1. Child Life Services: How to promote the best patient and family centered care
Bailey Trevillyan, MS, BS, CCLS
This is a general orientation that can be used with New Nurses, Residents or any Medical Team member.

2. 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.

3. 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
Certification examination
Professional development hours to maintain certification
Adherence to the code of ethics and standards established by the Association of Child Life Professionals
Including Professional Boundaries

4. Child Life Play Preparation Education Support Basics of Child Life
Therapeutic
Medical
Diagnosis education
Preparation
Support
Procedural
Emotional
Family

5. Play Basics of Child Life Informal/ Formal Assessment
Basic mechanism for developing cognitive skills
Promotes supportive and therapeutic relationships
Motivation for movement therapy
Energy Release
Informal/
Formal Assessment
Reduces frustration and anxiety
You may want to add specific scenarios to help add to your presentation.
Basic mechanism for learning and refining cognitive skills
Promotes supportive, therapeutic relationships between child and caregivers
Motivation for movement therapy – helps prevent/reduce risk of secondary health problems
Energy release
Creates an environment for formal and/or informal assessment of a child’s development or adjustment
Reduces frustration and anxiety – outlet for negative feelings related to hospitalization, immobilization, or medical procedures

6. Child life and play Therapeutic Play Medical Play
Facilitates expression, coping, and mastery
Addresses a child’s need to problem-solve
Child-directed play in response to own needs
Adult is a facilitator; not a leader
Medical Play
Allows for familiarization of equipment
Increases understanding and promotes mastery
Communication of fears and misconceptions
Develop coping techniques
Therapeutic Play >
Facilitates expression, coping, and mastery
Addresses a child’s need to problem-solve, resolve distress, and express feelings
Adult’s role is facilitator/reflector, not leader
Child-directed play in response to child’s own needs
Medical Play >
Express feelings or concerns
Become familiar with medical equipment
Increase understanding
Learn and practice coping techniques
Reenact healthcare experiences
Develop feelings of mastery
Communicate fears

7. Stop: time to play Hand out medical equipment for medical art!!
Bandaids
Markers
Paper
Gauze

8. Basics of Child Life
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
Preparation materials include, but are not limited to: medical play kits, medical play dolls, photo prep books, surgery prep videos, pre-surgery tours

9. Basics of Child Life Procedural Support Sensory
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 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

10. Basics of Child Life Emotional Support Family Support Normalization
Coping strategies
Appropriate outlets
Family Support
Siblings
End of life/Bereavement
Normalization
Celebrations
Kids being kids
Emotional Support
Allows patient to discuss previous hospital experiences
Provides an appropriate outlet for patient to discuss fears and concerns
Provides an opportunity for patient to discuss other factors that inhibit ideal coping
Family Support
Promotes family play and interaction
Increased family understanding
Increases sibling coping and interaction
Allows opportunity for family to discuss fears, concerns, and triumphs
Normalization
Important to celebrate holidays, birthdays, family traditions
Allows for coping with extended/frequent hospital stays
Give children the opportunity to do “normal” kid activities ie: have friends visit, go outside, play, etc.

11. Basics of Child Life Child Education
Developmentally appropriate education regarding diagnosis specific information
Medical play related to diagnosis
Therapeutic play related to how the body functions with new diagnosis
School re-entry
Medical teaching dolls
Parental/Sibling Education
Provide resources
Address family issues
Medical play for siblings demonstrating patient’s care regimen
Child Education
Developmentally appropriate education regarding diagnosis specific information (i.e. books: Taking diabetes to school)
Medical play related to diagnosis specific equipment (i.e. Diabetes meter and insulin shots)
Therapeutic play related to how the body functions with new diagnosis (i.e. blood soup)
School Re-entry
Medical teaching dolls (i.e. allowing a patient to access a port)
Parental/Sibling Education
Provide resources (i.e. support groups, pill swallowing)
Address family issues related to the diagnosis (how dynamics may change)
Medical play for siblings demonstrating pt’s care regimen

12. Developmental Responses to Hospitalization
This is a good place to talk about the differences between children and adults, different developmental stages, etc.

