Section 4: Starting a Caring Clown Program

Much of the information in this chapter is applicable to an individual or pair of clowns who are interested in working in a hospital or nursing home setting.  The type of program, the training, and record sections are useful for any caring clown.  However, this chapter was written with the assumption that a group of clowns will be going into a medical setting to set up a caring clown program.  There is a special section for leaders or teachers, those who are initiating the program and providing training for other clowns.

Volunteer versus Paid Clowning	Special Note for Teachers and Leaders
Sample Training Program	Getting Started
Mentoring - Apprenticeships	Records

Types of Programs

Prior to forming a Caring Clown Program, you will need to decide what type of program you plan to have.  Will it be a program based on spreading joy through brief visits or will it be a program based on making a connection with an individual, which might take more flexibility?  Either type of program is valuable, but there are different considerations for each one.

The first type of program, which focuses on spreading joy through brief visits, stems from the circus model.  Clowns traveling with the circus have been making community service visits for years.  These clowns typically perform a small show in a social area of a hospital, especially in the pediatric units, and following the show, will often allow time for pictures and autographs.  These clowns will occasionally visit individual rooms for a few moments, staying just long enough to plant the seed of happiness and to spread joy and laughter before they dash out to another room. This is the type of program the Big Apple Circus Clown Care Unit® is based on.  They are cheer spreaders, distracters, stress-relievers and boredom breakers.

Another type of program is known as therapeutic or heart-to-heart clowning.  While they also are cheer spreaders, distracters, stress-relievers and boredom breakers, caring clowns who prefer this type of program, focus on making a therapeutic connection with their patients.  This therapeutic connection may happen quickly and the clown may leave after only a few moments, or may need to stay longer.  The clown is often in the room with a patient or resident for a specific purpose.  It is up to the clown to decide what that purpose is, based on his or her interactions with the patient.  Some examples include providing an escape from boredom, reducing anxiety, providing permission for a patient to talk about his situation or life in general, or distracting the patient from physical or emotional pain associated with procedures.

Both of the above mentioned programs are needed.  Both provide a service that the hospital or nursing home environment is lacking.  While there are many wonderful staff members in these facilities, they are often overworked and in high demand.  Clowns can take the time that staff may not have to visit with a patient or resident who is scared or lonely.  Clowns, in their cheerful, bright costumes can provide this quality time and connection in a unique way.

Volunteer versus Paid Clowning

In this day of managed care and downsizing, it is difficult to find funding for just about anything, including a caring clown program.  Most hospitals or nursing homes have some form of Volunteer Department.  The Volunteer Coordinator is always looking for volunteers, so this is probably the easiest way to gain entrance for a clown.  

Being a volunteer has its advantages.  After agreeing to guidelines and avoiding restricted areas, volunteer clowns are free to visit on their own time and schedules.  Many volunteers also get some sort of compensation for their work such as free parking or a free lunch.  There is also often an auxiliary fund that will help pay for clown supplies such as face paints or hand-outs, also known as give-aways.  Jalapeña the clown finds her “payment” to be the personal gratification that volunteers provide.

The Comedy Connection in Clearwater, Florida is an example of a successful volunteer program.  Its founder, Leslie Gibson, started the program in 1987 with 5 volunteers and one humor cart.  Now there are over eighty volunteer clowns that can deliver humor carts and cheer anywhere in the hospital.

Paid clowning has some advantages as well as some disadvantages.  Shobhana Schwebke, also known as Shobi Dobi the clown, writes that being the editor of the Hospital Clown Newsletter has provided her with a lot of information about the topic of volunteering versus paid hospital clowning.  She notes that while many volunteer programs and “volunteers start out with a bang, they soon struggle to keep their commitment” (Schwebke, 1999, p. 13) and often stop visiting the hospital.  She also cautions clowns about the other disciplines attached to a salary or wage.  She mentions a loss of freedom that is found with being a volunteer.  A clown employee will have an authority figure to report to, someone who will dictate what a clown can or can not do.  A clown employee will also have a time commitment they must abide by as well as some form of accountability and possibly even a need to show continuing education.

