Certified Child Life Specialists Research Articles

Exploring the Experiences of First-Time Clinical Rotation Supervisors: Qualities, Training, and Needs

Little is known about the experience of first-time child life clinical rotation supervisors. The purpose of this study is to explore the thoughts, feelings, and experiences of these individuals using qualitative research methods. During a semi-structured interview, 13 participants were asked about their experience supervising an intern for the first time; qualities, skills, and experiences needed in a clinical rotation supervisor; and resources and trainings provided to support supervising an intern for the first time. Participants identified certain competencies they felt were important for clinical rotation supervisors to display, including the ability to put child life knowledge into practice and effective communication skills, while recognizing that formalized training is needed to further develop competencies and, overall, help first-time clinical rotation supervisors feel better prepared for their role. Related to their individual experience, participants expressed a desire to contribute to the next generation of Certified Child Life Specialist (CCLS). Participants recalled feeling nervous and often expressed feeling unprepared to step into the role even when seeking support from multiple outlets in varying formats. The participants acknowledged that a training program would be beneficial in preparing new clinical rotation supervisors, as well as in standardizing the internship experience for students. The perspectives offered by the first-time clinical rotation supervisors emphasized the need for accessible, standardized training for this role, as well as for various supports throughout the supervision (e.g., continued learning opportunities, support from colleagues, and meeting time with child life educators/managers).

Workplace Stress and Burnout in Child Life: Perspectives From Newer Professionals

Certified Child Life Specialists (CCLS) have previously reported experiencing workplace stress and burnout. To date, no studies have focused on early career CCLS’ perspectives on managing professional burnout. Interviews were conducted with 19 currently and formerly practicing CCLS about their experiences entering the field of child life, navigating global and systematic stressors, and their plans for the future. Data analysis yielded five themes: unexpected burnout presentation, the burnout triad, child life culture is immersed in burnout, self-care is effortful, and weighing the decision to stay in child life. These results have implications for hospital administrators, child life supervisors, and CCLS themselves.

Impact of Facility Dog and Certified Child Life Specialist Dyad on Children's Pain and Anxiety During Needlestick Procedures in a Pediatric Hematology Oncology Clinic Setting.

Pediatric Hematology Oncology patients undergo frequent needlestick procedures, often leading to negative outcomes including pain and anxiety. Animal-assisted therapy has been shown to minimize pediatric patient distress; however, its utilization by a Certified Child Life Specialist (CCLS) to reduce patient distress has not been widely studied. Pediatric patients receiving needlesticks in the Hematology Oncology Clinic were enrolled between March 2018 and May 2021. Patients who had scheduled visits when the facility dog was present were assigned to the intervention group. Patients were assigned to the control group if the facility dog was not present. The primary objective was to use the Children's Anxiety and Pain Scale to determine whether the CCLS and facility dog dyad minimized patient pain and anxiety during procedures. A total of 285 patients, 5 to 17 years of age, were enrolled. One hundred forty-three patients were assigned the intervention and received procedural support from the CCLS and facility dog; 142 patients were assigned the control group and received support from the CCLS only. Patient-reported pain scores were significantly lower among patients who received the intervention ( P =0.033). Utilization of a CCLS and facility dog dyad during painful needlestick procedures decreases patient-reported pain compared with utilization of CCLS support alone.

Characterizing psychosocial services in a pediatric urology practice

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4% were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4%), mental/behavioral/developmental health (29.1%), and referral and appointment management (19.9%). The largest proportion of time was spent on providing direct psychosocial support (45.9%), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9%). Relative time allocation across activities varied by provider type (p<0.001); care coordination constituted 64.2% of non-billable activities for the psychologist, 57.8% for the SW, and 12.3% for the CCLS. Activities were associated with treatment plan modification in 37.7% (n=357), outpatient coordination in 22.5% (n=213), and treatment plan adherence in 19.0% (n=180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Stress, Success, and Burnout: The Relationship Between Impostor Phenomenon and Burnout in Certified Child Life Specialists

