In the setting of a toxic mix of pressing healthcare needs, poverty, and structural social injustice, the UCSF/Mount Zion MERI Center for Education in Palliative Care and Glide Memorial Church will collaborate to build, operate, and sustain a Poetic Medicine program to promote health and dignity for members of the San Francisco Tenderloin Community, to foster resiliency for the Glide volunteers, congregants, and staff who serve this community, as well as to encourage interest and compassion among UCSF pre-professional learners for working with BIPOC communities.

Poetic Medicine for Health, Dignity & Social Justice

1. Applicant/s name; title; UCSF Mount Zion academic affiliation; Community Partner affiliation (if applicable)

Michael Rabow, MD, Director of the UCSF/Mount Zion MERI Center for Palliative Care Education

Marvin White, MDiv, Director of Celebration, Glide Memorial Church / GLIDE Foundation

2. Contact information: address, email, phone 

Michael Rabow, MD

The UCSF/Mount Zion MERI Center

1545 Divisadero St, 4^th Floor

San Francisco, CA 94115

415-215-4904

3. Project Title

Poetic Medicine for Health, Dignity & Social Justice

4. Brief Project Description (including the following elements):

One Sentence Project Summary

In the setting of a toxic mix of pressing healthcare needs, poverty, and structural social injustice, the UCSF/Mount Zion MERI Center for Education in Palliative Care and Glide Memorial Church will collaborate to build, operate, and sustain a Poetic Medicine program to promote health and dignity for members of the San Francisco Tenderloin Community, to foster resiliency for the Glide volunteers, congregants, and staff who serve this community, as well as to encourage interest and compassion among UCSF pre-professional learners for working with BIPOC communities.

Development of the MERI Mission

The MERI Center launched as a Mount Zion Health Fund-supported program at UCSF in July of 2018 to promote “primary palliative care” education for UCSF/Mount Zion healthcare providers across a range of specialty areas so they could better care for their patients facing serious illness and the end of life. Over the subsequent years, as a result of the distress, losses, and re-evaluation of priorities due to the COVID pandemic and the truth of the Black Lives Matter and other social justice movements, MERI has adapted and grown to focus on “universal palliative care” education for all people, beyond just healthcare workers. Our target audience is expanding to include more diverse communities and our mission is enhanced to include explicitly the principles of equity, inclusion, and anti-oppression. Notably, our educational offerings now include a focus on the utilization of the Humanities, specifically the burgeoning field of “Poetic Medicine.” 

• List of Goals

(1) Develop a sustainable Poetic Medicine program as a collaboration between the UCSF/Mount Zion MERI Center and Glide Memorial Church, serving Glide’s underserved BIPOC population living in the San Francisco Tenderloin community

(2) Promote health equity in the provision of palliative care via Poetic Medicine with a social justice focus

(3) Promote resiliency among providers, staff, congregants, and volunteers at Glide Church via Poetic Medicine with a “Wounded Healer” focus

(4) Promote the dignity of self-expression and the normalization of the varied and personal reactions to loss via public dissemination of poetry created, including payment to the published/presented poets

(5) Create training opportunities for UCSF learners (students, residents, fellows) to improve their facility with and commitment to engage in service to marginalized communities

(6) Further the development of the academic field of Poetic Medicine, building on MERI’s co-authorship of the seminal paper “Poetry as a Healing Modality in Medicine: Current State and Common Structures for Implementation and Research,”published in 2022 in the Journal of Pain and Symptom Management.

• Specific Aims

Specific Aim 1: to have Glide and MERI collaborate on a customized, sustainable series of Poetic Medicine programs for Glide’s SF Tenderloin BIPOC clients, their families, and staff/volunteers/congregants, as well as for UCSF pre-professional learners.

Specific Aim 2: to generate testable hypotheses, via participant observations, on the benefits to BIPOC participants and to health pre-professional learners of engaging with Poetic Medicine and specifically what is “healing” about Poetic Medicine.

• Details of Poetic Medicine Sessions

Current MERI Poetic Medicine sessions have been extremely well-received, with more than 4100 non-unique participants from around the world over the last three years.  MERI Poetic Medicine sessions follow a shared pedagogical outline, including poem reading (2 poems/session), a writing prompt, a 5-minute poem write, and participant poem reading & reflection. Evaluation (detailed in the JPSM paper) shows the sessions to be extremely valuable to participants.  In the current Open Proposals submission, one former participant described it as “transformational.”  