There are hospitals in the United States that have successful clown programs where wages or stipends are earned.  The best known, probably due to a wonderful article by Darrach in1990 in LIFE Magazine, is the Big Apple Circus Clown Care Unit® in New York City.  This program is funded by the Big Apple Circus®, a non-profit organization, the host hospitals, and other gracious contributors and foundations.  Michael Christensen, also known as Dr. Stubs, founded this organization in 1985 after his brother died of pancreatic cancer. Clowns in the Big Apple Circus Clown Care Unit® work for five hours a day and earn approximately the same amount of money they could make in one to two hours entertaining in the commercial world, such as at a child’s birthday party.   When these clowns audition for the clown care unit, they are expected to demonstrate circus and theatrical talents.  Once selected, they participate in a six-month training program where they learn about caring clowns as well as hospital procedures and hygiene.  Three to five days a week, fifty weeks out of the year, they spread cheer in hospitals throughout New York City’s metropolitan area and have been well received.  The Big Apple Circus Clown Care Unit® has affiliate programs throughout the United States and many other countries throughout the world.

“Clowns on Rounds” which can be found in the New York State Capital Region (the Albany area) is another program which pays their clowns to visit the area’s hospitals.  While many volunteer caring clowns roam throughout the whole hospital or nursing home, Clowns on Rounds is the only program, at the moment, that pays clowns to visit the entire hospital, instead of focusing solely on the children’s units.  These clowns can be found examining their patient’s funny bones, providing red nose transplants and drawing blood, with a crayon of course!

Another ‘paying’ clown program, “Clowns for Children’s Hospital” at Children’s Hospital of Wisconsin in Milwaukee, Wisconsin was recently spotlighted in the Hospital Clown Newsletter (Volume 5, Number 1, 2000).  This program was made possible by funding from the Children’s Hospital of Wisconsin and the International Clown Hall of Fame.  “Clowns for Children’s Hospital” originally started as a volunteer program with fourteen people involved in a seven month mentoring program.  “Mentoring introduced them to hospital protocols and infection control routines, as well as the highly specialized work of interacting with patients and families” (Schwebke, 2000, p.3).  After much consideration, it was decided that the program would become a professional based program (paying clowns) and would use fewer clowns who would be at the hospital on a more regular basis in order to provide consistency and reliability for the patients and hospital staff.  It now only includes four clowns plus the director, Korey Thompson, also known as Tunkal the clown.  The clowns visit the inpatient units on a weekly basis and offer a show once a month for patients and their family members.

Special Note for Teachers and Leaders

As the leader of a Caring Clown Program, you will need to determine what type of program you want to create (performance emphasis vs. therapeutic clowning; volunteer vs. paid) and your budget.  This will help aid your decision making such as whether or not the hospital/nursing home will provide all of the props and supplies (makeup, costumes, magic tricks, give-aways) or if this should be an individual clown’s responsibility.  Since caring clown programs run on many different budgets, there are special suggestions and tips for volunteer programs, or those programs with small budgets.  Look for the TIP sign within each special considerations and skills topic.

If you are planning to run a volunteer program, one group of people to consider training are grandparents and others who have retired.  After retiring from one career, a number of executives, bankers, and teachers have found a most rewarding second career as caring clowns.  Offering classes at senior centers, retirement villages or community centers that have special programs for seniors is one way to invite them to join your program.

As a leader, you will also need to decide how many people you would like to include in your program and what the age range will be.  As mentioned in the introduction, it is recommended that the training sessions consist of approximately 6-8 students of similar age who already know basic clown skills.  These classes are best suited for people 12 years of age or older.  See Appendix B for an adolescent version of the Clown’s Code of Ethics.  It is important to check with the facility that you plan to visit to see if they will allow ‘children’ clowns to visit patients/residents.  Many hospitals have visitor age-restrictions.  Find out if there are certain areas in the hospital where teen-agers would be allowed to clown with a supervising adult clown.

Often, clowns are concerned about bringing teen-agers into a hospital setting as caring clowns.  Based on my experience, training teenagers to become caring clowns has been extremely rewarding.   It has provided a positive activity for the teens helping them make a contribution to society.  It also increases their self-confidence and self-esteem while exposing them to populations with whom they might not otherwise have had interactions.  If your program plans to involve teenagers, be aware that teens are often busy with homework and extra curricular activities and are not always able to make a regular commitment.  Most teens are able to commit to coming at least once a month.

