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Shannon Halligan
Shannon Halligan

This document provides an overview of art therapy with aging populations, particularly those with Alzheimer's disease or dementia. It discusses how art therapy can engage areas of the brain not damaged by these conditions. While short-term memory is lost, emotional memory remains intact, and art provides a way to access those memories. The creative process itself can help reduce anxiety, agitation and improve mood. Several art techniques and materials are described that are appropriate and beneficial for older adults, such as collage, drawing, and texture activities. Close facilitation and a non-judgmental focus on the process rather than products is emphasized.

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Art Therapy with an Aging Population Creative Applications with the Elderly Shannon Halligan, Licensed Creative Arts Therapist
PART ONE: OVERVIEW
Facts about Alzheimers Disease Alzheimers disease or some other form of Dementia affects an estimated 24 million people worldwide. Imagination is still intact even in advanced Alzheimers. International Alzheimers experts agree that creative activities engage areas of the brain that are not damaged by the disease and reawaken a sense of personality, identity and dignity.
Effects of Alzheimers Disease Short-term memory loss. Loss of procedural memory, how to perform daily tasks. Confusion, getting lost in familiar places. Often characterized by the four As: anxiety, agitation, aggression and apathy.
Memory and Alzheimers Scientists are finding that most memories are stored as images and are not destroyed by Alzheimers. Alzheimers doesnt take away memory; the part of the brain affected by Alzheimers is the part that gives you access to memory.
What is Art Therapy? Art Therapy uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. -American Art Therapy Association
What is Art Therapy? Art Therapy uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. -American Art Therapy Association
What is Art Therapy? Art Therapy uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. -American Art Therapy Association
Art Therapy/Creative Arts is Not not: Art Therapy is not about being a great artist. You do not have to be an artist to benefit from art therapy. You also do have to be an artist to offer creative arts programs. Art Therapy is not about learning skills, but enjoying the process of being creative. Skills are often gained but thats not the core aspect of art therapy. Is not arts and crafts, or art education, art therapy can be any activity that has a therapeutic purpose.
Art washes from the soul the dust of everyday life -Pablo Picasso People dont need short-term memory to enjoy art. Art can decrease the four As that characterize Alzheimers disease: anxiety, aggression, agitation and apathy. Emotional memory comes alive even in the face of Alzheimers. Feelings people have had before resurface and they can relate them to events and people earlier in their lives.
Benefits of Creative Arts Improves Concentration, focus. Promotes independence and independent choice making. Alternative way to communicate. Art allows one to communicate in a non- verbal way. Better Behavior: Promotes relaxation, improves mood and decreases disruptive behavior. Art projects can help open lines of communication and expression, as well as provide a sense of accomplishment. Closer relationships: Increases socialization, decreases isolation.
Art Is: Non-verbal. Emotional. Encouraging hands-on exploration of materials. For example, clay gives resistance and makes muscles work. A creative way to bypass physical or mental limitations.
Why Art? To enjoy a movie, one needs to remember the beginning to understand the end. With an image or painting, its all there to experience at once in the moment. Art can increase opportunities for joy in the MOMENT. New York Movie, Edward Hopper, 1939 MOMA
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Research Dr. Oliver Sacks, Professor of Psychology and Neurology, studies Alzheimer's at Columbia University. Dr. Sacks wrote the book, Awakenings, and the movie is based on his work with Alzheimers patients. Theorizes that music and art engage parts of the brain that govern procedural memory, which controls routine physical activities. He believes that these brain centers remain intact long after the onset of the disease. Nietzsche used to say that we listened to music with our muscles, he said. The question is whether a similar mechanism is at work in making and looking at art.
I remember better when I paint. Actress Rita Hayworth suffered from Alzheimers Disease later in her life. She chose painting to soothe and relax her. This film documents the benefits of creative arts for people with Alzheimers/Dementia: http://www.youtube.com/watchv=54AtoQVGfwU&featur e=related
PART TWO: ACTIVITY IDEAS & DIRECTIVES
Pre-planning and Materials Art materials have qualities associated with them. Materials evoke emotional reactions. There should be careful consideration when planning art activities.
