I. Care of Infants, Children, Youth, and Families
A. The ability to assess the developmental and psychosocial needs of infants, children, youth, and families.
Selected Knowledge Area/Skillset
Knowledge
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Recognize families as they define themselves, identifying strengths and challenges in family dynamics and community supports
Skill
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Integrate the strengths and resources of the child and family into the plan of care
Having had the opportunity to meet children and families in a variety of settings through my internships at both Boston Children’s Hospital and Good Shepherd Community Care I have learned about the unique tools of assessment used by child life professionals and other clinicians. When interacting, it's important to build a quick and strong rapport with children and families to encourage trust and a strengths based model of care. Through this trust and understanding, families and caregivers can feel more comfortable sharing their unique perspectives and goals for intervention, treatment, and care. These skills can also be bridged with professional abilities in chart reviews and clinical discussion to best understand the overall plan of care for a child and their family.
In my interactions with patients and families in the home setting this past semester, I’ve learned from my supervisor Certified Child Life Specialist Jessica Heirtzler about how to format visits to allow for important medical and psychosocial updates while still leaving room to meet intervention goals. Through the use of 10-15 minute caregiver conversations at the start of home visits, both the child and family are given the space to express their needs and progress. Now shifted to providing independent visits, I have been able to develop these skills of assessment further and continue to learn through clinical supervision and education.
Evidence
Good Shepherd Pedi Pal Journal Entry Week 3... Throughout our visits this week, I was excited to see a broad spectrum of patient and family demographics, specifically seeing patients with a wide array of physical, psychosocial, and medical needs. During our first session of the week, I practiced my skills of hand-over-hand to accommodate the needs of a non- ambulatory patient with low muscle tone, and contracted hands. The legacy project which I had planned for this visit was an apple tree created using handprints for the leaves, fingerprints for the apples, and coloring/cutouts for the base of the tree. Jessica demonstrated how to use the patient’s eye tracking device and although we weren’t able to use it in this session, I hope to gain a better understanding and skillbase with this technology in the future. Using our own assessment of eye tracking to express the patient’s choices and hand-over-hand with elbow support as modeled by Jessica, the patient was able to complete the project in his own unique way. While adaptation and accommodation were factors I readily considered when choosing this project, in practice I found it was difficult, at times, to know which accommodations were best for each patient. Having Jessica there, helped for guidance and to make me feel confident that the project was doable no matter the physical limitations or patient needs.
Good Shepherd Pedi Pal Journal Entry Week 4... On Monday, Jessica informed me that a patient we had visited the prior week had unfortunately been re-admitted to Boston Children’s following a second stroke. This visit was especially pressing as she had been discharged from a rehabilitation hospital only days prior and had been eager to go home, indicating to me that this recurrent stroke may be even more frustrating and scary for both the patient and her family.
Good Shepherd Pedi Pal Journal Entry Week 7…. During my visits with Jessica this week we discussed these conference sessions along with having opportunities to interact with patients and provide interventions unique to their needs and development. In one of these visits, the mother of the patient, a 14 year old girl recently discharged from Spaulding Rehabilitation Hospital, shared that her daughter has been struggling to drink water on a daily basis. With this in mind, her mom requested child life assistance in practicing this habit to help with stroke prevention. Jessica and I engaged in empathetic listening with the patient and discussed past efforts to encourage hydration to better understand why they didn’t succeed. Additionally, we created a “water contract” and applied a strengths-based approach to highlight the ways in which hydrating allows her independence and control, needs crucial to the adolescent stage of development. This visit emphasized to me the ways child life can balance meeting developmental and health goals, while still providing outlets for creativity, choice, and expression.
BCH Journal Entry Week 10… On Wednesday, in radiology, we had two 7-year-old girls scheduled for VCUGs for similar complaints of chronic UTIs. Looking at them on paper, both patients had similar presentations, as they were typically developing, had no prior VCUGs, and had requested child life support to cope with the exam. As they were both school age, I anticipated some fears about privacy and having people touching their bodies. In my discussion with Angela, we spoke about letting the patient led the introduction to see what they already knew, what they were comfortable with knowing, and offering choices for distraction during the exam. Both patients expressed some prior knowledge of the exam, having been prepared through either videos or conversations with caregivers. During the first exam, the patient verbalized that she was in pain and had to pee regularly and cried out for most of the exam. I stayed at the head of the table with her mom and tried to encourage deep breaths and distraction and while, at times she was able to find comfort, she would then quickly return to a heightened state. The other patient, comforted at the head by her mother and father, laid still for the entirety of the exam, only briefly becoming teary when her bladder reached capacity, but then returning to her iPad and talking with her parents. These observations are in no means meant to compare these patients or their coping styles, as both are useful and helped them through the exam. But rather, I found it interesting to see how two girls, so aligned developmentally, utilized different methods to cope and expressed their distress in different ways. Additionally, the factor of trying to learn about the exam prior, fits in well as they become settled in the “industry versus inferiority” stage and look to acquire knowledge as a means of growth and prospering in their daily lives.