A sample training program follows this section, use it creatively.  These are only examples and guidelines, not specific instructions.  Bring your own experience and expertise into your classes.  Your stories and personal experiences will be a better teacher than any article or book.

Sample Training Program

Session 1	Introductions, Personal and Class Goals, History of Clowning, The Positive Effects of Humor, Defining ‘Caring Clown’, The Clown Code of Ethics
Session 2	Specific Hospital/Nursing Home Procedures & Policies, Safety Measures
Session 3	Balloons and Magic for Caring Clowns
Session 4	Skits and Puppetry for Caring Clowns
Session 5	Special Populations, The Hospital Visit (Role Plays)
Session 6	Continuing Education/Professional Development
Session 7	Reflection and Evaluation of Training
Additional Apprenticeship (10 hours: to occur after Session 5 before Session 7)

The sample training program is set up to consist of seven (7) weekly, two hour “in class” sessions.  There is also an additional “apprenticeship” that adds to the training experience, that is not included in the “in class” sessions.  As a leader, you must decide how many apprenticeship hours you think your students should have and how you will monitor this.

Getting Started

On the first day of classes, before the group arrives, have all the materials prepared and in place.  Provide a structured environment with an outlet for creativity.  Dress in bright, cheerful clothes, wear a loud hat or a funny pin.  Set the mood for the group.  Show your enthusiasm and energy while exhibiting professionalism.

During the classes, encourage individuality.  A good leader will take enthusiasm and creativity and guide it into appropriate outlets.  Each clown brings an area of expertise into the caring clown class.  One clown might specialize in bubbles, another in puppetry, another in improvisation.  Remember this and encourage each clown to find and build on his or her own expertise.  Encourage individuality when developing routines or skits.  Allow your clown students to create their own skits or activities.  Let the dialogue develop spontaneously from your students or encourage them to personalize an established skit that you provide.

Listen to your clown students.  Not only will you hear their questions, excitement, and fears, but you will also be modeling a caring clown skill.  If your program is the type that is trying to make a connection with a patient or resident, listening to that patient or resident is what will help create a meaningful connection.

While visiting a hospital or nursing home is part of the training, do not require a student to participate before he or she is ready.  See the section on Mentoring for thoughts on how to help a student prepare to visit a hospital or nursing home.

Mentoring - Apprenticeships

Formal mentoring or supervision is still a relatively new idea in the caring clown world.  Traditionally, clowns have been mentored into the life and world of clowning by apprenticing with more experienced clowns.  Clowns are very generous characters and are always willing to help each other.  These young apprentices were called “1^st of Mays.”  When the circus first started back in the late 1700’s, the beginning of May is when the travelling tour would begin.  This meant that this was the time when the new clowns would be able to start showing off their newly acquired skills.  Today new clowns are still known as “1^st of Mays” until the end of their first year when they take the traditional name “Joey.”  Offering your students the chance to be mentored or receive supervision is a positive addition to your training program.  This will provide newer caring clowns with the opportunity to learn from more experienced clowns.  It also provides the opportunity for support and immediate feedback during and following a visit to a patient or resident.

I was mentoring two teenage clowns in a hospital that served the elderly and chronically ill.  These two young women approached one room, and after knocking on the door, reported to me that the resident did not want a clown to visit.  Since I had witnessed the attempt, I realized that the resident probably did not understand what they were asking, since he was severely mentally handicapped.  I had the two clowns watch as I approached the young man very slowly blowing bubbles.  I was not sure if this resident would know that I was a clown, or if he did recognize that I was a clown, if he would appreciate such a visitor.  I continued to sing a little jingle as I blew bubbles and cautiously approached what I thought was his range of view.  All of a sudden, a huge grin grew on his face.  He started talking, but it was very difficult to understand him.  I continued to blow bubbles for a bit and then made a balloon dog for him.  He had a hard time holding on to the dog, so I placed it on the table next to his bed.  The young man tried to reach for it again, so I put it on his bed.  He quickly hugged it and held it as I began to blow bubbles again and make my exit.  Although the new clowns originally believed that this man was not interested in receiving clown visitors, they were able to receive immediate feedback and to observe me modeling an appropriate interaction.  We were able to discuss their reactions after we left the room.