I found I could say things with color and shapes that I couldn't say any other way - things I had no words for ~ Georgia OKeeffe Georgia O'Keeffe
Colors Have Feelings Colors have emotions associated with them. Simple Color Association Activities: Show participants single color sheets and have them name a feeling/emotion that they associate with it. Example: Blue: Sad/Calm, Red: Love/Anger, Yellow: Happiness, White: Peace, Healing.
Examples of Art Materials Collage: Structured, controlled. Allows person to choose pictures rather than drawing; can help ease the transition into making artwork. Excellent with cognitive deficits. Pastels: Less controlled. Can be blended and used for shading. Drawing: Pencils, Colored pencils, markers: Dry materials are the safest art medium. Colors are emotional. Allow for control and fine detail. Provide template to begin such as a outline of a shape or item. Paint: Somewhat regressive medium, encourages expression of feelings by blending colors and brush strokes. Example: finger paint is more regressive than painting with a brush. Paint with various applicators: sponges, Q-tips, rollers, foam brushes, etc. Regressive means that is can cause a person to return to an earlier state, such as a child-like state of behavior. Clay: very regressive material. Tactile quality provides for free association. Can be primitive. Can be built, destroyed, and rebuilt, as well as encourage play and storytelling.
Qualities of Art Materials When planning art projects for groups, start with simple materials, then work your way up to more complex materials. Do not introduce wet and regressive materials for first activities. Dry Materials: pencils, colored pencils, pastels, fabric, collage, markers. Wet Materials: Paint, watercolor, etc. Regressive Materials: clay, messy projects. [example]
I dont know what I am doing, but I am doing it! [Story] Her hands remembered when the familiar materials were in hand. Use familiar materials in unique ways. For example, wrap yarn around wood frames, decorate with buttons, costume jewelry, etc.
Touch and Memory Promote recall of memories using textures. Tactile items have qualities that remind participants of things experienced in their lives. Textures may include: smooth, rough, soft, hard, bumpy, silky, fuzzy. Examples of textured items: marbles, beads, wire, yarn, ribbon, sandpaper, foam, cotton, velvet, silk, rice, beans, seashells, wood, clay.
Texture Collage
Textured Collage: Beach, Water, Sky Canvas sectioned into 3.
Mandalas: Texture
Sand Mandala
Guidelines for Art Making: Basics Choose projects that only require basic instruction and assistance. Model how to use materials. Avoid toxic substances and sharp tools (Safety) Mid to high quality materials such as fine art markers, pencils, watercolor papers, etc. There are good quality art materials that arent designed for kids, avoid Crayola or things that make participants feel like children. Focus on the process not the final product.
Tips and Techniques: Exploration Not all art projects have to have to have a final product. Art Therapy is about the process of art-making. Focus on the emotions, feelings, ideas that come from doing something with your hands. Use textured fabrics, in bold colors and patterns. Pass fabrics around, have people explore with their hands. Explore ribbons, yarns, lace, etc.
Guidelines for Art Making: The Process Allow participants the choice to just watch instead of participating. Use images to spark discussion, facial expressions or emotions. Build conversation into the project by initiating storytelling. Comment on dedication to process, rather than judgements of final product and using words such as beautiful, pretty, nice, etc. Comment on behaviors and process such as working hard, using lots of colors, etc. Have them work together, assemble a final product. Decrease opportunities for judgement.
Guidelines for Helping Help the person begin the activity. Provide encouragement. Provide enough time to complete the project or the opportunity to complete the project in another session. Avoid doing for. If the task is complex, break into smaller steps. Allow participants to do the parts that they can. One participant may be able to cut, while another may be able to just choose a color of paper. The artwork is complete when the person says it is.
Socialization: Making Connections Sustaining Empathy Communication
Art Activities Fabric Art: Layering, Painting over, quilting with glue or safety needles and yarn. Tactile interesting pieces, assembled together. Adult coloring sheets: mandalas, Zentangles, etc. Color shapes, color mixing, form. Instead of a blank white sheet of paper, give them a piece in the shape of a circle, star, flower, etc.