Certified Child Life Specialists (CCLS) are pediatric healthcare professionals who help prevent and reduce psychological trauma resulting from a medical experience. They aid children and families in coping with the effects of hospitalization, illness, stress, and trauma, primarily in healthcare settings. Because their clinical work includes frequent exposure to trauma and emotional investment with patients, child life specialists are at high risk for developing Impostor Phenomenon (IP), burnout, or a combination of both. The aim of the present study is to better understand how child life specialists experience these phenomena and what factors put them at risk for experiencing IP, burnout, or a combination of these two factors. After surveying a sample of child life specialists (N = 270), IP and burnout experiences were found to be related. Additionally, IP and the impact of COVID-19 on CCLS predicted levels of burnout. By understanding the relationship between IP and burnout, we can work to promote better professional quality of life for CCLS, especially in light of the COVID-19 pandemic.

Child Life Internship Readiness: Perspectives of Child Life Academics

Certified Child Life Specialists provide psychosocial care that supports development and coping to children and families in pediatric settings. The child life profession is growing, and research is needed to support the profession’s continued development. This mixed-methods study captures the perspectives of child life academics with the goal to understand the child life intern preparation process. Results suggest that academics focus on specific knowledge, skills, and abilities when preparing child life interns and assessing internship readiness. Quantitative data shows that it is taking longer for child life students to secure an internship placement. This delay has implications for the profession’s sustainability and ability to meet the needs of children and families in hospitals. Additional implications for this research include opportunities for improvement in academic education, clinical training, and diversity, equity, and inclusion.

Assessing Child Life Specialists' Management of Challenging Behaviors in Autistic Pediatric Patients.

Given that autistic children are hospitalized at higher rates than neurotypical peers, it is important to understand the autism-specific preparedness of healthcare providers. Certified Child Life Specialists (CCLSs) play a crucial role in pediatric hospitalizations by providing socioemotional support and coping strategies. The present study assessed perceived competency and comfort levels among 131 CCLSs regarding the management of challenging behaviors exhibited by autistic pediatric patients, including aggression and self-injury. All participants reported experiences providing care to autistic children who exhibited challenging behaviors, but very few reported both high perceived competency and high comfort in managing these behaviors. Autism-specific training positively correlated with perceived competency and comfort. These results have implications for providing autistic children high quality hospital care.

Certified Child Life Specialist role in implementation of individualized coping plans for children receiving botulinum toxin injections.

The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach. A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety. Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation. CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis.

Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)-virtual reality (VR-MRI) and a certified Child Life Program (CLP). A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs. VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged fromCAN$190.69to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91-$426.64) to CAN$3843.41 (CAN$3196.59-$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20-$188.76) to CAN$283.85 (CAN$283.71-$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient. While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes of pediatric patients scheduled for MRI at their facilities.

Child Life Internship Readiness: Perspectives of Child Life Training Coordinators and Supervisors

Certified Child Life Specialists serve an important role in the pediatric healthcare system providing psychosocial care for children and their families. While the child life profession continues to grow, the student-to-professional pipeline has not been researched. This mixed-methods study focuses on internship readiness from the clinical internship coordinators’ and supervisors’ perspectives to understand the child life intern selection process. Results indicate there are criteria that qualify and disqualify child life interns related to the internship candidates’ knowledge, skills, and abilities. Implications for this research include areas to improve access and decrease potential bias in the internship selection process as well as future research related to child life training.

The certified child life specialist: A novel resource in the pediatric primary care clinic for managing children's pain during routine immunizations.

This study evaluated the effect of the Certified Child Life Specialist (CCLS) on pediatric pain and pain management during routine immunization administration in the pediatric primary care clinic. Children 4-12 years of age (n= 125) presenting for a well child physical examination at a rural primary care clinic were selected to receive standard nursing care or standard nursing care plus CCLS support during routine immunization administration. Patient reported pain was measured using the Faces Pain Scale-Revised (FPS-R), and patient behavioral responses were measured during immunization administration using the Children's Emotional Manifestation Scale (CEMS). The performance of psychosocial interventions and administration of topical pain-relieving interventions were measured between both groups. CCLS support was associated with fewer negative emotional behaviors during immunization administration among 7- to 12-year-old children and a significantly higher provision of psychosocial interventions and topical pain-relieving interventions among all ages. This study demonstrates that the presence of a CCLS can increase the provision of psychosocial and pain-relieving interventions and reduce distress during immunization administration in a busy pediatric primary care clinic.

