I. Care of Infants, Children, Youth, and Families
D. The ability to provide a safe, therapeutic and healing environment for infants, children, youth, and families
Selected Knowledge Area/Skillset
Knowledge
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Identify emotional safety hazards and corresponding preventive and protective measures.
Skill
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Establish and maintain a therapeutic, healing and family-centered environment
A crucial component of the child life profession is the ability to assess a patient’s and families’ needs and respond appropriately through positive coping techniques, rapport building, and provision of comfort either through verbal affirmations or physical actions. Child life specialists may be accompanying individuals through some of the most trying and turbulent times of their lives, including illness, injury, and even (as appropriate) grief and loss. During both my internship placements at Boston Children’s Hospital and Good Shepherd Community Care Pedi Pal, I was able to join children and families as they experienced ICU admissions, outpatient procedures, grief, loss, unknowns, changing diagnoses, and so much more. Through these unique learning interactions, based on trust and connection, I was able to identify the ways in which child life can best support and create a therapeutic and healing environment, regardless of the setting.
During my internship placement at Good Shepherd Community Care Pedi Pal, working with Certified Child Life Specialist Jessica Heirtzler, I observed the skills she uses to create a strong, safe rapport such as using the first 15-minutes of a visit for all relevant updates, always adjusting the environment to a patient and families needs, and finding ways to get on the child’s level regardless of the accommodation needed. Many of these skills paralleled those which I had practiced during my internship at BCH, however, visits with Pedi Pal offered more routine experience with patients and families and allowed for more vulnerable and sensitive conversations. In the first few weeks of my second internship placement, I found it useful to mirror Jessica’s body language and verbiage to hone these skills in my own practice. Now, as I have begun to visit with patients and families independently and prepare for my future career as a child life specialist, I find that these skills come more naturally. Communication with caregivers was a large part of my goals binder this semester, as it relates to best identifying the goals and needs for appropriate family-centered care and providing respectful, considerate interventions [ to read about this goal and its’ completion you can visit the Goals and Objectives page on my website under “Internships→ Good Shepherd Community Care”]. Reflecting on the relationships and connections I have built over my past two internship placements, I am acutely aware of the importance which safety, rapport, comfort, and respect hold in the child life setting.
Evidence
Good Shepherd Pedi Pal Journal Entry Week 1... On Monday, I had the opportunity to accompany Jessica on two visits to become more familiar with her process of interacting with the patients and families and practice my own routine in these settings. Our first visit was able to offer some sense of familiarity, as we met at Boston Children’s Hospital to meet with a patient who had recently been admitted into the inpatient unit on 9NE. While Pedi Pal services are regularly facilitated in the home setting, staff also have the unique opportunity to visit patients and families during admissions or routine visits to the hospital, offering family’s access to continuity of care and trusted resources for advocacy. This patient and her mom are well known to Jessica and Pedi Pal services and were excited to have visitors to provide activities and comfort in the hospital setting. Jessica first ensured that the patient’s mother had time to discuss any medical updates, important news, and personal matters before beginning her planned activities. This separation signified to me an important step in allowing the caregivers time to take up space and share their thoughts without feeling as though they were interrupting the child’s session and/or taking time from the activity itself. Throughout the week, I saw how Jessica facilitated this step each time. She offered opportunities for caregiver discussion, and I worked to add my insights and join in with active engagement and questions when appropriate. This skill of communication and allowing the caregiver to express their needs and concerns upfront is something that I plan to add into my own practice and will model with Jessica as I continue to shadow her.
Good Shepherd Journal Entry Week 6…. On Monday, Jessica and I met a patient, his mom, and a young family member at an apple orchard for an off site visit to celebrate his birthday. This patient, a 14-year-old, on the autism spectrum had limited verbalization and some difficulty ambulating on his own. Mom had chosen this outing as a means of preventing sensory overwhelm and finding means of memory making with her son for this milestone. Although mom packed his adaptive chair, he was able to walk for the majority of the visit only requiring assistance on uneven surfaces and taking breaks to sit towards the end of the visit. The patient was quick to warm-up to me and led me by hand to the rows of apples or pumpkins which he was interested in exploring. Not only did this help display his expression of choices but as we built a stronger rapport Jessica and I were also able to encourage screen breaks and take his iPad away for brief periods to facilitate engagement with his family and the activity at hand.