Mixed Media Letter Painting: Making Sense of Dementia
Fabric Quilting
Wire-Wrapped Frames Texture/Found Items Floral Arrangements: Use of Color, Texture
Frog Pond:Clay Scene with Found Objects Clouds and Sun
G温姻糸艶稼
Group Mosaics
Garden Mosaic
Tile Mosaics
Puppets, Etc. Felt Puppet, mixed media. [Cross made of clay, added textures] Memory of her Father.
Tips and Techniques Still life: use vase of flowers or arrangement of real items. *Drawing from real life is easier than drawing from photos Work on table easels instead of flat on tables. Break down items such as flowers into shapes: circles, ovals, bell, square, etc.
Zentangles Repetitive patterns, motions may be soothing and calming.
Art History Show art history images of famous painters: Impressionists (Monet, Van Gogh, Degas, etc.), Renaissance (DaVinci, Michelangelo, etc.) Ask participants what they see in the paintings, what the people are doing, where they are going, etc. Begin a narrative description and write down what the participants say on a large sheet of paper. The final product is a collection of their thoughts.
Art History What do you feel when looking at a Starry Night?
Art History What feelings do these images evoke in you?
Mens Groups Wood working, building, hands on. Use glue instead of sharp tools, make a simple box frame and then they can add details instead of building from scratch. Practical projects that have a useful purpose. Fixing objects, make them feel like they are helping. Looking at images of design, tables, shelves, garden boxes, etc.
Time Slips http://www.timeslips.org [Interactive Site] Can be trained to facilitate program.
Altered Images: A picture is worth a thousand words . . . He is a spiffy man from Broadway and she is a plain girl with no make- up. She is wearing a fancy hat, black bathing suit and slippers. They are on the beach because they want to show off their outfits!
Altered Images Ask questions like: Did you ever wear a coat like this? Did you ever ride in a car like this? Where were you going? What is the person doing? What are they thinking about? These type of questions can help a person with Alzheimers bring back happy memories. *There are no wrong answers. Sometimes the subconscious process is often expressed in artwork... things that can no longer be described in words.
Other Forms of Art Music: Live music, recordings, cds, percussion instruments, etc. Gallery/Museum Visits Movement and Dance: simple movements in chair or standing. Motion can decrease agitation. Invite local artists, historians to discuss and show local artwork. Utilize strengths of volunteers/students/community members to share their knowledge of creative arts with your participants.
Part 3: Moving Forward: Expanding our Creativity
Working with Resistance Why are people reluctant? Fear Self-consciousness Memory issues. Cognitive issues Depression/Anxiety. Medical issues that cause fatigue, illness, etc. People may verbally refuse and say they cannot do something, or try to get you to do it for them. Positive, calm encouragement works best to promote independence and interaction.
Working with Fear Every child is an artist. The problem is how to remain an artist once we grow up. ~Pablo Picasso What would you make if you had no fear? Children are natural artists as they do not have the fear of failure and self-consciousness that adults do. Elderly people may be able to dive in more often that we expect, especially if they are not afraid of looking silly. Role-model activities, they will be more likely to try something if they observe you doing it.
What Is the Point of Creative Arts? Promotes quality of life. Allows people to live in the here and now, enjoy the present moment. Allows people to take a break from limitations and frustrations. They may not remember the experience, but will remember the feelings it evokes. Allows people to retain their dignity.
Resources MOMA (Museum of Modern Art) Meet Me at MoMA is one of about a dozen such programs in the U.S. in which the museum closes for a time in order to allow their Alzheimers guests to focus on the works of art without the distraction or anxiety that might be generated by other viewers around them. Musicophilia: Dr. Oliver Sacks [http://www.oliversacks.com] For information about the Alzheimers Associations art therapy program Memories in the Making, visit: http://thememoriesinthemaking.com
Hands-on Activity: Reaching for the Stars Side 1: Write/draw a memory that you cherish, that you want to always remember. Write words but add a few images, symbols, simple sketches. On backside, write one way in which you will be more creative in your programming with older adults. When complete, hole punch and hang with other stars for inspiration.
