1. H OLDING THE P IECES T OGETHER : U SING T HERAPEUTIC P LAY WITH G RIEVING C HILDREN Ben Broxterman, CCLS Child Life Specialist Wesley Medical Center

2. C HILD L IFE S PECIALISTS : A N O VERVIEW Minimum of bachelor’s degree with coursework focusing on children/families Completion of 480-hour internship under Certified Child Life Specialist Successful completion of standardized examination to earn CCLS credential Work to promote optimal coping for children & families through developmentally-focused, family-centered interventions

3. W HAT IS P LAY ? Play, in particular, is the special manifestation of freedom in childhood. From: “White Paper #6: The State of Children’s Play.” www.academyofleisuresciences.org/alswp6.htmlwww.academyofleisuresciences.org/alswp6.html

4. W HAT IS P LAY ? Webster’s definition: exercise or activity for amusement or recreation The Association for Play Therapy, Inc. states: “… play is a natural medium for self-expression, facilitates children’s communication, is conducive to cathartic release of feelings, and can be renewing & constructive.”

5. W HAT IS P LAY ? Most play researchers agree that, to be called “play”, an activity must be: Voluntary Internally motivated Pleasurable, relaxed “as if” or present text Organism rather than object dominated Unique, unpredictable Active, both motorically & cognitively From: Meeting Children’s Psychosocial Needs Across the Healthcare Continuum. Rollins, J., Bolig, R., & Mahan, C.

6. T HERAPEUTIC PLAY Therapeutic play is a term used for play in health care settings, classified as “play that is used to prevent psychologic injury.” Its goals are to: Meet children’s ongoing developmental needs Help children cope with unfamiliar hospital environment Increase children’s understanding of their hospitalization & treatment Promote a sense of control, mastery, positive self concept Facilitate self-expression Meet children’s needs to cope with separation & deprivation. From: Meeting Children’s Psychosocial Needs Across the Healthcare Continuum. Rollins, J., Bolig, R., & Mahan, C.

7. T HERAPEUTIC PLAY The National Association for Hospital Play Staff (NAHPS) in England, states that play: Creates an environment where stress & anxiety are reduced Helps child regain confidence & self-esteem Provides an outlet for feelings of anger & frustration Helps the child understand treatment & illness. Through play, children are able to effectively learn the sensory and concrete information they need to prepare for hospital procedures and treatment Aids in assessment& diagnosis Speeds recovery & rehabilitation

8. T HERAPEUTIC PLAY Usually consists of at least one of the following types of activities: Encouragement of emotional expression (ie- re-enactment of experiences through doll play) Instructional play to educate children about medical experiences Physiologically enhancing play (ie- blowing bubbles to improve breathing) From the Child Life Council Evidence-based Practice Statement: Therapeutic Play in Pediatric Health Care: The Essence of Child Life Practice. Koller, D.

9. T HERAPEUTIC P LAY VS. P LAY T HERAPY Goal is to prevent psychological injury Focuses on the process of play as a mechanism for mastering developmental milestones & critical events Goal is to alleviate psychological injury Addresses basic & persistent psychological issues Therapeutic PlayPlay Therapy

10. U SING P LAY AS A T OOL WITH G RIEVING C HILDREN Play helps to make the grieving process more approachable Play “normalizes” experience & can allow time for children to return to their normal state in between periods of active grief

11. C HILDREN ’ S P ERCEPTION OF D EATH BY A GE Newborns-3 years old: don’t comprehend death, but are very aware of changes in caregivers, routines, & are aware that someone in the home is missing Preschoolers (3-5 years old): can understand biological differences between dead and living, but sees these changes as temporary & reversible. May assume responsibility for the death through magical thinking. Young school age (6-9 years old): begin to understand the concept of death, but feel it only happens to others. Begin to worry that important people in their life might die.

12. C HILDREN ’ S P ERCEPTION OF D EATH BY A GE Middle school (10-12 years old): Understand finality of death, & develop a personal fear of death. Might be more interested in gruesome details of violent deaths, or in what happens to the body after death. Adolescents (13+): have an adult concept of death; ability to deal with loss varies greatly depending on their personal experiences. Still see selves as invincible.

13. U SING P LAY WITH THE F AMILY OF THE D YING P ERSON Play can help children understand in developmentally appropriate terms Play can serve as a medium for self-expression, and an outlet for concerns, misconceptions, or other needs Case example

14. P LAY AS M EDIUM FOR P ARENT - CHILD OR F AMILY - CHILD INTERACTION Case example: Sandra Family expressed concern to medical staff, who consulted CLS Single mother, 8 y/o daughter, “very close” Mother given a few weeks to live Family stated in conversation with this CLS that mother had shut down, & daughter was trying to understand but had become increasingly quiet after visits with her mother

15. P LAY WITH THE G RIEVING P ATIENT Can help the patient express questions/fears/desires that might not be brought out in other formats Helps promote a sense of control in an otherwise “out- of-control” situation Case examples

18. Q UESTIONS ?