I. Care of Infants, Children, Youth, and Families
B. The ability to initiate and maintain meaningful and therapeutic relationships with infants, children, youth, and families.
Selected Knowledge Areas/Skillsets
Knowledge
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Identify effective communication skills to support a child and family.
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Recognize educational opportunities and resources that are responsive to the needs of the child and family in order to promote learning and mastery.
Skill
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Build trust and rapport with infants, children, youth, and families.
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Match and pace interactions according to developmental level, emotional state, family preferences, and individual needs.
In high-stress, high-acuity, and often fast paced areas, such as the Medical ICU and Radiology departments, the ability to build quick rapports and foster trust is crucial. In many instances, child life staff have only a few brief minutes, before procedures or while caregivers are present, to introduce ourselves, the role of child life, and identify appropriate means of coping, comfort, and diversion. During my internship at Boston Children's Hospital in the radiology department, I would most often use this time to discuss caregiver concerns, introduce opportunities for patient's choice in play/distraction method, and confirm comfortability with child life presence. Each family dynamic and approach to dealing with the medical environment is unique and by leaving room for their individualized and multifaceted preferences, family-centered care underscored each interaction. During exams, I observed how my supervisor would meet the family where they were, often matching their body-language or modeling comfort positioning and then taking a step back once families had gained their own comfort in using this practice. In my own practice of this, I found it easier to identify and communicate about the coping needs of the child during the VCUG procedure [as detailed in the chart below], but I hope to continue my work on caregiver assessment and education, in the future.
In the Medical ICU, the practice of forming therapeutic relations was often centered on the ability to meet the developmental needs of long-term patients and the acute needs of those recently admitted. Through conversations with caregivers, clinicians, and multidisciplinary staff, along with routine practice and engagement with my supervisor, I gained comfort in broaching these interventions independently. For many families, this hospitalization was one experience of many, therefore, by providing education and encouragement to advocate for their needs I could best highlight the role of child life to them. Education included sharing my insights about patient's developmental growth, providing comfort hold education sheets, or advocating for multidisciplinary services such as physical therapy, music therapy, speech augmentative communication, etc. These instances allowed for rapport building and trust with caregivers, but also helped promote confidence in their role as the "expert in their child." By always reflecting back to these attachments, the needs of children and families could be met in tandem.
Evidence
BCH Journal Entry Week 4… In the Medical ICU, I made my first solo introduction this Thursday to a 7-year-old patient and his great aunt, on the unit for respiratory treatments. In the introduction, I was able to engage with the caregiver and identify that they did not have an understanding of child life, which I highlighted as a resource they could call upon for education, materials, or comfort items to make the hospital feel more normative. The patient perked up immediately at the mention of toys and was excited to make a list for me to gather including video games, paint supplies, and toy cars. As we set up the PS3 at his bedside, his nurse had a chance to give him an additional nebulizer treatment and to test his ambulatory ability. It was so interesting to see how our goals of engagement and distraction could fit into the larger medical treatment plan.
BCH Journal Entry Week 5… 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
BCH Journal Entry Week 6…. On Tuesday, I spent time with a 7y/o patient, admitted to the MICU for respiratory symptoms and an existing diagnosis of Bardet Biedl, a genetic condition with which affects weight gain, vision loss, and developmental delays. Lauren had been providing this patient procedural support in the week prior and reported that she was very social at baseline, loved the Seacrest Studio programming, and enjoyed engaging through parallel play. With this in mind, in my initial introduction, I referenced my connection to Lauren to help cater to her pre-operational, bordering-operational, stage thinking. I emphasized elements of egocentrism and symbolic thought, to try and establish a connection between child life, socialization, and play. [Piaget] I then gauged her interest in attending a virtual “dance party” together and she was eager to do so. We interacted in the event by picking out songs, decorating items for a fashion show, and reflecting on past Seacrest studio events she’s attended. I involved her in dance on a few occasions by asking questions about rhythms or modeling movements and having her follow along.
BCH Journal Entry Week 8… In the MICU, I had the opportunity to continue supporting a 14-year-old patient, from the week prior, and work on more long-term goals with him such as schedules, normalization of the hospital, and physical activity. This patient’s bedside nurse made a referral to child life referencing her concerns about the patient’s extended screen time in hopes to format a more regulated schedule for him. To meet these needs, Lauren suggested I go into the patient’s room despite his gaming and ask to find a time to meet without distractions. Despite some initial hesitancy and promises that we could talk “even when he’s gaming”, the patient agreed to a 15-minute meeting at noon. This patient is firmly centered in the identity versus role confusion stage of Erikson's development, where he is grappling with questions of self-expression, interests, and goals for the future. The hospital setting creates added difficulties, as he is now separated from peer groups, normative school routines, and has additional fears surrounding his illness and long-term outcomes. During my introduction of the schedule, I referenced school numerous times asking him how his hospital routine differs from or is similar to a school day and what he’d like to maintain. We also brainstormed ways to decorate the space to make it more personalized including adding initials to his door, sneaker coloring pages around the room, and adding a small basketball hoop above his trash can to encourage physical activity. Although we had agreed to a 15-min meeting, we ended up talking for nearly an hour. I practiced active listening and he shared about his passions of gaming, connections with his friends, and birthday wishes. While I was initially nervous to enter the room with such specific goals, we were able to find moments to focus on the schedule and decor, and then naturally divert to more natural conversations. Although his schedule still includes a large portion of the day dedicated to screens and gaming, he also agreed to taking walks around the unit– despite fears about ambulating–, weekly tutoring sessions, and taking time for healthy routines like showering, mealtimes, and meds. This patient was transferred to the oncology unit shortly after our discussion, however, I made sure to pass along decorative materials and email any details gathered about the patient’s interests, and demographics along with a mock schedule for his week.
BCH Fluoroscopy VCUG Coping Chart- Goal #2, Objective 2