For my part I know nothing with any certainty, but the sight of the stars makes me dream. Vincent Van Gogh THANK YOU!

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Conferenceppt

  • 1. Art Therapy with an Aging Population Creative Applications with the Elderly Shannon Halligan, Licensed Creative Arts Therapist
  • 3. Facts about Alzheimers Disease Alzheimers disease or some other form of Dementia affects an estimated 24 million people worldwide. Imagination is still intact even in advanced Alzheimers. International Alzheimers experts agree that creative activities engage areas of the brain that are not damaged by the disease and reawaken a sense of personality, identity and dignity.
  • 4. Effects of Alzheimers Disease Short-term memory loss. Loss of procedural memory, how to perform daily tasks. Confusion, getting lost in familiar places. Often characterized by the four As: anxiety, agitation, aggression and apathy.
  • 5. Memory and Alzheimers Scientists are finding that most memories are stored as images and are not destroyed by Alzheimers. Alzheimers doesnt take away memory; the part of the brain affected by Alzheimers is the part that gives you access to memory.
  • 6. What is Art Therapy? Art Therapy uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. -American Art Therapy Association
  • 7. What is Art Therapy? Art Therapy uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. -American Art Therapy Association
  • 8. What is Art Therapy? Art Therapy uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. -American Art Therapy Association
  • 9. Art Therapy/Creative Arts is Not not: Art Therapy is not about being a great artist. You do not have to be an artist to benefit from art therapy. You also do have to be an artist to offer creative arts programs. Art Therapy is not about learning skills, but enjoying the process of being creative. Skills are often gained but thats not the core aspect of art therapy. Is not arts and crafts, or art education, art therapy can be any activity that has a therapeutic purpose.
  • 10. Art washes from the soul the dust of everyday life -Pablo Picasso People dont need short-term memory to enjoy art. Art can decrease the four As that characterize Alzheimers disease: anxiety, aggression, agitation and apathy. Emotional memory comes alive even in the face of Alzheimers. Feelings people have had before resurface and they can relate them to events and people earlier in their lives.
  • 11. Benefits of Creative Arts Improves Concentration, focus. Promotes independence and independent choice making. Alternative way to communicate. Art allows one to communicate in a non- verbal way. Better Behavior: Promotes relaxation, improves mood and decreases disruptive behavior. Art projects can help open lines of communication and expression, as well as provide a sense of accomplishment. Closer relationships: Increases socialization, decreases isolation.
  • 12. Art Is: Non-verbal. Emotional. Encouraging hands-on exploration of materials. For example, clay gives resistance and makes muscles work. A creative way to bypass physical or mental limitations.
  • 13. Why Art? To enjoy a movie, one needs to remember the beginning to understand the end. With an image or painting, its all there to experience at once in the moment. Art can increase opportunities for joy in the MOMENT. New York Movie, Edward Hopper, 1939 MOMA
  • 15. Research Dr. Oliver Sacks, Professor of Psychology and Neurology, studies Alzheimer's at Columbia University. Dr. Sacks wrote the book, Awakenings, and the movie is based on his work with Alzheimers patients. Theorizes that music and art engage parts of the brain that govern procedural memory, which controls routine physical activities. He believes that these brain centers remain intact long after the onset of the disease. Nietzsche used to say that we listened to music with our muscles, he said. The question is whether a similar mechanism is at work in making and looking at art.
  • 16. I remember better when I paint. Actress Rita Hayworth suffered from Alzheimers Disease later in her life. She chose painting to soothe and relax her. This film documents the benefits of creative arts for people with Alzheimers/Dementia: http://www.youtube.com/watchv=54AtoQVGfwU&featur e=related
  • 17. PART TWO: ACTIVITY IDEAS & DIRECTIVES
  • 18. Pre-planning and Materials Art materials have qualities associated with them. Materials evoke emotional reactions. There should be careful consideration when planning art activities.
