Stephen Spotswood

Capt. Sara Kass, MD

BETHESDA, MD—If Capt. Sara Kass, MD, has any regrets about the path that led her to her current role of military medical adviser for Creative Forces—a unique program that straddles DoD, VA and the National Endowment for the Arts—it might be that she didn’t recognize the power of art therapy sooner.

Her career in the Navy started like many others. She wanted to go to medical school, and the Navy’s Health Professions Scholarship program was a good way to pay for it. She trained as a family physician, expecting to do her time and leave but found the military so rewarding that she spent the next 23 years exploring the opportunities it could provide.

The last decade of that career was focused on wounded warrior policy. She was involved in developing and implementing programs designed to meet the needs of the latest generation of wounded soldiers. In 2011, she became the medical director for the National Intrepid Center of Excellence (NICoE)—DoD’s TBI and PTSD research center in Bethesda, MD.

At NICoE, art therapy was included as part of servicemembers’ highly integrated care regimen. In individual and group sessions, patients would paint, create collages and make paper mache masks, among other activities. Rather than in a traditional art class, the focus is not on the end product but on how the process of creation can act as a springboard for other discoveries.

“It has to do with creation and engagement,” Kass explained. “Patients who are struggling with TBI and PTSD often find themselves frustrated in a traditional model of care that involves sitting in a room and talking about what they’re experiencing. In art therapy, they have to be an active participant in the therapy. It makes them engaged in every other aspect of their care.”

“It also provides a new way to communicate,” she added. “Physiologically, it allows them to use a different part of their brain to express what they’re struggling with and what they’re dealing with.”

Most physicians, Kass admitted, know little about the benefits of art therapy, and likely consider it an unnecessary add-on to more traditional treatments.

Masks made by military service members as part of their creative arts therapy at the National Intrepid Center of Excellence at Walter Reed Military Medical Center. Photo courtesy of the National Endowment for the Arts.

“I wish I was in tune earlier in my career, but I wasn’t really aware of the power of art in health and wellness until I took this position at NICoE and started working with art therapist Melissa Walker [who developed NICoE’s Healing Arts program],” Kass said. “I think that’s probably true of a lot of healthcare providers in the military and in the civilian sector. If you don’t have exposure to creative arts therapists, you don’t know what they have to offer.”

Increasing the reach of arts therapy programs for servicemembers is what Kass is doing at Creative Forces, NEA’s Military Healing Arts Network. The network has three components: placing creative arts therapies at the core of patient-centered care in military medical facilities and telehealth programs; providing increased community-based arts opportunities for servicemembers and veterans in areas near treatment facilities; and investing in capacity-building efforts. Capacity-building includes developing manuals, doing research on the impact of art therapy and training caregivers.

There are 11 Creative Forces clinical sites around the country. VA joined the network in 2017, with Tampa’s James A. Haley VAMC being the first VA facility to stand up a new arts therapy clinic as part of the program.

“The goal for Creative Forces is to take this effective and yet sometimes not fully understood therapeutic opportunity and make it more available in many more locations, increasing access to creative arts therapy nationwide,” Kass declared. “We want to create a bigger footprint for creative art therapy by creating the kind of content and information that can be shared with other organizations and entities so they can implement programs in their own environments.”

That access to art should not end when patients leave the treatment facility, Kass noted. A full third of Creative Forces’ mission statement is devoted to promoting arts activities in the community, because they’ve found that it’s important for veterans and servicemembers to have somewhere to continue creating art after they leave the clinic.

“We want to create a connection from a clinical treatment program to community arts organizations that allow patients to stay engaged in the arts,” she explained. “We need to look beyond clinical care and see how art helps wellness and supports integration of military servicemembers and families back into the community. The goal is never just to be healthy when you leave the hospital; it’s to be healthy two, three, four years later.”

Creative Forces is supporting 12 ongoing research projects in various stages that are examining the effectiveness of art therapy and how it can best fit into an interdisciplinary model of care. The network recently hosted a summit that brought together experts from creative arts, neuroscience, psychotherapy and wounded warrior care. The goal was to understand, based on literature review, the state of creative art therapy and to identify gaps in knowledge.

Some of those gaps include needing to better define the patient population, such as breaking down patients with TBI into more specific, clinically-useful, categories. Another is gaining a better understanding of the best ways to embed create arts therapists into an interdisciplinary care team.

“We are very near completion of drafting a five-year strategic research plan that will take advantage of this network of sites where we have integrated Creative Forces programs,” Kass said.

One finding that has been reinforced over and over again by patient surveys is that the patients themselves highly value the art therapy component of their treatment. “It’s rated by patients as one of the most effective treatments and one of the things they most want to continue,” she explained.

This enthusiasm should not come as a surprise, Kass added. “Creative arts therapy focuses on what patients can do in creating something new. It isn’t focused on what’s broken in them. It’s about what they can achieve.”