Steven Bognar and Julia Reichert
225 minutes, 2006.
Jessica Clark and Barbara Abrash: DESIGNING FOR IMPACT
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A Lion in the House is a four-hour documentary series that follows five racially and economically diverse young people, along with their families and caregivers, over six years as they confront pediatric hematological cancer and the aftereffects of treatment at Cincinnati Children’s Hospital. The series, which identifies health care professionals as key agents of social change, is the centerpiece of a strategic campaign conceived as part of a social movement for equitable and inclusive health care.
The film was broadcast nationally over two nights on the public television series Independent Lens, accompanied by a national, regional and local outreach campaign that brought together service providers, local television stations, and partner organizations. Conceived as a “convener of publics” including health care professionals, families, and health educators, the project has become a resource for a network of professionals and advocates. It has demonstrated how a compelling narrative and well-organized campaign can give visibility to a difficult subject and mobilize a network of support.
The project highlights underrepresented aspects of childhood cancer care, including:
Dr. Robert Arceci, Chief Medical Oncologist at Cincinnati Children’s Hospital Medical Center, approached veteran independent filmmakers Steven Bognar and Julia Reichert about making a documentary film about the human experiences of health care providers, families and children dealing with childhood cancer. The purpose was to bring a painful and rarely-discussed subject into public awareness and contribute to holistic, inclusive health care
for this population.
The primary objectives were to:
A Lion in the House was designed for general audiences on public television, as well as:
Reichert and Bognar produce films in a collaborative process with partners who help them establish clear goals, identify audiences, and develop effective strategies for diverse audiences and users. In the case of A Lion in the House, they:
A Lion in the House was intended for television broadcast, festivals, educational distribution, and community screenings. It is the centerpiece of a strategic national, regional, and local outreach campaign that engages a network of partner organizations and provides resources, educational tools, and websites, including special sites targeted to young adult survivors and youth-based community service projects. The series was broadcast on Independent Lens over two consecutive nights in two-hour segments.
A related series of educational modules on survivorship, end-of-life care, school issues, sibling stories, nurse/patient/family relationships, and spirituality are included in for-credit curricula for health care professionals. (At present only the “Survivorship” module is available for Continuing Medical Education credit.)
Reichert and Bognar’s mission-driven work is supported primarily by foundations, government agencies, and non-profit organizations. The budget for A Lion in the House was 2.6 million dollars ($1.3 million for production and
$1.3 million for outreach).
Principal production and outreach funding for Lion was provided by ITVS, the Centers for Disease Control and Prevention (CDC), the Corporation for Public Broadcasting (CPB), and the Lance Armstrong Foundation (LAF). Sales of institutional DVDs and training modules have grossed approximately $16,825.
Topic: This is a painful and disturbing topic.
Response: The filmmakers helped to make the topic accessible through compelling human stories with uncertain outcomes, marked by love and courage.
Partners: Most partner organizations that agreed to bring outreach programs to young people did not know how to reach those populations effectively.
Response: The filmmakers recognized the need to carefully evaluate the capacity of partners.
Training: Many health care and social service professionals are inadequately prepared to meet the complex needs of young cancer patients and their families.
Response: The Lion project responded by bringing the film to professional conferences, producing curriculum and training modules, and enabling local public TV stations to convene local and regional health care and social service providers in conjunction with broadcast.
Diversity: The homogeneity of partner organizations was contrary to one of the project’s main goals.
Response: The filmmakers identified partners committed to inclusion and requiring diverse representation in national, regional and local initiatives.
Sustainability: The filmmakers sought to establish the principles and tools of the project firmly enough so that its work could continue after they had gone on to make films on other topics related to social justice.
Response: Strong institutional partners such as the Centers for Disease Control, the Lance Armstrong Foundation, and the Children’s Hospice and Palliative Care Coalition have the capacity to carry the work forward.
Creative control: For Reichert and Bognar, like many independent filmmakers, creative control of their work is a sine qua non. Some of the organizations that provided media funding for this project expected to have strong creative input into content and style.
Response: Reichert and Bognar responded to such claims over content and style with patience, as well as with thoughtful discussion, rough-cut screenings and collaborative opportunities.
A Lion in the House was a response to two perceived problems: (1) lack of public awareness of the nature and challenges of pediatric cancer, and (2) health care inequities.
The film project stimulated organizations such as the Centers for Disease Control and hospice care providers to address the needs of pediatric cancer patients, their families, and health care providers. By dramatizing human experiences and providing trusted resources, the project catalyzed advocates to share information, form new partnerships and expanded their services.
The five years of filming and seven years of outreach indicate how social issue documentaries and their campaigns evolve over time, in response to opportunities and challenges.
Evidence of Quality
A Lion in the House premiered at the 2006 Sundance Film Festival. It was broadcast on PBS’s Independent Lens on June 21 and 22, 2006, and subsequently earned a Primetime Emmy Award. Film critics chose it as one of
the top ten documentaries of 2006.
The film travelled the international film festival circuit (New Zealand, Canada, the International Documentary Film Festival in Amsterdam, BritDoc, etc.) and received multiple honors, including:
A Lion in the House reached two million viewers through its PBS broadcast in June 2006. In addition, there have been approximately 10 purchases of the full institutional DVD and approximately 60 purchases of individual modules.
Reichert and Bognar call themselves “conveners” who pull together a variety of collaborators, from well-funded national organizations to regional and local community-based service providers.
Reichert and Bognar engaged health care professionals by producing clips forspecialized audiences and participating in hundreds of conferences, meetings,and symposia over seven years; distributing free DVDs; and introducingtraining modules into professional education.
ITVS provided a resource-rich website that drew 100,000 hits immediatelyfollowing broadcast. The ITVS Community Engagement Campaign andCommunity Media Productions, Inc. together organized strategic outreach,including ITVS-hosted community screenings, and grants to local public TVstations that became trusted hubs for community health care and serviceproviders and members of the public.
Between April and June 2006, PBS’s website for A Lion In the House (www.pbs.org/independentlens/lioninthehouse) received 3,525,412 page views and 1,581,880unique views, and ITVS’s website (www.itvs.org/outreach/lioninthehouse) received69,001 page views. In addition, 20,796 resources, including an annotatedlist of national resource organizations, information about cancer healthdisparities, and a community service opportunity for youth groups weredownloaded.
So far, A Lion in the House has advanced palliative and hospice care for young people with cancer and put the needs of young cancer patients and their families on the agendas of the CDC, LAF, and palliative care givers.
In addition, A Lion in the House modules are now embedded in the curriculum of the End-of-Life Nursing Education Consortium (ELNEC).
An overarching goal of the project was to fortify a holistic, inclusive health care system that responds to psychological and spiritual needs, as well as medical issues. This was achieved by:
Professional organizations such as the American Academy of Pediatrics, Association of Oncology Social Work, and Children’s Cause for Cancer Advocacy became stakeholders, as they were drawn into the process of shaping
the film and its uses. They later provided an informal outreach network through local and regional members.
Production and outreach are interwoven activities that ensure stakeholder engagement and contribute to the usefulness of the film. Co-producer ITVS provided funding and conducted an extensive outreach campaign. The
Intercultural Cancer Council, which shares the filmmakers’ concern with socio-economic inequities in health care, was a key partner. Two other early partners, the Lance Armstrong Foundation and the Centers for Disease Control
and Prevention, supported the production and distribution of the series and professional-training modules. Later partnerships extended outreach to Spanish-speaking communities, youth service organizations, and health care