Child Life

What is Child Life? Child Life Specialists help children understand why they are in the hospital. We do this by explaining procedures, tests, or a new diagnosis they might have. We also provide support and distraction during those procedures and tests. You may choose to add a picture of your Child Life Team to give a visual to your audience. Pictures of the playroom and other specific areas give a good visual and can add some local “color” to the presentation.

Certified Child Life Specialist Professional Standards of Practice Minimum bachelor’s degree or master’s degree with specific coursework in human growth and development, family studies, psychology, and related fields Minimum of 600 hour internship National Certification examination Professional development hours to maintain certification Adherence to the code of ethics and standards established by the Child Life Council

Basics of Child Life Play Preparation Support Diagnosis Education Basic Play Therapeutic Medical Preparation Support Procedural Emotional Family Diagnosis Education Death and Bereavement Developmental Play Theraputic Play

Additional Aspects of Child life Patient Goals Pill Swallowing Schedules (long term hospitalization, behaviors) Children of adult patients Pediatric traumas in the ED Sibling Support Preparing to see siblings NICU sibling visitation day Normalizing Events in the Hospital Community Events Kids Fair Teddy Bear Clinic Flu Shot Clinic

Preparation The communication of accurate, developmentally appropriate information prior to a healthcare experience Includes: Reason for procedure Anticipated sequence of events Sensations that accompany the experience Preparation materials EEG Preparation Preparation materials include, but are not limited to: medical play kits, medical play dolls, photo prep books, surgery prep videos, pre-surgery tours Evidence validating that most children prepared for medical procedures experience significantly lower levels of fear and anxiety compared to children who are not prepared. Preparation also promotes long-term coping and adjustment to future medical challenges.

Child Friendly Language Word It’s Not… In the hospital, it is: I.V. A poisonous plant Medicine straw Dressing change Changing your clothes Putting on a new bandage Stretcher Stretching your body A bed on wheels Move to the floor Lying on the floor To a different room on another level of the hospital Leads To take you somewhere Stickers on your chest to listen to your heartbeat and your breathing Urine “You’re in” Pee Other examples: RN couldn’t get IV for surgical patient, told her she would get it “in the back” meaning OR patient thought she meant in her back Tourniquet: blue rubber band This chart is adapted from: Gaynard, L. et al (1998). Psychosocial care of children in hospitals: A clinical practice manual from the ACCH child life research project. Rockville, MD: Child Life Council.

Prep for an EEG Prep book reads like a book Tells each step including: What they will feel, hear, taste, see, smell Gives patient appropriate choices What their “job” is during each step (if have one) Appropriate choices: do you want to sit by yourself or on Mom’s lap? Would you like soda or juice to take your medicine? Not: are you ready for your IV? Jobs: help child feel in control, gives them something to focus on

Important to see if have questions, provide teach back: do you remember what your jobs are?

Procedural Support/distraction Because some procedures may be lengthy and anxiety-provoking, procedural support and distraction can be utilized as a patient’s choice to engage in an activity to keep their focus on something else (such as an I-Spy book, a View Finder, or a game on an iPad) rather than the procedure alone. Non-Pharmacological Pain Management Sensory Positioning, holding, pressure, motion, rocking Cognitive/Behavioral Preparation Thought stopping, guided imagery, distraction Validate child’s feelings and words Relaxation, deep breathing Here is some information that can be referenced: one voice should be heard during procedure, encourage parental involvement, prepare patient before the procedure about what is going to happen, validate child with words & feelings, offer the most comfortable, non-threatening position, provide individualized support including appropriate distraction, eliminate unnecessary people not actively involved with the procedure Sensory Positioning (comfortable and non-threatening), holding, pressure, motion, rocking Cognitive/Behavioral Prepare the patient for the procedure Thought stopping, guided imagery, distraction Validate child’s feelings and words Relaxation, deep breathing Distraction during PICC line

One Voice One Voice What does it look like? One designated person speaking to patient before and during procedure (can be a staff person or parent/guardian) When can it be implemented? During any procedural preparation and during all procedures How is it effective? The child focuses on one person and more easily engages in distraction https://www.youtube.com/watch?v=2IdwPFyAuDg video of "one voice" child life Debbie Wagers

Comfort positioning What is it? Positions to sit in/be supported in to promote comfort for the child as well as immobilization for success of the procedure When/How can it be implemented? For procedures – most commonly IV starts, NG placement, blood draws, injections Why should we use it? Standard of Practice in Children’s Hospitals Nationwide Children who are calm before the procedure will react with less intensity than children who are already upset for other reasons (Korner and Thoman, 1971) Procedures require less time and fewer staff Parent or caregiver participates in positive assistance, not negative restraining By letting a child sit upright during a procedure, they will feel more in control of their body, and are more likely to stay calm and compliant

Distraction tips Ask child what they would like to do, make a plan Taking turns Conversation Ask about school, pets, siblings Some of my favorite distraction items: Bubbles I spy/look and find books Songs (toddler tunes) Favorite video/show

Recent Article- April 2018 Abstract The goal of this study was to determine the value of a certified child life specialist (CCLS) on the patient and staff experiences in an epilepsy monitoring unit (EMU). We integrated a CCLS into the EMU for all children as well as adults with intellectual disability. We surveyed families to determine the impact of child life services on their stay. EMU staff completed questionnaires to determine perceived impact to their job performance from the integration of the CCLS. All of the families (pediatric and adult patients) who responded to the survey reported the presence of the CCLS improved their hospital experience. Staff reported that the CCLS improved their daily work by allowing them to focus on their assigned medical duties. This preliminary pilot study suggests that CCLS can have a strong impact on the experience of patients and staff in an EMU. Clinical Pediatrics 2018, Vol. 57(11) 1269– 1274 http://journals.sagepub.com/doi/full/10.1177/0009922818769469 Families reported presence of CCLS improved their hospital stay Staff reported CCLS improved their daily work, allowed them to focus on assigned medical duties

Questions??? Contact Information: Bridget Ullery, CCLS, CTRS Child Life Coordinator WVU Medicine Children’s radmerb@wvumedicine.org