For the proposed project, MERI and Glide will develop customized Poetic Medicine Sessions to serve three core communities within Glide: the Poetic Medicine Street Intervention, Poetic Medicine for Congregational Life Groups, and Poetic Medicine for other Glide Groups (e.g. Glide’s yoga class).  Across these three arms, Poetic Medicine will be available to Glide Clients, Care-partners (families and friends), Staff/Volunteers/Congregants, and Pre-professional UCSF Learners.   The Poetic Medicine sessions will be developed serially over the course of project Years 1 and 2, and run through Year 3 of the project.

With the guidance of the Glide Poetic Medicine Resident (see below), the creation of each session will be launched with an initial needs assessment/community exploration to understand how stories are currently being told in the community and how people in the community want to be trained. We will start with the creation of a new Poetic Medicine for Congregational Life Group of congregants. Ultimately, each session will be developed with a specific plan for each of the following design elements:  facilitators, marketing, group size, frequency of sessions, session duration, session location, session format, and evaluation strategy (see below).  Notably, given that many participants may be unhoused and given the possibility of additional COVID lock-downs, the Poetic Medicine sessions will utilize both in-person attendance and video meeting technology.

Facilitators will be a team comprised of an experienced poetic medicine facilitator (White, Keyssar, or Rabow) working with the newly-established, annual “Glide Poetic Medicine Resident” (also known as the “Glide Poet-in-Residence”).  The Glide Poetic Medicine Resident will be hired from the local community, paid a living wage for their work, and serve for a year each as a core collaborator and leader for the further visualization and implementation of this project.  A Poetic Medicine Resident will be selected annually for each year of the project. Poems and prompts will be selected by the facilitator pairs and will typically include particular themes customized for the relevant session (e.g. hope, resiliency, wounded healer).

Session poems as well as poetic prompt selection will be directed to serve the participant community and session goals, and might include prompts such as:

-What is a poem that you would want to write?

-What do you wish you had said during a difficult personal or health care interaction?

-What would you have like to have been said to you?

-What does healing sound like, read like, or look like to you?

-Do you feel like you have been fully heard or listened to?

A Community Advisory Group (comprised of volunteers from prior MERI Poetic Medicine Groups and from Glide Memorial Church) will assist in the development and implementation of the Poetic Medicine Sessions.  Of note, one of the commentators in the Open Proposal system has already volunteered to be a part of this group.

• Details of Poetry Dissemination

Participants will be invited to share their work (a public extension of the safe space and powerful experience of self-disclosure from the inidividual Poetic Medicine groups).  During year 1, professional session facilitators will work with the Poetic Medicine Resident to decide on how poems may be documented and distributed in the community, and at what frequency.  Based on MERI, Glide, and Open Proposal feedback, possible dissemination strategies include:

            -Publication of a printed book

            -Filming of a documentary video

            -Dissemination via the internet (i.e. digital exhibition) or social media (e.g. Instagram, You Tube)

            -Public performance (poetry reading and slam)

            -Posters, post cards, banners for the community

Key to all of these strategies is being respectful of the personal elements of this poetry and promoting dignity of authors by including them in the selection of the dissemination strategy and by fairly compensating them for their creative work.  Of note, additional funding will be sought for strategies not possible with the currently submitted grant funds.

• Evaluation, Dissemination, & Sustainability

Accomplishment of the project goals and specific aims will be addressed by a rigorous evaluation and research effort, directed by Dr. Rabow.  Both quantitative and qualitative methods will be used to evaluate the project outcomes and will include assessing for program feasibility & accessibility (Specific Aim 1), program impact (Specific Aims 1 & 2), and mechanism of program impact (Specific Aim 2). 

(1) Feasibility and accessibility will be determined for each of the Poetic Medicine courses based on attendance and narrative feedback from participants. 

