I. Care of Infants, Children, Youth, and Families

C. The ability to provide opportunities for play for infants, children, youth, and families

Selected Knowledge Area/Skillset

Knowledge

Identify therapeutic approaches that facilitate open-ended, developmentally-supportive play and expressive arts

Skill

Plan and implement appropriate play activities and materials for children and families of diverse cultures, varying developmental needs, and physical abilities

Play is an integral part of the child life career as it defines a large portion of the interventions utilized to create rapport, trust, and distraction in interactions with children and families. When considering the initiation of a play activity, it is important to to reflect on the ways in which this intervention impacts the goals chosen by individuals and families. Additional considerations include how the play can be accommodated to attend to a variety of physical, medical, and psychosocial needs which may be present in a child life setting. Through my internship experiences in both Boston Children’s Hospital and Good Shepherd Community Care Pedi Pal, I have had the opportunity to both create and initiate open-ended and goal based, developmentally appropriate play interventions.

As a part of my goals binder for my second internship, I chose to create and format three legacy projects to support and offer an outlet for creative expression to the children and families served [ to see examples of these legacy projects you can visit the Goals and Objectives page on my website under “Internships→ Good Shepherd Community Care”]. Additionally, both this semester and last, I worked to engage children using hand over hand, medical play, and collaboration with interdisciplinary team members. These interventions include playing out doctor and patient to promote opportunities for control and choice, using art projects to express creativity, and identifying relevant materials useful to distraction and positive coping. Having trialed and observed these interventions it has become even more clear how play serves to both support children and families and defines the role of child life for many as one led with creativity, openness, and fun.

Evidence

Good Shepherd Pedi Pal Journal Entry Week 2... Throughout the week, I not only had valuable opportunities for connections with caregivers but also was able to practice therapeutic and supportive interventions with children, as relevant to their medical needs and the child life goals established by Jessica. Some of these included practice with hand-over-hand play using adaptive scissors, legacy making projects to incorporate siblings and parents, and a co-treatment session with one of the Pedi Pal Music Therapists, Bryanna.

Good Shepherd Pedi Pal Journal Entry Week 9... Now officially settled into the second half of my internship placement at Pedi Pal, I was fortunate enough to have numerous opportunities this week for patient contact which align with my personal goals and objectives for this semester. On Monday, Jessica and I visited a patient at Dana Farber’s Jimmy Fund Clinic. This patient is a school aged girl currently receiving 5 rounds of chemotherapy and participating in a drug clinical trial, as a means of treating her relapsed neuroblastoma. She presented to the clinic on Monday for an infusion and due to low platelet count was receiving a transfusion, adding to her length of stay. To help promote opportunities of choice and the ability to express control, Jessica and I initiated medical play using a doctors kit. This patient engaged with each tool and instructed me as her “nurse” to use them on Jessica. To best support the patient’s imagination and goal-driven developmental stage, I worked to follow her lead and prompt for further play using guided questions and my own play with the items. As we participated in this play, the patient’s demeanor and energy levels changed, growing more excited and awake throughout our visit. Having this opportunity to initiate and engage in medical play with a patient receiving routine outpatient care, was a meaningful learning opportunity as I observed her reactions and familiarity with the tools and medical procedures.

BCH Journal Entry Week 5…. In the MICU this week, I worked to further my practice supporting long term patients in meeting their developmental goals through play and engagement. On Tuesday, Lauren and I were referred by a bedside nurse for a visit with a “frequent flier” patient experiencing increased agitation since their admission. This patient is 20 months old and has recently transitioned to living at Franciscan’s but has been having difficulty with feeds, respiration, and skin rashes. Upon entering the room, we noticed that the patient was kicking, trying to self soothe with her hands in her mouth, and crying intermittently. After this assessment, I gathered a glowing aquarium, teether, and kick gym for her to best meet developmental milestones and needs for coping. This patient is firmly established in the sensorimotor stage of development and using visual distraction with glowing lights and stimulation through oral soothing and opportunities for reaching and kicking she can explore her environment with her senses. Lauren and I provided soft touch and gentle crib rocking to help decrease agitation and with this, the patient was observed to reduce the frequency of her crying spells and find more periods of stillness. I checked in on this patient, by myself, later in the week and was excited to find her playfully engaging with the kick gym and closer to her baseline of smiles and laughter. Using music and hand over hand play, I was able to engage in auditory and physically stimulating play that emphasized call and response, allowing her to initiate the play with more autonomy and interaction than in days prior