Outgrowing the Pediatric Intensive Care Unit: Adults With a Pediatric Medically Complex Condition.

With more than 20 years of experience as pediatric and adult critical care nurses, we have observed an increase in the number of medically complex children who are living into adulthood and a troubling lack of adult intensive care unit (ICU) systems and processes for these patients.Medical advances have resulted in a significant decline in the mortality rate in the pediatric ICU (PICU), from 15% in 1980 to 4% in 2006. However, an unintended consequence is that more children experience significant morbidity. In fact, more than 50% of all PICU admissions are children with medical complexity.1,2 Families caring for a child who is chronically critically ill have special care requirements. Nurses in the PICU have extensive experience with pediatric-onset conditions such as congenital heart defects, sickle cell disease, neurodegenerative diseases, chromosomal abnormalities, and muscular dystrophies. They are also familiar with growth and development and have expertise in providing developmentally appropriate care. In addition, PICU nurses are trained in the principles of family- and patient-centered care, which include communicating and collaborating with family caregivers about the processes of care to a much greater extent than usually done in an adult ICU. Certified child life specialists are also available in the PICU to provide specific tools to assist in meeting the needs of the family, including siblings. When medically complex children become adults, many of them transition to adult ICUs that may not be ready for them. As a result, approximately 2% of PICU admissions (range 0%-9%) are adults who have had complex medical needs as children.3,4 However, as the number of medically complex children reaching adulthood continues to grow, the “PICU for adults” model is not sustainable.At this time, many adult ICUs are not prepared for patients with pediatric conditions. Creating an environment in which adult and pediatric health care professionals work collaboratively is essential to providing quality care to these patients and families. Systems need to be developed and expanded to provide complex care in the adult ICU. A proactive, interdisciplinary approach including specialized training for the adult ICU team is needed to sustain a high level of quality care and to support the transition to adult care. Staff in the PICU can help to prepare families for the transition as well as provide education and support to the adult ICU team. Issues to consider include differences in anatomy and physiology of pediatric patients, the unique developmental needs of this population, expansion of specialized services (ie, child life specialists), dedicated sleep areas for parents, and involving parents in decisions and patient care.

Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic.

Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment. In this role, CCLSs are likely to have important insights into the experiences and needs of pediatric patients and their families during COVID-19. Using a mixed-methods design, 101 CCLSs completed an online survey and 15 participated in follow-up interviews examining their experiences with and observations of children and families in medical environments during the pandemic. Participants emphasized a need to maintain a focus on child- and family-centered care for the well-being of patients and their families. While recognizing the need to socially distance to limit the spread of COVID, participants expressed concern about restrictive policies that did not balance the physical and mental health needs of patients and families. Participants also discussed the important role of child life services during the pandemic and the unique and multifaceted contributions CCLSs made to support patients, families, other medical professionals, and communities. Recommendations for supporting children and families in medical environments moving forward are discussed in light of lessons learned during the pandemic.

“Working with What You Have:” Child Life Group Play Programs in North America

Since the early twentieth century, group play programs have been a staple offering in children’s hospitals across North America, however little research to date has explored or evaluated these programs. Therefore, the purpose of this narrative inquiry study was to describe child life specialists’ experiences coordinating and contributing to group play programs in healthcare settings across North America. Interview responses from 32 Certified Child Life Specialists clustered around four emerging themes: (1) “working with what you have,” (2) assessing patient and family needs, (3) implementing the group play program, and (4) intended benefits of group play programs. Thus, organizational supports, adequate funding, individualized assessment, and appropriate staffing appear instrumental to the creation, implementation, and maintenance of child life group play programs in pediatric healthcare settings.

Exploring the implementation of child life services with facility dogs.