(2) Program impact will be measured using pre/post session evaluation and will include:  

For all participants

-Being Seen & Heard

-Comfort & Emotional Safety

            -Grief & Bereavement

            -Empathy & Compassion

            -Resiliency & Burn-out

For pre-professional learners

-Professional development including:

          -Commitment to BIPOC population

          -Clinical skills used

          -Skills learned also used elsewhere in training

Quantitative evaluation tools for the above outcomes will be used, including well-accepted, brief, validated instruments, including the “Maslach Burnout Inventory” and the “Seen & Heard” evaluation survey (see also References in the Supplementary Materials submitted).  

(3) Dr. Rabow will supervise pre-professional UCSF learner participation in further formal research analysis, including the development of a qualitative interview guide, the interviews themselves, and formal analysis/write-up.  Free response survey and qualitative interviews of participants, facilitators, and learners will generate hypotheses to explore the research questions addressing Specific Aim 2: “How does Poetic Medicine promote resiliency” and “How does Poetic Medicine heal?”

Dissemination of program findings will occur via presentation at national conferences (including the American Association of Hospice and Palliative Medicine Annual Meeting and their palliative care safety-net interest group) and publication in peer reviewed journals (including a follow-up article from our original in the Journal of Pain & Symptom Management).

Evaluation results will determine next steps for the program, including which innovations should be continued and the most effective strategies for public dissemination of the products of the Poetic Medicine sessions.  Ultimately, sustainability of the Poetic Medicine program after the MZHF Community grant project period ends will be developed during Year 3 of the project period and will be achieved via a combination of: (1) incorporating the Poetic Medicine program administrative responsibilities into existing Glide structures (e.g. the Congregational Life program); (2) developing an ongoing train-the-trainer session for community facilitators (i.e. future Poetic Medicine Residents); and (3) building a philanthropic fund to support both community facilitators and the poetry dissemination project elements.  These funds may include contributions both from Glide as well as from MERI supporters.

• Summary of healthcare-related needs being addressed
  

In prior, foundational work supported by the Mount Zion Health Fund, the UCSF/Mount Zion MERI Center has made more than 4100 Poetic Medicine contacts with participants from around the world.  Based on the MERI Center’s 3-year experience helping to develop the field of Poetic Medicine and Glide Church’s remarkable 50-year history of work in social services and social justice and its experience as a “Writer’s Church,” the “Poetic Medicine for Health, Dignity & Social Justice” program will address three core healthcare-related needs. 

(1) People living in the Tenderloin Community face illnesses created and/or exacerbated by social determinants of health.  Palliative care is focused on supporting patients to live as well as possible in the setting of serious illness.  However, the primarily BIPOC community in the Tenderloin is underserved by palliative care expertise and access to services.  As one Open Proposals commentor wrote: “We desperately need more models of intervention for palliative and end-of-life care that address the needs of people experiencing homelessness and their families.” 

As an instrument for palliation in the face of suffering, Poetic Medicine serves patients facing illness by promoting recognition, processing and integration of the diagnosis of serious illness and its implications, including the prospect of loss of function, suffering, and death.  Patients dealing with illness who have participated in MERI’s existing Poetic Medicine programs and published their work in its anthologies have reported amazing value from the processing and community promoted in Poetic Medicine sessions.   One participant remarked: “Our poetry hour has grown on the zoom squares into a safe and sacred space.  Writing poetry through 2 years now of being part of the poetic medicine community is the discovery of our own stories, sharing them and having them received so lovingly. Many of us began not believing we were poets. Perhaps one of the most important things poetic medicine delivers is the discovery that we all have the power to heal through creative arts.”  Participants have learned how to listen carefully and connect with others who are suffering, and through this process of listening and connecting, to heal their own pain and suffering.

(2) Family and Friends of those facing illness in the Tenderloin are underserved with regard to support for sustainable caregiving and grief around loss, including complicated grief in the setting of sudden or potentially preventable death.  Poetic Medicine includes a focus on loss and grief, promoting healthy bereavement in the context of self-expression and a supportive community.  Participants from MERI’s current Poetic Medicine “Loss, Losing, and Loosening” sessions have reported Poetic Medicine to be among the most helpful bereavement resources they have encountered.  One commented: “I know that my healing through grieving the loss of my wife was made hopeful and productive because of our fabulous Loss, Losing and Loosening gathering every Tuesday.”