13. Common fears Separation Stranger anxiety Pain Parental anxiety
Loss of physical/emotional control
Pain/Needles
The unknown
Loss of body function
Needles
Loss of control
Death
Loss of body control, function, & independence
Privacy
Change in physical appearance
Body mutilation
INFANT
TODDLER
Separation
Stranger anxiety
Pain
Parental anxiety
PRESCHOOL
SCHOOL-AGE
ADOLESCENT

14. Show me your art!

15. Medical art samples

16. How Can I provide better care?
Family –Centered Approach!
Giving Appropriate Options/Choices:
What name would you like me to call you?
Would you prefer to take your medication from a cup OR a syringe?
Would you like to color OR watch TV?
Would you like to go into the hall to get your height and weight OR would you like me to get your height and weight in the room?
Notice that this questions offers two appropriate choices for one aspect that is NOT a choice – getting the child’s height and weight.
Would you like to have two minutes alone with your family before going back to the operating room OR would you like to go now?
Notice this question does not ask: “Are you ready?” or “Do you want to go back now?” Without offering an actual option – the patient cannot say no and have that be respected.
Use Child-Friendly Language
But also, don’t make Teens feel like you are “babying” them!
Always ask the question: “How can we make you and your child feel the most comfortable through this process?”
And then follow through to the best of your ability!
We often get so caught up in our role, that we can easily get into a routine – providing the same care to each patient when in reality, each patient and family should be treated as individuals and included in each aspect of their care possible. This starts at how you enter the bedside! (Eye contact with family, approaching slowly, allowing the child to feel comfortable and COME TO YOU first)
It is important to remember that when asking a question, you are offering an opportunity for the patient/family to make a choice regarding their care. When a choice is then made from an option you gave them. That choice is to be respected. If that cannot be upheld, do not give the option.

17. Special considerations: Autism spectrum disorder (asd)
ASD is defined as a large continuum of disorders that are characterized by impairments in socialization and repetitive behaviors (Batshaw et al. 2013).
Autism often occurs in conjunction with other diagnoses, such as:
Learning Disabilities
Genetic Syndromes (ex: Rett, Prader Willi, and Williams syndrome)
Biological Behaviors (ex: Tics)
Medical Conditions (ex: Epilepsy)
Due to impairments in social reciprocity, a person with Autism may struggle with:
Eye contact
Understanding facial expressions
Understanding sarcasm or gestures
Understanding emotional tones
Atypical behaviors seen in people with Autism may include:
Repetitive motions
Strict adherence to routine
Rituals and/or obsessions
Patients with Autism are often LITERAL thinkers due to impairments in social reciprocity (inability to understand gestures and sarcasm). For example: “push saline” – this child may only know the term push as it relates to an unwanted gesture on the playground.

18. Tips and Considerations for Patients with ASD:
Always speak to the child upon entering the room, but look to parents/caregivers to understand the patient’s specific needs, likes, and dislikes.
Ask if the patient is verbal or how they prefer to communicate.
Determine if the patient struggles with negative behaviors and learn how to promote comfort or de-escalate appropriately.
Keep the room quiet, dim the lights, use the least amount of restraint, and allow self-calming behavior in whatever form that is.
Tell the patient what you are going to do, even if they act like they aren’t listening.
Quietly praise them for doing what you ask (try not to be too physical).

19. Tools to take with you You already have all of the tools you need!
Be creative
Be interactive
Be honest
Show children and families respect
Involve them in their care
I thought about gathering toys and other materials in gift bags for each of you, however I know all too well how quickly those items would be utilized and you would be left with nothing. Instead, I laminated these cards for each of you to be aware of what types of toys and play items are appropriate for each developmental stage and then showed you how even if you do not have access to these types of toys to comfort patients, you can use just about any piece of medical equipment to create art, more so than just blowing up a glove.

20. References
Batshaw, M. L., Roizen, N. J., & Lotrecchiano, G. R. (2013). Children with Disabilities. Baltimore: Paul H. Brookes Publishing Co.

21. Thank You to:
The Association of Child Life Professionals Professional Resources Committee, who provided a template to help in the creation of this presentation for this audience.