Many children's hospitals around the United States have programs in which a trained facility dog goes to work daily with a psychosocial healthcare worker, typically a Certified Child Life Specialist (CCLS). CCLSs help children and their families cope with the stress of a healthcare experience by utilizing evidence-based, developmentally appropriate interventions. The purpose of this study was to explore how CCLSs incorporate facility dogs into their treatments and gain their perspectives on handling a facility dog. Participants, four CCLSs, completed a checklist, which assessed patients seen by facility dogs for 10 workdays, and a semi-structured interview. Participants primarily saw patients of ages three to five years and aided with general anxiety and coping support. Findings indicated the dog's specific training, therapeutic value, and ability to bond with patients allowed these interactions to be successful and impactful. This study provides information about the benefits of facility dogs for child life programs and presents data for programs that are considering incorporating this therapeutic modality into their services offered.

Child Life-Facilitated Coping Support With Adult Patients Undergoing Cardiac Surgery: A Pilot Program

Purpose With little empirically known about the translation of child life services into adult patient populations, the purpose of this pilot project was to explore the feasibility of offering non-pharmacological child life support to adult cardiac surgery patients. Specifically, the aims were to explore the practical feasibility of extending and integrating child life care into this adult healthcare service, as well as the preliminary perceptions of adult patients who participated in the pilot program. Methods A pilot program was designed to provide child life care to an initial group of 11 adult patients undergoing cardiac surgery at a large academic medical center in the midwestern United States. Patients were randomized into a control condition consisting of standard pre- and post-cardiac surgery care or an intervention condition that involved five coping support interactions with a Certified Child Life Specialist serving as a “comfort coach.” Patient perceptions were gathered via telephone survey at the conclusion of the study, and insights into practical feasibility were gathered from associated study staff, clinical team members, and leadership to understand stakeholder experiences with the program. Results According to the feedback gathered, it appears that Certified Child Life Specialists can be clinically and practically integrated into adult cardiac surgery populations without patient care disruption. Additionally, feedback from program participants suggested that child life services were appreciated and seen as a beneficial component of the cardiac surgery experience. Conclusion This study suggests that it is both possible and practical to extend non-pharmacological coping support from Certified Child Life Specialists into adult cardiac surgery care, and this appears to be a desirable service from patient and staff perspectives. Future research is needed to evaluate the effects of child life services on specific outcomes in this population specific to anxiety, pain management and overall patient experience and care satisfaction.

Replicating a Therapeutic Art Group Protocol for Parents of Youth With Chronic Pain

Interventions for parents are important during intensive interdisciplinary pain treatment (IIPT) for youth. Therapeutic art reinforces parent strengths and promotes healthy coping during their child’s treatment. This study measured the feasibility of implementing a published, parent-only group-based therapeutic art intervention in an IIPT program, delivered by a Certified Child Life Specialist (CCLS) with training in therapeutic art. While their child participated in IIPT, forty-two parents participated in at least one therapeutic art group. Content rotated through four modules designed to promote reflection on interpersonal relationships, cultivate support, identify values, acknowledge personal struggles and barriers, and increase artistic self-expression (Pielech et. al., 2013). Following each group, parents completed measures of perceived satisfaction and helpfulness as well as open-ended questions for qualitative analysis. The mixed method design was used to provide depth to the understanding of these parents’ experiences. Supporting feasibility, the full intervention was replicated in a different setting with different providers. Parents attended 69% of sessions, reported little difficulty attending, and reported a high degree of satisfaction, helpfulness, and support. Following each group, parents completed measures of perceived satisfaction and helpfulness as well as open-ended questions. A mixed method design was used to provide depth to the understanding of these parents’ experiences.