Good Shepherd Pedi Pal Journal Entry Week 9... After this visit, I joined Jessica and Iliana on an initial visit for an adult hospice patient with two school-aged children. This patient and her husband are Mandarin speaking and to best support their needs and communication, their Good Shepherd social worker joined the visit and assisted with translation needs. In this visit, the family wanted to address goals of explaining the patient’s death to her children as her health declines. Based on personal and cultural values, the patient currently does not want to be seen by providers and therefore, our conversation was focused with her husband. In this discussion, he shared candidly the fears he has about his wife's passing, her pain, the children’s coping, and his family's expression of their emotions. Jessica empathized with the patient’s husband while also explaining the ways in which child life can help support during this difficult process. To best support this family's needs and values, we shared examples of social stories and how they can deliver these tough messages through developmentally appropriate language. The patient’s husband was so thankful to have this resource offered and has since communicated with us to add in pictures and a handwritten letter to the children as a part of their individualized stories.
Good Shepherd Pedi Pal Journal Entry Week 5... Finally, this past Saturday, Pedi Pal held its Fall Build-A-Bear event, which had been eagerly anticipated by myself and many families seen under the program. Over 20+ families attended, each having the opportunity for their child to stuff a bear, pick an outfit, and get a birth certificate to take home with their new stuffed animal. This event not only allowed me the unique opportunity to meet many children and their families at once, but also created numerous opportunities for me to engage with caregivers and practice introductions in a new and fun setting. Families and children were overwhelmingly excited with the event and grateful to have this opportunity for fun and creativity outside their normal routines. One family even shared with me that this was the “kickstarter” for their week of family fun in which they would go on outings together to help their 1 year old understand that car rides don’t always equate to trips to the doctor. I encouraged them that the week sounded like a wonderful idea and that I would love to hear about it the next time we met. I’m grateful to have been a part of this event as I saw firsthand the impact that this form of outreach and community can have on these families. While the comfort item was largely important to many children and families, some of which could or could not afford them on their own, being in a shared space of positivity and happiness to make memories with their children was far more significant.
Good Shepherd Journal Entry Week 8…. This week Jessica and I began our visits, by meeting with a family who lost their child nearly 1 year ago. In this visit, I was able to see firsthand how discussions of bereavement and grief can be handled in a delicate yet conversational manner to best support a family in their continued processes of mourning. The family, made up of mom, dad, and a 13-year old brother, is Spanish speaking and has been seen by Pedi Pal services prior to their loss and throughout the course of their grieving process. As outlined by the Pedi Pal service guidelines, following the loss of the patient receiving care, families and friends can receive support for 13 months following. In this visit, we discussed the plans for the one-anniversary of the patient’s death, including writing on balloons and releasing them to heaven for him.
BCH Journal Entry Week 3…. The following day I had the opportunity to work with CLS Kristen Hildreth as she responded to a referral by a bedside nurse for a crying baby girl who didn’t seem to be appeased by pain medications. Upon arrival this baby was visibly upset and red, having worked herself into an overheated state and sweat off many of her monitor stickers. The bedside nurse had attempted to soothe her using a mobile, lullaby music, vibrating pad, and pacifier. While these were all very thoughtful methods, the combination of all of them, as well as the proximity of the mobile to the infant’s face appeared to be overstimulating, as she batted at the items. We began by moving these away and turning off the music to provide sensory relaxation and comfort. Throughout the entire intervention, the baby stayed elevated and crying, however, I feel that it was important that Kristen and I stayed. According to Erikson, this infant is in the stage of trust versus mistrust in which she is determining who in her environment is dependable and will provide safety. Although all members of the healthcare team are working to provide medical improvement to this patient, they do not all have the ability to stay at the bedside and allow the patient time to engage and feel connected with them. As child life, however, we stayed for nearly an hour working to rock her, stroke her hair, and cool her down. This presence is crucial at this age and helps activate such trusting, coping mechanisms
BCH Journal Entry Week 7... Upon arrival, we worked to move the patient into a private room quickly to allow for normalization and comfort in the environment. While waiting for the versed to be administered, I engaged her in play using light up and musical toys, books, and comfort items. Despite brief periods of upset when being touched for blood pressure readings or temperature, she proved distractable and was able to calm down and engage playfully with the environment including exploring the room, pointing at different colors, and laying her toys on the stretcher. This behavior indicated to me that although there was a deep-set fear of the hospital environment. this patient was most likely experiencing protest during this visit. Protest is a more normative response to the hospital which could be remedied with access to caregivers, comfort items, and age-appropriate desensitization of the environment. Using the versed was an additional measure to ensure that the child’s fear did not grow any further and shift her hospital experience towards despair. After administration of the pre-med, she quickly calmed down physically and was able to cope calmly and without panic during her VCUG. Not only did this benefit the child’s experience but her parents were so grateful and more relaxed in seeing their child comfortable and responding without fear to the medical experience.