we were receptive to trying it out and ultimately if it was going to be something that the young people found helpful, we were willing to do it.

Could you talk about your observations of the process?

I suppose initially I didn’t entirely understand the idea of it. Then when I actually saw what the young people had produced and when you explained it to me, I certainly did find it very interesting. It did give insight into their personalities. As healthcare professionals there can be a huge amount of assumption, that the information you’re giving is good, it’s beneficial, it’s something you think they need. Then when you see them put something on paper in terms of drawing, and I mean one particular instance where you showed them the drawing of that famous painting…

The Scream

The Scream … I think for a young person to be that expressive, it is a terrifying process for them really, it literally is a big transition for them, so I found that very interesting.

You know, that made me reflect on how I was approaching the theme of transition with young people here in the hospital as well. I’ve always been careful about bringing up the subject explicitly because I don’t know how prepared they are to explore it themselves, or how much support they have to do that around their team afterwards. But I constantly second guess that as well because I think when someone needs to bring it up – and maybe the arts can bring it up in a more gentle way – but just having had that experience and seeing the range of responses that the young people put into their artwork in terms of their feelings about transition, what would you advise on broaching the subject of transition with young people?

The recommendation in place is that you would ideally be 12 years of age but definitely [you would broach it] at 14 years. The sooner you can broach the subject the better because they can have plenty of time to prepare. The later you leave it, the more difficult it is for them to transition and the likelihood of there being more problems. From an artistic point of view and talking to the parents, I suppose [the art making] is offered as something that they may find helpful and that there is no pressure to participate in it. When the process is explained to them and that there is no pressure to participate either way, then, if they take part, they’re doing it of their own free will and they might be more likely to enjoy it.

There’s one thing that struck me after we reflected on what the young people had produced and that was how the timeline of their transition was overlapping with the timeline of their own lives like socialising…

Yes, the timing of transition is important – that it’s not during an exam year or it’s not during a family bereavement; you have to factor home life and their personal lives into when they transition.

Going forward then for the ‘Transition Clinic’ and for future opportunities to collaborate with the arts, what do you think would be beneficial?

It’s the tip of the iceberg, what we did with them. Going forward, I suppose there would be more time needed – that if they meet you at the first clinic they would have the opportunity to also meet you at the second clinic if it’s something they find helpful. It would be important to have good follow through and that might possibly be at the third clinic when they meet the consultant from Beaumont. We need feedback, so maybe a survey with the families to see if they found it helpful – asking for the parents’ ideas and asking for the young person’s ideas.

Also to find out from other hospitals in Europe or the UK who maybe have artists working with them, how they have advanced it and what pitfalls they found with it. So rather than us nearly reinventing the wheel, finding out from people who do it and do it well.

What would you advise others running ‘Transition Clinics’ who are considering working with artists or facilitating creative activities?

We do have a psych. social meeting here every Monday where we meet with the MDT. I would, in hindsight, have invited you to that meeting for you to explain to the complete MDT what the Fireflies programme was about. Then you have more of a brainstorming opportunity with the MDT. I would have also included a representative from our Play Therapy team in the initial meeting as that team also has significant experience. It was a big learning curve for me because I hadn’t been involved in transition before in my previous role. And certainly looking at it now I can already say the things I’m going to change.