Integration of child life services in the delivery of multi-disciplinary differences in Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) care

Multiple studies have demonstrated the benefit of incorporating certified child life specialist (CCLS) services in various aspects of pediatric care. Although the significance of psychosocial support of patients with Disorders of Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) is increasingly recognized, the involvement of CCLS services into the DSD and CAH multidisciplinary care model has yet to be described. To evaluate the feasibility, acceptability, and patient and family experience of routinely incorporating CCLS services into the multidisciplinary DSD and CAH care model. As part of a quality improvement initiative, CCLS services were routinely incorporated in the multidisciplinary DSD and CAH clinics at our institution. Encounters for patients seen in clinic between July 2018 through October 2019 were reviewed for demographic information, DSD diagnosis classification, CCLS documentation, and whether an exam under anesthesia (EUA) was required due to an incomplete clinical exam. CCLS documentation was reviewed for assessments, interventions, whether patients tolerated their physical exams, time of CCLS services, and additional CCLS support beyond the physical exam. All patients were limited to one physical exam per clinic visit. Out of the 45 encounters with CCLS involvement, 42 (93.3%) exams were well-tolerated. CCLS assessments considered patient development, communication considerations, temperament, medical stressors, coping preferences, and patient preferences for activities and distractions. Interventions included preparing patients for their physical exams, encouragement before and during exams, addressing patient stressors, distractions and coping mechanisms, and advocating for the patient. No patients required an EUA. The CCLS aimed to provide families with a sense of control during clinic visits and teach them to advocate for themselves. The CCLS helped prepare and distract patients for their clinic visit and addressed the sensitive nature of the physical exam by focusing on the emotional and development needs of patients. CCLS contributions to a positive patient experience are consistent with multiple studies demonstrating the benefit of CCLS services for pediatric care. This quality improvement initiative ultimately helped to create a positive experience for patients and families. This study demonstrates the feasibility, acceptability, and positive impact of CCLS services in the delivery of patient and family-centered care for patients with DSD and CAH as part of the multidisciplinary team model.

Prenatal Considerations and Outcomes for Girls Aged 14 and Under: Development of a Multidisciplinary Team in a Large Tertiary Care Facility.

Adolescent girls account for 11% of all births that occur globally every year. Among developing countries, the United States continues to have one of the highest adolescent birth rates, despite a decreasing trend between 1990 and 2010. Pregnant adolescents are a vulnerable population who are at increased risk for maternal morbidity and mortality. Additional risks are noted within the early adolescent population, usually defined as age 10 to 14. At Parkland hospital, a large tertiary care facility in Dallas, Texas, a multidisciplinary team was created in 2017 to care for this vulnerable population. The team consisted of a certified nurse-midwife (CNM), a Certified Child Life Specialist, a maternal fetal medicine physician, a social worker, and a Spanish interpreter, with additional services consulted as needed. Between 2017 and 2020, this team grew to include 8 CNMs and provided care to 76young adolescents ages 14 and younger. Of the young adolescents who attendedprenatalvisits with theAdolescent Prenatal Care Team at Parkland, 87%presented toParkland for birth.Eighteen percent had pregnancy-induced hypertension or eclampsia. Only7% of adolescents in the program gave birthprior to 37 weeks. Seventy-four percent had vaginal births. Sixty percentof the adolescents attendedknown postpartum visits. In contrast to most studies, this Adolescent Care Team did not find a high rate of premature birth in early adolescents. Further work by this team is needed to compare the data obtained during this period with data on similar adolescents who have given birth at Parkland in prior years. In addition, comparing outcomes of early adolescents with those aged 15 to 19, who were not included in the Adolescent Care Team, will help to understand the impact that such a team or similar intervention might have on this vulnerable population.

Exploring child life specialists’ perspective on the role and benefits of child life in pediatric sexual assault forensic examinations

ABSTRACT The purpose of this study was to describe Certified Child Life Specialists’ (CCLSs) perspectives on their role and the benefits of their role during pediatric sexual assault forensic examinations (PSAFEs). Using a structured interview, discussed roles included preparing the patient for and supporting the patient during the examination and supporting the multidisciplinary team. Perceived benefits of child life services included increasing patient coping and completion of the examination, decreasing re-traumatization, and minimizing parent stress. The findings highlight how CCLSs feel they support the emotional safety of PSAFE patients and families. Thus, healthcare programs providing PSAFEs should consider staffing a CCLS.