(3) Caregivers:  In the setting of the desperate health and social challenges in the Tenderloin community, Volunteers, Congregants, and Staff at Glide face significant threats to their well-being and resiliency, including compassion fatigue, vicarious trauma, and burnout.  Current participants from MERI’s Poetic Medicine “Wounded Healer” sessions have reported on the unique benefits of Poetic Medicine to explore the demands and promise of caregiving.  One concluded: “Connecting with like-minded Souls "lights up my Life and gives me Hope to carry on" as the song goes.”

In addition, UCSF nursing and medicine learners currently are inadequately exposed to the unique challenges of promoting health among marginalized populations and can potentially graduate from UCSF’s programs with an unrealistic understanding of the needs and opportunities of service in marginalized communities.  These UCSF learners (including Zion-based housestaff in General Medicine, Women’s Health, Pediatrics, Radiation Oncology, Neurology, Dermatology, and Otolaryngology) will be able to join the MERI/Glide Poetic Medicine program as participants or facilitator trainees.  Importantly, Glide clients may be learning a clinical language for stress and illness; UCSF learners will be learning a poetic language for their clinical work.  As one Open Proposals commentator wrote: “I think poetry is the language that sits smack dab in the middle of the vernacular and the clinical. We can meet there and speak in poetics. We can believe that every who meets there in that middle language, is trying to express something beautiful.”

• Collaboration between Glide Memorial Church and MERI

The proposed MERI/Glide Poetic Medicine program represents a deepening of existing efforts and collaboration between MERI and Glide.   The proposed Poetic Medicine project will further the developing medical services programming at Glide, including a current focus on end-of-life care case management.  The proposed MERI/Glide collaboration will add to MERI’s current collaboration with Glide (partially funded by the Stupski Foundation) to support improved communication around serious illness for Glide clients, staff, volunteers, and congregants.

Both Glide and MERI have histories of Poetic Medicine dating from their respective creations as organizations and including the belief that poetry is one way individuals can heal and a community can come together.  MERI has become a leader in Poetic Medicine in the health care environment and within academic medicine.  Glide’s Marvin White is a well-known poet and has brought poetry to Glide’s congregants.  Glide’s founder, Janice Mirikitani, created the “Writer’s Church” with a focus on writing and storytelling as revolutionary tools.  With the current proposal, Glide and MERI will be collaborating to achieve Janice’s vision to not leave anyone out of poetry.

As one Open Proposals commentator wrote: “It's super-exciting to think about how GLIDE and UCSF might harness and channel their respective superpowers in this project.”  As another wrote: “I couldn't think of a more GLIDE initiative! Especially now that GLIDE Memorial Church is a writer's church and the Minster is a poet. Serving our community in this way is aligned with GLIDE's core values on every level.”

MERI and Glide have already begun work with each other, with MERI serving Glide as a consultant in a palliative care services navigation project funded by the Stupski Foundation.  We have continued this collaboration with the conception and development of this proposed and submitted Poetic Medicine project.  Members from both the Glide Community and the UCSF Division of Palliative Medicine have actively participated in this proposal development via comments and suggestions on the Open Proposals platform.  Importantly, the Poetic Medicine format will be customized for specific communities at Glide in their development and operationalization.  Adapting Poetic Medicine for participants who are unhoused will be a particularly challenging but central piece of this project and will rely on the experience and creativity of Glide’s leadership and the Poetic Medicine Resident.

MERI and Glide staff will work together on nearly all aspects of the Poetic Medicine program, including co-facilitating Poetic Medicine sessions, co-training the Poetic Medicine Resident to serve as the session co-facilitator, and seeking ongoing funding to sustain the program.  MERI and Glide will work together to integrate Poetic Medicine services with the emerging medical services and advocacy currently being developed at Glide (as above, with MERI’s consultation and technical assistance).  The formal collaboration between Glide and MERI will continue throughout the project period and is expected to then continue in an ongoing fashion.

Glide will take the lead in structuring community participation in the Poetic Medicine programs, including with logistics and advertising.  MERI will take the lead in training facilitators around Poetic Medicine principles and facilitation techniques and will be responsible for program evaluation and quality improvement efforts.  Understanding the feasibility and disseminating the impacts of a Poetic Medicine program for social justice is central to the goals of our program.

