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Second in a three-part series on the MUSC Children’s Hospital Child Life: meeting needs of patient, family by Cindy Abole Public Relations When a child enters MUSC Children’s Hospital or undergoes outpatient surgery in the ambulatory cares area, that child and family will experience a level of care that blankets them in the security of clinical expertise and professional attention. Five-year-old Collin Newton checks out a toy stethoscope with child life specialist Jennifer Redfern, right, as mom Tammy Ward looks on. Collin had cochlear implant surgery March 26. At the Children’s Hospital, everyone shares a commitment towards children. Since its beginnings in 1987, the Children’s Hospital has created a medical environment that’s designed and dedicated to the care and well-being of children and their families. These are qualities that has led MUSC to recognition, ranking as Child magazine’s 11th best children’s hospital, in the nation and top in the Southeast. The Child Life Department, a group of eight certified specialists, provides psychosocial support in various health care settings and situations. Their purpose is to work directly with children while training staff in learning how to approach and communicate with pediatric patients and their families regarding their health care experience.  “Child life plays an unbelievable role in the care of patients,” said Edward P. Tagge, M.D., head of the Division of Pediatric Surgery. Their role extends from just taking care of the patient. They are also advocates and focus primarily on family-centered care.” The staff operates as members of the hospital’s whole team approach to care involving physicians, medical students, nurses, therapists and other specialists in the overall care of a child. This team approach has resulted in more positive experiences and better patient outcomes.  Age-appropriate and psycho-socially sound interventions are not only practiced at the initial phases of the health care experience but continually—setting a positive tone and making a difference in the child and family’s reactions and long-term coping.  “Our child and family-centered philosophy and provision of child life specialists are what distinguish us from other hospitals,” said Sandra Oberman, manager of MUSC’s Child Life Department. Child life encourages the emotional well-being and development of a child while in a health care setting through the use of play, education and support. Child life specialists work in all inpatient units, some ambulatory clinics, the pediatric emergency department and ambulatory surgery. They manage the hospital’s 3,712-square foot Atrium and other outpatient play areas. They provide patient and parent education and coordinate the Children’s Hospital Volunteer Program,  more than 150 special events and facilitate several teen support groups. Their efforts support age-appropriate care to children of all ages ranging from infants to adolescents. Guiding a child towards emotional stability without fear and pain usually associated with medical treatment results in a positive hospitalization experience, Oberman said.  Preparing  children and their families for their health care encounters is a big part of child life’s role. Often children do not understand what will happen and fill in the blanks with fantasies and misconceptions.  “The process is more than telling a child what to expect,” said Betsy McMillan, a child life specialist with more than 10 years in child development and counseling. “Preparation is a hands-on philosophy aimed at providing age-appropriate information and coping strategies based on the individual child and family needs.” This therapeutic-based philosophy has been around since the 1920s. It’s only been recently that it was scientifically supported. In 1993, the Association for the Care of Children in Hospitals (ACCH) awarded a grant to establish the Phoenix Research Project, a study that looked into the efficacy of a child life theory that measured fear and anxiety among children in a hospital setting. Its results proved that under specific care, children ate better, voided easier and recovered more quickly, resulting in faster recoveries and shorter hospital stays.  “Fear of the unknown can be intimidating, especially for a child,” Tagge said. “We’re dedicated to finding ways to help a child and family through this experience. We want to remove any anxiety and fear as we provide quality medical care for any child.” Four days a week, child life specialists Betsy McMillan and Jennifer Redfern take turns supporting pediatric patients and their families at the outpatient surgery area in Rutledge Tower. There they assist children who are scheduled for pediatric general surgical procedures— ENT, orthopaedic, urology, as well as dental and eye procedures.  In the Ambulatory surgery area, the child life specialists’ job is to provide supportive care to the child in preparation for surgery or other medical procedures. They also help guide the medical staff in the child’s physical care by addressing psychosocial issues as important keys to preparation and coping. Pre-operative tours of the waiting, holding and recovery rooms are offered for children and families.  The child life specialist begins by talking and playing with the child to develop a bond or rapport. They also talk to the child’s parent for additional information about the child. Next, they assess the child’s coping by identifying the child’s fears and concerns.  To help illustrate what’s going on, McMillan or Redfern can use a toy, picture book or dolls for play therapy. Items like Sesame Street’s Elmo doll or the Muppet’s Kermit the Frog can be dressed in a patient gown with a surgical cap, bandages and tubes as one way for the child to understand what’s expected for an upcoming procedure. For example, if a child is afraid of needles  the specialist can use toys, dolls or illustrations to describe what will happen. They can even work with a child using coping strategies like blowing bubbles or conducting a book activity to help ease  their anxiety prior to starting an IV or administering a shot.  “Depending on their age, a child needs to know why he will be wearing a hospital gown and what part of his body is being fixed,” McMillan said. “Play and preparation are valuable to a child at all ages. This provides a cognitive, emotional release that has therapeutic value. The dolls are a helpful way of allowing the child to  communicate and promote self-expression.” For inpatients, the child life specialist completes an assessment on each new patient and plans and facilitates interventions to meet individual emotional, psychosocial and developmental needs. Information about the patient’s current medical condition, anxiety and coping skills, current family issues and involvement and the child’s experience with previous medical encounters are all taken into consideration. This assessment also includes other pertinent information such as whether a child is mobile or in isolation, upcoming  procedures, and emotional and behavioral reactions to hospitalization.  As the medical team evaluates patients every day, so do the child life specialists. Recognizing that medical conditions, coping and psychosocial needs can change moment to moment, child life specialists must be very flexible and available to jump in and intervene in response to the child and family needs. This may mean accompanying a scared child to a procedure, spending time visiting siblings to help them understand the medical world, or facilitating expression of feelings, all while manipulating Playdough. McMillan, like her fellow child life specialists, continually demonstrates to members of the medical team how children can cope with and master their medical events. Often, when the child is at play or engaged in normal childhood activities the child’s real personality appears, allowing the staff to understand more about their patients. She and the child life staff share their expertise and methods through in-service presentations and collaborations with other specialists to help them recognize certain child behaviors and respond to their diverse needs. “It’s important to respect a child’s point of view and feelings in any health care setting or situation,” McMillan said. Terms like “be a big boy or “this doesn’t hurt” are unsupportive comments that are insensitive to what a child may truly be feeling, she said. Instead, responses such as “this is scary for you,” it’s okay to cry,” and “you are really helping by holding so still,” recognize the child’s perspective and provides positive reinforcement without damaging the child’s self-esteem. Another vital component of the Children’s Hospital’s whole team concept is the value of feedback. Patients and their families are encouraged to complete patient satisfaction surveys that evaluates their care and the effort of team members including medical students, residents and other specialists including the child life staff. The staffs recognize the importance of feedback as reinforcement to their actions. An unfavorable response usually results in an assessment of an individual(s) followed by a review and plans for additional training and support as needed. “The Children’s Hospital would not have been able to achieve the national recognition we have without our excellent child life staff,” said Carol Dobos, Ph.D., R.N., director of children’s services “They provide an important type of hands-on care and understanding that sets the tone for how we provide our level of care to our young patients and their families.”  Child life integral to peds burn team Is there anything more soothing than the crooning sounds of Elvis, rap with L.L. Cool J, or George Thoroughgood and the Destroyers jamming to their rock song, “Bad to the Bone?” What do Pokemon and Super Mario Brothers have in common with Barney, Disney’s Lilo and Stitch or the joy of bubble blowing? These are all cues identified by pediatric burn patients to help them get through some of the most difficult moments in their burn care recovery. Undergoing a dressing change or time spent in a hydrotherapy bath can be both therapeutic but painful and distressing for a child. At MUSC Children’s Hospital, it is the child life specialist who helps  a child cope through behavioral intervention and distraction techniques using music, a video or hand-held video game. “It’s amazing how they can focus in on finding the one thing that works in helping to calm a child,” said Jill Evans, R.N., pediatric burn services coordinator.  Child life specialist Betsy McMillan plays an integral role with the Children’s Hospital’s Pediatric Burn Services. In every situation, she works with Evans and a team of occupational and physical therapists, pharmacist, nutritionist, LPN burn technician, pediatric surgeons, staffs of 7A, PICU, the pediatric emergency department and outpatient clinics to provide very personalized, child-centered care. McMillan performs individual assessments of her patients daily. She makes observations, takes notes, talk to parents and team members to try to identify things that each patient can respond positively to. Surviving a burn injury can be a life-changing experience. A burn recovery can range from less than a day to more than nine months, depending upon the injury. The burn care team is involved in educating the patient, parents and siblings about their burn care. They can also help coordinate a child’s return to school or match a child with an adult in the firefighter buddy program. “The work we do everyday is not child’s play,” Evans said. “We’re able to offer our patients specialized care for what they specifically need even if that includes working with other subspecialities—plastic surgery, orthopaedics, dental, ENT, etc. and areas throughout the medical center. Our ability to communicate and work together with others by providing pediatric-specific care makes a big difference in the recovery and outcomes of our patients.” What pleases Evans most is the team’s ability to follow the patient’s long-term care and outcome from admission to out-patient care and beyond. She  knows that a patients and  families have received the best, most anxiety-free level of care from beginning to end.   Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.