  • 19. I found I could say things with color and shapes that I couldn't say any other way - things I had no words for ~ Georgia OKeeffe Georgia O'Keeffe
  • 20. Colors Have Feelings Colors have emotions associated with them. Simple Color Association Activities: Show participants single color sheets and have them name a feeling/emotion that they associate with it. Example: Blue: Sad/Calm, Red: Love/Anger, Yellow: Happiness, White: Peace, Healing.
  • 21. Examples of Art Materials Collage: Structured, controlled. Allows person to choose pictures rather than drawing; can help ease the transition into making artwork. Excellent with cognitive deficits. Pastels: Less controlled. Can be blended and used for shading. Drawing: Pencils, Colored pencils, markers: Dry materials are the safest art medium. Colors are emotional. Allow for control and fine detail. Provide template to begin such as a outline of a shape or item. Paint: Somewhat regressive medium, encourages expression of feelings by blending colors and brush strokes. Example: finger paint is more regressive than painting with a brush. Paint with various applicators: sponges, Q-tips, rollers, foam brushes, etc. Regressive means that is can cause a person to return to an earlier state, such as a child-like state of behavior. Clay: very regressive material. Tactile quality provides for free association. Can be primitive. Can be built, destroyed, and rebuilt, as well as encourage play and storytelling.
  • 22. Qualities of Art Materials When planning art projects for groups, start with simple materials, then work your way up to more complex materials. Do not introduce wet and regressive materials for first activities. Dry Materials: pencils, colored pencils, pastels, fabric, collage, markers. Wet Materials: Paint, watercolor, etc. Regressive Materials: clay, messy projects. [example]
  • 23. I dont know what I am doing, but I am doing it! [Story] Her hands remembered when the familiar materials were in hand. Use familiar materials in unique ways. For example, wrap yarn around wood frames, decorate with buttons, costume jewelry, etc.
  • 24. Touch and Memory Promote recall of memories using textures. Tactile items have qualities that remind participants of things experienced in their lives. Textures may include: smooth, rough, soft, hard, bumpy, silky, fuzzy. Examples of textured items: marbles, beads, wire, yarn, ribbon, sandpaper, foam, cotton, velvet, silk, rice, beans, seashells, wood, clay.
  • 26. Textured Collage: Beach, Water, Sky Canvas sectioned into 3.
  • 29. Guidelines for Art Making: Basics Choose projects that only require basic instruction and assistance. Model how to use materials. Avoid toxic substances and sharp tools (Safety) Mid to high quality materials such as fine art markers, pencils, watercolor papers, etc. There are good quality art materials that arent designed for kids, avoid Crayola or things that make participants feel like children. Focus on the process not the final product.
  • 30. Tips and Techniques: Exploration Not all art projects have to have to have a final product. Art Therapy is about the process of art-making. Focus on the emotions, feelings, ideas that come from doing something with your hands. Use textured fabrics, in bold colors and patterns. Pass fabrics around, have people explore with their hands. Explore ribbons, yarns, lace, etc.
  • 31. Guidelines for Art Making: The Process Allow participants the choice to just watch instead of participating. Use images to spark discussion, facial expressions or emotions. Build conversation into the project by initiating storytelling. Comment on dedication to process, rather than judgements of final product and using words such as beautiful, pretty, nice, etc. Comment on behaviors and process such as working hard, using lots of colors, etc. Have them work together, assemble a final product. Decrease opportunities for judgement.
  • 32. Guidelines for Helping Help the person begin the activity. Provide encouragement. Provide enough time to complete the project or the opportunity to complete the project in another session. Avoid doing for. If the task is complex, break into smaller steps. Allow participants to do the parts that they can. One participant may be able to cut, while another may be able to just choose a color of paper. The artwork is complete when the person says it is.
  • 34. Art Activities Fabric Art: Layering, Painting over, quilting with glue or safety needles and yarn. Tactile interesting pieces, assembled together. Adult coloring sheets: mandalas, Zentangles, etc. Color shapes, color mixing, form. Instead of a blank white sheet of paper, give them a piece in the shape of a circle, star, flower, etc.