• Name(s), title(s), agency/department/division(s) of individuals who will lead the project, with brief background information relevant to ability to accomplish the project activities

Marvin K. White, MDiv, is the Minister of Celebration at Glide Church and the energy behind much of Glide’s social justice and advocacy work.  He is a writer, artist, preacher and public theologian.  He is the author of four collections of poetry and his poetry has been adapted for stage and screen. He holds a fellowship in the national African-American poetry organization, Cave Canem, and founded and sat on the board of two BIPOC and LGBTQ writer’s organizations: Fire & Ink and B/GLAM. In 2019, Yerba Buena Center for the Arts named him as one of the “YBCA 100”.

Redwing Keyssar, RN, is MERI’s Director of Patient and Family Education and the co-lead of MERI’s 3 current Poetic Medicine offerings.  She is a published poet and palliative care author.  Redwing was a driving force behind the development and publishing of the academic paper on Poetic Medicine published in 2022.

Gayle Kojimoto is the coordinator of the MERI Center, co-lead of MERI’s current Poetic Medicine offerings, co-Chairperson of the DEI Committee in the UCSF Division of Palliative Medicine, and a poet herself.

Michael Rabow, MD, is the founding Director of the MERI Center, Medical Director of Palliative Care at the Helen Diller Family Comprehensive Cancer Center at UCSF, Associate Chief of Education in the UCSF Division of Palliative Medicine, and an award-winning poet (https://med.stanford.edu/medicineandthemuse/events/paul-kalanithi-essay-contest.html).  Mike was the senior author on the Poetic Medicine academic paper.  He is fellowship-trained in education research and evaluation.

• Note which of the six MZHF values the project embodies

The UCSF/Mount Zion MERI Center was founded in 2018 as an instrumental part of the history and values of the Mount Zion campus. The MERI Center works with the clinical programs at Mount Zion and its office is located on the Zion campus, within the offices of the Division of General Internal Medicine.  The proposed MERI/Glide Poetic Medicine program embodies the Jewish values at the core of the Mount Zion Health Fund and updates the history of how these values are manifest at UCSF and in San Francisco. 

• The MERI/Glide Poetic Medicine program is about service (Avodah) as it is structured to support Glide volunteers and staff, as well as UCSF learners, in sustainable service to the Tenderloin community, specifically geared to address patient and family healthcare needs, including adjustment to illness, identification of needs, and the processing of potentially life-threatening illness and its associated grief.

• The MERI/Glide Poetic Medicine program is being proposed to promote social justice (Tikkun Olam) in providing service to members of an under-served community in the middle of a city full of world-class medical institutions often unavailable to our neighbors.

• The MERI/Glide Poetic Medicine program seeks to help build community (Kehilah) within the Tenderloin district itself, bringing together community members in a safe setting of disclosure and self-expression, as well as to deepen the historic connections between Glide and UCSF.

• The MERI/Glide Poetic Medicine program will engage UCSF learners (students, housestaff, and fellows) as participants or facilitator trainees, exposing these learners to the complexity, truth, collegiality, and unique opportunities of healthcare practice in under-served communities (Limud u’Manhigut).

• The MERI/Glide Poetic Medicine program is innovative (Hidush), building on the nascent field of Poetic Medicine and customizing it for a BIPOC, vulnerable, and under-served community.  Understanding and promoting the learnings from this program is key to the success of this project

• The MERI/Glide Poetic Medicine program is founded on the principle of compassion (Rahamin) with the intent to promote the dignity of those facing illness in the harshest of economic and social situations.

• Project start date and duration (earliest start date is December 1, 2022)

Start date 7/1/23 (This is the day after the completion of foundational funding for the UCSF/Mount Zion MERI Center by the MZHF Harris M. Fishbon, MD, Fund).

Duration: 3 years (Project period 7/1/23 – 6/30/26).

• Total budget required and the amount requested from MZHF

Amount requested from the MZHF: $150,000/year for 3 years (to be shared between MERI and Glide).

Total budget: $150,000/year for 3 years.

Please see attached budgets and budget justifications for both MERI and Glide (including additional financial information from Glide).