In the sample training program, you will notice there is an opportunity for role-playing (Session 5) prior to going to the hospital.  This works as a first step in mentoring or providing supervision.  Many people feel a little uncomfortable being on stage or acting in front of their peers at first.  However, I have found that role-playing has been a useful and much appreciated activity to help new caring clowns overcome their fears and to work out any kinks they might have in their interaction or responses to patients. 

There are a few possible ways to organize the role-play.  For example, in the beginning, you could announce what type of setting the caring clown will be walking into and what he or she should expect.  Another activity is to have the clown who is role-playing the ‘patient’ secretly decide how he or she will act and what his or her symptoms are.  I bring cards with different types of patient/resident behaviors and symptoms for my clown students to pick as yet a third way to organize the role-play activity.  This way, the role-play becomes similar to the game of charades and provides a guideline for those students who are having difficulty thinking of behaviors or symptoms on their own.  Have different clowns play different types of patients or residents.  Try to cover a large age range and a variety of symptoms.  For example, a person could role-play a scared child, an angry teenager, or a lonely elderly patient who has not had a visitor in weeks.

After the general training and role-play are complete, and once the clowns feel comfortable in a number of different situations, and are responding appropriately to the role-play patient/resident, it is time to move to the real patient/resident.  This is the additional ten hour “apprenticeship” mentioned in the sample training program.

There are a number of different ways to approach this part of the training.  One way is to let your students go and trust that you have trained them properly and that they will be fine.  Another way to approach the apprenticeship is to schedule a time in which you would accompany each individual during his or her ten hours of visits to provide a one-on-one mentoring opportunity.  A third possibility, one that will save you some time and provide your students with that support that is so often requested during a first visit, is to go to the hospital or nursing home as a group.  Clowns who feel more comfortable or who have had some previous experience in a medical setting can pair up with clowns that are less comfortable or have not had any previous experience.  You, as the leader, can rotate through the class and visit different rooms with different clowns.  I have also found that many experienced clowns are willing to have a new caring clown tag along, either watching from the doorway or joining in the action.  However, there are also some caring clowns who are very protective of their environment and their skits and would not welcome the opportunity to share their experience.

During an apprenticeship, new caring clowns should have an opportunity to reflect on their experiences.  Providing a weekly meeting time allows new clowns an opportunity to share their experiences and to receive feedback from other clowns in the group.  Occasionally clowns will have unexpected personal issues arise that can either help or hurt their interactions with patients/residents.  Being able to discuss this and receive feedback from other clowns, and you, the experienced leader is beneficial. 

It is also a good idea to have someone in the hospital or nursing home identified for clowns to contact if they observe something they are not sure how to handle.  For example, if a clown observes some family dynamics in a room that he or she believes to be counterproductive to a patient’s health, he or she can discuss it with the identified contact (i.e. psychologist, social worker, or customer representative) to alert hospital or nursing home staff.  This is also something the clown will be likely to want to discuss during the weekly meeting time, to receive feedback on how other clowns would have reacted or handled the situation if they had been in that situation.

There is more about mentoring and reflecting on experiences in the Section 8 under professional development since this is important throughout your program, not just during the apprenticeship.

Records

While some administrators may request that a clown keep records of how many people he or she has interacted with or touched, this can be very challenging.  It is possible to keep a running count of how many rooms you visited and how many patients or family members were in each room.  But it is more difficult to count the people you affect in the lobby or the emergency waiting room, or as you walk down the hall to a specific unit.  If you are truly focusing on making a connection with your audience, you will find it difficult to count all of the people in the lobby that might be smiling as you entertain a scared child.

Some clown programs have opted for qualitative records as opposed to quantitative records.  In the “Clowns for Children’s Hospital” program, clowns are required to keep a journal of each day they spend in the hospital.  This is a place for clowns to record how they touched someone or how a patient reacted to their visit.

Building on this idea, clowns could record any comments or thoughts they had about their interactions with patients, family members or staff.  What went well, what did not?  Were there any surprises or disappointments during their visits that day?  Your clown group could also keep a group journal where clowns record their experiences to share with others. While keeping a group journal is a great idea, it does not replace clowns actually getting together to talk about their experiences and should only be used as a supplement.