  • 37. Wire-Wrapped Frames Texture/Found Items Floral Arrangements: Use of Color, Texture
  • 38. Frog Pond:Clay Scene with Found Objects Clouds and Sun
  • 43. Puppets, Etc. Felt Puppet, mixed media. [Cross made of clay, added textures] Memory of her Father.
  • 44. Tips and Techniques Still life: use vase of flowers or arrangement of real items. *Drawing from real life is easier than drawing from photos Work on table easels instead of flat on tables. Break down items such as flowers into shapes: circles, ovals, bell, square, etc.
  • 46. Art History Show art history images of famous painters: Impressionists (Monet, Van Gogh, Degas, etc.), Renaissance (DaVinci, Michelangelo, etc.) Ask participants what they see in the paintings, what the people are doing, where they are going, etc. Begin a narrative description and write down what the participants say on a large sheet of paper. The final product is a collection of their thoughts.
  • 47. Art History What do you feel when looking at a Starry Night?
  • 48. Art History What feelings do these images evoke in you?
  • 49. Mens Groups Wood working, building, hands on. Use glue instead of sharp tools, make a simple box frame and then they can add details instead of building from scratch. Practical projects that have a useful purpose. Fixing objects, make them feel like they are helping. Looking at images of design, tables, shelves, garden boxes, etc.
  • 51. Altered Images: A picture is worth a thousand words . . . He is a spiffy man from Broadway and she is a plain girl with no make- up. She is wearing a fancy hat, black bathing suit and slippers. They are on the beach because they want to show off their outfits!
  • 52. Altered Images Ask questions like: Did you ever wear a coat like this? Did you ever ride in a car like this? Where were you going? What is the person doing? What are they thinking about? These type of questions can help a person with Alzheimers bring back happy memories. *There are no wrong answers. Sometimes the subconscious process is often expressed in artwork... things that can no longer be described in words.
  • 53. Other Forms of Art Music: Live music, recordings, cds, percussion instruments, etc. Gallery/Museum Visits Movement and Dance: simple movements in chair or standing. Motion can decrease agitation. Invite local artists, historians to discuss and show local artwork. Utilize strengths of volunteers/students/community members to share their knowledge of creative arts with your participants.
  • 54. Part 3: Moving Forward: Expanding our Creativity
  • 55. Working with Resistance Why are people reluctant? Fear Self-consciousness Memory issues. Cognitive issues Depression/Anxiety. Medical issues that cause fatigue, illness, etc. People may verbally refuse and say they cannot do something, or try to get you to do it for them. Positive, calm encouragement works best to promote independence and interaction.
  • 56. Working with Fear Every child is an artist. The problem is how to remain an artist once we grow up. ~Pablo Picasso What would you make if you had no fear? Children are natural artists as they do not have the fear of failure and self-consciousness that adults do. Elderly people may be able to dive in more often that we expect, especially if they are not afraid of looking silly. Role-model activities, they will be more likely to try something if they observe you doing it.
  • 57. What Is the Point of Creative Arts? Promotes quality of life. Allows people to live in the here and now, enjoy the present moment. Allows people to take a break from limitations and frustrations. They may not remember the experience, but will remember the feelings it evokes. Allows people to retain their dignity.
  • 58. Resources MOMA (Museum of Modern Art) Meet Me at MoMA is one of about a dozen such programs in the U.S. in which the museum closes for a time in order to allow their Alzheimers guests to focus on the works of art without the distraction or anxiety that might be generated by other viewers around them. Musicophilia: Dr. Oliver Sacks [http://www.oliversacks.com] For information about the Alzheimers Associations art therapy program Memories in the Making, visit: http://thememoriesinthemaking.com
  • 59. Hands-on Activity: Reaching for the Stars Side 1: Write/draw a memory that you cherish, that you want to always remember. Write words but add a few images, symbols, simple sketches. On backside, write one way in which you will be more creative in your programming with older adults. When complete, hole punch and hang with other stars for inspiration.
  • 60. For my part I know nothing with any certainty, but the sight of the stars makes me dream. Vincent Van Gogh THANK YOU!